甲状腺乳头状癌36例临床病理分析

我院1990-04-2002-04外科病理诊断甲状腺乳头状癌共计36例，报告如下。     

31例甲状腺乳头状癌的临床病理分析

目的：探讨甲状腺乳头状癌的形态学特点。方法：对我院1998年～2001年收治的31例甲状腺乳头状癌进行回顾性分析。结果：良性病变、滤泡型腺瘤发病率最高，占55．O％；恶性肿瘤中，乳头状癌发病率最高，占76．O％。乳头、核沟、毛玻璃样核、核体积增大、核重叠、砂粒体及核内假包涵体是乳头状癌的主要形态学特点。结论：甲状腺乳头状癌与乳头状增生、滤泡型腺瘤、滤泡癌的鉴别依靠细胞参数。     

甲状腺微小乳头状癌9例临床病理分析

目的探讨甲状腺微小乳头状癌的临床病理特点。方法常规病理检查手术切除88例甲状腺癌中共检出9例微小癌,应用光镜观察其形态改变。结果9例均为甲状腺微小乳头状癌,具有诊断意义的主要组织学特征为毛玻璃样核,核内包涵体、核沟及纤维性间质反应。结论甲状腺微小乳头状癌是乳头状癌变形的特殊表现,主要依据组织病理学诊断。     

甲状腺乳头状癌合并髓样癌一例

患者女,60岁,体格检查发现甲状腺结节后3个月入院.自述近1年吞咽有异物感,无声音嘶哑及饮水呛咳.外院检查TSH 0.63(正常参考值0.35～4.94) mU/L、FT3 3.33(正常参考值1.71～3.71) ng/L、FT4 10.1(正常参考值7.0～14.8) ng/L、TPOAb186.07(正常参考值0～5.61)×103 U/L,TgAb 712.74(正常参考值0～4.11)×103 U/L.生化指标正常.本院体格检查:眼突(-),手抖(-),双侧甲状腺Ⅲ度肿大,轻微压痛,右叶可扪及约3 cm×2 cm结节,质稍硬,边界清晰,随吞咽上下活动.双侧颈部淋巴结未触及肿大.甲状腺B超示:甲状腺左叶中下部见混合回声,大小1.2 cm×0.9 cm,周边条状血流内部穿入.右叶内见多个混合回声,较大者低回声,大小3.0 cm×1.5 cm,边界清,血流丰富;右叶另见1.5 cm×1.0 cm的低回声,内见强回声0.3 cm.颈部淋巴结未见异常.患者幼年患地方性甲状腺肿,补碘后好转;否认明确颈部辐射史,否认明确甲状腺肿瘤家族史(其母亲及妹妹均为肺癌患者).     

灰阶超声预测甲状腺微小乳头状癌颈部淋巴结转移的临床分析

目的探讨灰阶超声应用于甲状腺微小乳头状癌中的预测效果,并观察甲状腺微小乳头状癌与颈部淋巴结转移的关系。方法分析我院62例(64个结节)均经手术病理证实为甲状腺微小乳头状癌患者临床资料,所有患者均采用灰阶超声予以评估,根据患者是否存在淋巴结转移分组为观察组(颈部淋巴结转移,21例)与对照组(颈部淋巴结未转移,41例)。记录所有患者灰阶超声表现情况,并与术后病理结果相比较,同时找出两者间相关性。结果经分析发现,甲状腺结节数目(2=0.92,P=0.33)、癌结节形态(2=1.13,P=0.28)、癌结节内部回声(2=0.46,P=0.49)、癌结节边界(2=0.50,P=0.47)、癌结节后方回声(2=0.57,P=0.44)、癌结节周边回声(2=0.01,P=0.92)、癌结节位置(2=0.78,P=0.85)与甲状腺微小乳头状癌颈部淋巴结转移无关;观察组与对照组患者癌结节大小(2=12.68,P=0.00)、癌结节与被膜间关系(2=9.64,P=0.02)、癌结节内钙化类型(2=7.94,P=0.04)相比,差异显著具有统计学意义。经多Logistic回归多因素分析发现,颈部淋巴结转移与癌结节大小(OR=5.631,P=0.00)、癌结节与甲状腺被膜关系(OR=4.526,P=0.00)、癌结节内钙化类型(OR=4.017,P=0.00)有关。结论灰阶超声用于临床诊断甲状腺微小乳头状癌可通过观察患者临床灰阶超声表现来判断其是否存在颈部淋巴结转移,为临床治疗提供参考。     

