颈部超声评价胸段食管癌颈部淋巴结转移

目的　探讨提高胸段食管癌颈部淋巴结转移诊断正确率的方法。　方法　 42例胸段食管鳞癌患者 ,术前行双侧颈部超声检查 ,转移淋巴结判定标准包括淋巴结的大小 (长径≥ 1 0mm)和形态 (短径 /长径 >0 5)。　结果　术前超声发现颈部淋巴结肿大 (短径≥ 5mm) 1 6例 ,触诊可扪及 5例。其中根据超声检查结果 9例判定为转移淋巴结 (cM1 LN) ,触诊可扪及 4例。本组 5例无法行肿瘤根治性切除者行非手术治疗 ;37例手术切除肿瘤的患者中 ,术后病理证实 6例颈部淋巴结转移(pM1 LN) ,其中 4例肿瘤侵犯食管外膜 (pT3)、2例术中发现肿瘤外侵 (pT4 ) ,并且均同时伴纵隔淋巴结转移 ,其中 4例还伴有腹腔淋巴结转移 ;1 1例pT1 、pT2 患者中无一例发现颈部淋巴结转移 (P =0 0 2 0 )。根据病理及临床治疗结果 ,超声判定颈部淋巴结转移的准确率显著高于触诊 (40 / 4 2 ,95 %比34/ 4 2 ,81 % ,P =0 0 4 3) ,敏感性亦明显高于触诊 (82 %比 36 % ,P =0 0 81 )。全组病例中 ,有 5例 (5/ 39,1 3 % )因颈部超声检查结果而改变治疗方式。　结论　超声检查判断颈部淋巴结转移的敏感性及准确率明显高于体检触诊 ,有助于提高食管癌术前分期的准确性     

选择性颈部淋巴结清扫在甲状腺癌根治术中的应用效果

目的 研究甲状腺癌根治术中应用选择性颈部淋巴结清扫的效果.方法 选取新疆生产建设兵团第十三师红星医院2019年8月至2021年8月收治的50例甲状腺癌患者,按随机数字表法分对照组、研究组各25例,对照组患者采用甲状腺根治术,研究组采用甲状腺癌根治术+选择性颈部淋巴结清扫术,比较两组患者颈部淋巴结转移情况、并发症发生情况...     

原发性肝脏间质瘤并颈部淋巴结转移1例并文献复习

目的:探讨原发性肝脏间质瘤的诊断和治疗方法。方法:回顾分析1例原发性肝脏间质瘤患者的临床资料及文献复习。结果:女性患者1例,45岁,因肝脏占位6个月,介入术后4个月入院。无肝炎及肝硬化病史,AFP正常。术前检查均提示肝内占位。行复杂性肝癌切除+胆囊切除术。术中探查胃肠道及腹腔其余脏器未发现肿瘤。术中快速冷冻病检提示肿瘤内可见梭形细胞,不排除来自胃肠道间质瘤。术后病理报告:左肝胃肠外间质瘤,高危度(核分裂像约5个/50HPF)。免疫组化:瘤细胞CD117(+)、CD34(+)、DOG1(+)、Des(-)、S-100(-)、EMA小灶(+)、Ki-67约3%。PDGFRA基因12、18号外显子序列无突变。C-KIT基因13、17号外显子序列无突变。术后1个月余左颈部淋巴结肿大,予以穿刺活检见梭形细胞,轻度异型,结合病史,倾向于胃肠间质瘤转移。予以口服甲磺酸伊马替尼药物治疗后颈部淋巴结明显缩小,目前已随访18个月,未见肿瘤复发及转移。文献报道的17例肝脏原发性间质瘤患者,最小年龄17岁,最大年龄73岁,平均年龄48岁,男女比例为10:7;肿瘤直径最小的5 cm,最大的44 cm,平均直径17.8 cm,可单发或多发,大多无肝炎及肝硬化病史,AFP为阴性。CD117和CD34在间质瘤中阳性率分别为92.3%及66.7%。结论:原发性肝脏间质瘤是一种罕见的胃肠道外间质瘤,其诊断主要依靠组织病理及免疫组化结果,治疗以手术为主,辅以化疗,疗效可。     

首发淋巴结转移的潜隐性甲状腺癌5例报告

我们自1982年10月到1992年10月,共收治了以颈部淋巴结转移为首发症状的甲状腺癌5例,现报告如下:     

甲状腺癌颈部淋巴结清扫术后双侧乳糜胸及乳糜腹1例报告

正颈侧区淋巴结清扫术后发生乳糜胸的情况少见,尤其是双侧乳糜胸更为罕见~([1]),大量乳糜液压迫肺和纵膈可导致呼吸循环功能障碍而危及生命。甲状腺癌颈部淋巴结清扫术后发生双侧乳糜胸及乳糜腹文献尚无报道。笔者单位近期诊治1例甲状腺癌双侧颈侧区淋巴结清扫术后发生双侧乳糜胸及乳糜腹的病例。报道如下。     

术前胸中上段食管癌颈部淋巴结转移相关因素分析

目的分析术前胸中上段食管癌病人发生颈部淋巴结转移的相关因素。方法行食管癌切除+三野淋巴结清扫手术的食管胸中上段癌病人64例,按照是否发生颈部淋巴结转移分为转移组(20例)和未转移组(44例)。比较两组病人的术前临床资料,分析发生颈部淋巴结转移的独立危险因素。结果食管癌病人超声检查结果中淋巴结短径、纵横比、内部回声、RI值与是否发生颈部淋巴结转移关系密切(P0.05