甲状腺乳头状癌淋巴结转移诊疗现状研究

甲状腺乳头状癌（PTC）是甲状腺癌最常见的组织病理学类型,其淋巴结转移影响患者的预后。目前PTC的淋巴结转移机制尚不明确,其诊断方法包括超声、细针穿刺活检、CT、MRI、SPECT/CT、PET/CT等,但特异度及灵敏度均不高,联合使用可以提高检出率。PTC淋巴结转移首选的治疗方式是手术。目前PTC淋巴结转移早期综合诊断及有效治疗是改善和提高PTC患者生活质量的难点。笔者就PTC淋巴结转移的诊疗现状及研究进展进行综述。     

甲状腺乳头状癌临床检查方法的价值分析

目的探讨甲状腺乳头状癌常用临床检查手段的有效组合策略。方法总结我院自2002年1月—2010年7月收治的74例甲状腺乳头状癌患者的临床检查资料,对比超声、CT及细针穿刺细胞学检查3种检查中,每一单项、任意两项检查组合、三项检查组合对本病的阳性诊断率。结果超声、CT及细针穿刺细胞学检查对本病的诊断阳性率分别为55.4%、70.3%、73.0%,后两者比较差异无统计学意义(P>0.05);任意两项检查组合中,各组合之间比较,差异无统计学意义(P>0.05),且超声+CT组合对本病的诊断阳性结果与单项细针穿刺细胞学或CT检查结果无统计学差异(P>0.05);三项检查组合的诊断阳性率达98.6%。其余各组对比结果均有统计学差异(P<0.05)。结论单项CT或细针穿刺细胞学检查对本病的诊断阳性率高,同时行三项检查,对本病的诊断效能最高。     

甲状腺乳头状癌及淋巴结转移的CT表现

目的:评价甲状腺乳头状癌及淋巴结转移的CT特点。方法:回顾性分析我院手术病理证实的53例甲状腺乳头状癌伴淋巴结转移的CT表现。结果:44例为单发病灶,9例呈多发病灶;25例单发病灶和9例多发病灶表现为边缘模糊;25例肿块内见有钙化,14例颗粒状钙化,5例乳头状钙化,6例不规则钙化。49例转移淋巴结边缘规则,另4例边缘模糊或呈融合趋势;转移淋巴结有明显钙化的25例(颗粒状钙化19例,乳头状钙化4例,不规则钙化2例);22例淋巴结有囊性变,13例囊壁内见有乳头状强化。结论:甲状腺体积增大,肿块呈浸润性生长,边界不清的伴有颗粒状钙化的,是诊断甲状腺乳头状癌的重要指征;若同时伴有颈部淋巴结囊性变、囊壁内乳头状结节及颗粒状钙化,是诊断甲状腺乳头状癌的最可靠征象。     

转移性甲状腺乳头状癌误诊为鳃裂囊肿1例

<正>患者女性,50岁。因右颈部肿物伴疼痛1月入院。患者1月前无明显诱因发现右颈部肿物如红枣大小。体检:耳鼻咽喉科检查未见异常,甲状腺检查未触及结节。右颈部隆起一肿物,大小约3cm×2cm×2cm,质韧,触压痛,表面光滑,活动度不明显。MRI显示右侧胸锁乳突肌内侧见囊状T1WI及T2WI高信号影,其内信号均匀,囊壁光整,边界清晰(图1a～1d)。诊断为鳃裂囊肿。手术行右颈部肿物切除术,见肿物位于胸锁乳突肌深面,为一薄壁嚢肿,边界清楚,包膜完     

彩色多普勒检查甲状腺乳头状癌临床价值分析

目的 探讨甲状腺乳头状癌超声特征,并分析其超声表现与病变MVD的关系。方法 选择42例甲状腺乳头状癌患者进行超声学检查,并经病理证实。观察甲状腺乳头状癌的超声图像特征及多普勒超声特征。分析其血流动力学特征〔最大血流速度（Vmax）、搏动指数（Pulsation index,PI）及阻力指数（Resistance index,RI）〕与MVD的关系。结果 42例甲状腺乳头状癌患者单发37例,多发5例,平均径线（3.47±1.18）cm。边界不清34例、包膜不完整或未见包膜、回声不均匀31例、有钙化回声29例、伴有颈部淋巴结转移30例。平均MVD值为（65.54±19.21）个/HP。伴有淋巴结转移的甲状腺乳头状癌MVD值（71.34±21.21）个/HP,显著高于未合并淋巴结转移者的（55.45±18.56）个/HP（P〈0.05）。甲状腺乳头状癌多普勒超声参数Vmax值大于对照组,PI值低于对照组（P〈0.05）。甲状腺乳头状癌MVD计数与多普勒超声参数Vmax间存在显著正相关（r=4.35,P〈0.05）。结论 甲状腺乳头状癌超声学表现具有一定的特征,且MVD计数与多普勒超声参数Vmax间存在正相关。     

Skull metastasis in papillary carcinoma of thyroid: A case report

Papillary thyroid carcinoma with metastasis to the skull is extremely rare.We report a case of unsuspected papillary thyroid carcinoma with skull metastasis.A 48-year-old female patient presenting with painless,pulsatile,progressively increasing swelling in the occipitoparietal region of the scalp approached for an X-ray of the skull.Ultrasound of palpable swelling in the neck revealed a heteroechoic lesion with increased vascularity.Foci of calcification were seen involving both lobes of the thyroid.Ultrasound of scalp showed a destructive mass in the skull with increased vascularity.Biopsy of thyroid lesions revealed branching papillae having a dense fibrovascular core covered by cuboidal epithelial cells with nuclei having a clear ground glass appearance.This case illustrates how isolated extensive skull metastasis can be found in papillary carcinoma patients without causing significant morbidity.Therefore,in the clinical course of thyroid papillary carcinoma,skull metastasis should be considered,and the patients should be meticulously investigated and followed up.     

Seven cases of brain metastasis from papillary thyroid carcinoma

Brain metastases from differentiated thyroid carcinoma are extremely rare and carry a poor prognosis. We describe here clinical details of 7 cases of brain metastases from papillary thyroid carcinoma. Of 153 patients with metastases from differentiated thyroid carcinoma (papillary in 123, follicular in 30) treated at our institution between 1981 and 1999, 7 patients (4.6%) had brain metastases. Histologically, the primary tumor was papillary carcinoma in all 7 cases. Four were males and 3 were females. The median age at first diagnosis of distant metastases was 63 yr (range, 47-76 yr). Of these patients, one had brain metastases only and six had metastases to the lungs as well. Five of these patients were treated with 131I. Three of these 5 patients had marked uptake in the metastases (131I positive) on post-therapy 131I scans and another 2 patients had no significant activity (131I negative) in both pulmonary and brain metastatic lesions. One of 3 patients with 131I positive lesions had intense activity in the brain tumor, but no uptake in multiple pulmonary metastatic tumors. In a patient with 131I positive brain metastases, the tumors progressed rapidly after 131I therapy. In another one patient, acute hemorrhage of the tumor occurred four days after 131I therapy, requiring surgical removal. Loner case of 131I negative 2 patients was treated with radiosurgery (gamma-knife) and complete reduction in tumor volume was observed. On the other hand, one of 2 patients receiving no 131I therapy had radiosurgery (x-knife) and remaining one received conventional external radiation and chemotherapy for small solitary brain and pulmonary metastatic tumors. These therapeutic interventions were useful in both cases. The mean length of survival after the development of brain metastases in the five patients who died of the disease was 30 months. One patient treated with x-knife has been alive at 21 months and another one who has 131I uptake in the brain tumor without uptake in lung lesions has been alive 15 months after diagnosis of brain metastasis. These results indicate that it is important to detect brain metastasis by imaging techniques and Tg measurements and give treatment as early as possible since the brain is the third most common distant metastatic site and the prognosis is poor.     

以腰痛为首发症状的肺癌骨转移1例

患者,男性,56岁,因下腰部疼痛不适3月余,来我院行CT检查:腰3～骶1椎间隙未见异常,但腰3～5椎体及附件、髂骨见广泛性溶骨性破坏和局部软组织肿胀(见图1-图3)。追问病史,3月前曾有咳嗽咯血,在乡村诊室治疗后好转。遂行胸部CT扫描:右上肺见团块影,分叶征,其内密度不均,有小泡影(见图4、图5),右肩胛骨亦见溶骨性破坏及局部软组图1-图3示腰4椎体及附件、双侧髂骨、右肩胛骨广泛性膨胀性溶骨性破坏,并局部软组织肿胀图4,图5右上肺块影,有毛刺、分叶及小泡征图6肝内多发低密度灶,以右叶为主织肿,肝内见多发低密度灶,局部见“牛眼征”(见图6)。C…     

Papillary thyroid microcarcinoma and ectopic papillary thyroid carcinoma in mediastinum: a case report

Papillary thyroid microcarcinoma is defined as a papillary thyroid cancer measuring <10 mm in its largest diameter. We present the scan images of a 36-year-old white woman, with the diagnosis of an incidental papillary thyroid microcarcinoma of 2 mm developed from lymphatic thyroiditis, associated with an invasive papillary thyroid carcinoma with lymph node metastases occurring in an ectopic thyroid gland in the mediastinum. This case underlines the need to evaluate individually and carefully every patient with papillary thyroid microcarcinoma, to accurately plan a therapeutic strategy.     

甲状腺乳头状癌术前颈部淋巴结转移超声诊断价值

目的探讨影响甲状腺乳头状癌(PTC)颈部淋巴结转移及转移区域的相关因素。方法选取自2016年1月至2017年8月于北部战区总医院行甲状腺手术的223例PTC患者为研究对象。根据术后病理颈部淋巴结是否转移将其分为淋巴结转移阳性组(LN+组,n=99)与淋巴结转移阴性组(LN-组,n=124)。记录患者的临床资料,包括性别、年龄、实验室检查指标、是否合并桥本氏病、术后病理诊断资料,以及超声声像图特征。采用χ~2检验、Fisher精确概率法及二分类Logistic回归分析影响PTC颈部淋巴结转移及转移区域的危险因素。结果性别、是否合并桥本氏病、病灶大小及典型PTC的超声征象具有预测颈部淋巴结转移及转移区域的价值(P<0.05)。结论当患者为男性、不伴有桥本氏病,且病灶较大并具有典型PTC超声特征时,外科医师应警惕颈部淋巴结转移。PTC肿瘤位置影响淋巴结的转移区域。     

cN0期甲状腺乳头状癌中央区淋巴结转移的危险因素分析

 目的 探讨cN0期甲状腺乳头状癌患者中央区淋巴结转移相关危险因素。方法 纳入北京协和医院行双侧中央区淋巴结清扫的cN0期甲状腺乳头状癌患者570例,回顾性分析患者术前甲状腺超声图像及临床病理资料特征,分析预测cN0期甲状腺乳头状癌中央区淋巴结转移相关危险因素。结果 570例cN0期甲状腺乳头状癌患者中发生中央区淋巴结转移282例,占49.5%;其中男性(OR=1.787, 95% CI:1.066-2.997, P=0.028)、年龄小于45岁(OR=2.063, 95% CI:1.366-3.115, P=0.001)、多发病灶(OR=1.764, 95% CI:1.134-2.743, P=0.012)、肿瘤直径＞1 cm(OR=1.844, 95% CI:1.201-2.831, P=0.005)、伴有微钙化(OR=1.965, 95% CI:1.296-2.979, P=0.001)且有被膜侵犯(OR=2.868, 95% CI:1.880-4.377, P=0.000)是中央区淋巴结转移的独立危险因素。结论 对于男性、年龄小于45岁、多发病灶、肿瘤直径＞1 cm、伴有微钙化且有被膜侵犯的cN0期甲状腺乳头状癌应根据影像学及临床病理资料考虑采取积极的手术方式或更加密切的随访。     

甲状腺微小乳头状癌与乳头状非微小癌的临床特点及131I疗效的比较研究

目的研究比较甲状腺微小乳头状癌（PTMC）和除PTMC以外的甲状腺乳头状癌（PTC）的临床特点及131I疗效。方法将369例行甲状腺全切术后拟行131I治疗的PTC患者,按照肿瘤直径分为PTMC组（≤ 1.0 cm）和PTC组（>1.0 cm）。回顾性分析两组患者的临床资料并评估患者的预后,应用SPSS22.0统计软件对结果进行t检验和卡方检验统计分析。结果PTMC组发生淋巴结转移和中央区淋巴结转移的患者比例均低于PTC组,且转移的淋巴结数量更少,差异有统计学意义（χ2=44.23、23.56、42.80,均P<0.05）。与PTC组相比,PTMC组患者大多单叶发病（χ2=45.94,P<0.05）且更少发生包膜侵犯（χ2=11.22,P<0.05）,PTMC组有更多的患者合并桥本氏甲状腺炎,两者间的差异有统计学意义（χ2=9.08,P<0.05）。2组患者发生远处转移及合并毒性弥漫性甲状腺肿和结节性甲状腺肿等良性疾病的情况之间的差异无统计学意义（χ2=8.09、2.16、0.21,均P>0.05）。2组共197例患者经过治疗达到临床缓解,其中PTMC组患者治疗后的缓解率（67.53%）高于PTC组（37.71%）。197例达到临床缓解的患者中有102例经首次治疗即达到临床缓解。虽然PTMC组经首次治疗即达到临床缓解的患者多于PTC组,但两组间差异无统计学意义（χ2=3.18,P>0.05）。结论PTMC患者的临床特点不同于乳头状非微小癌患者,经131I治疗后PTMC总体治愈率更高。在临床工作中,建议对PTMC患者制定个体化的治疗方案,从而达到更好的治疗效果及预后。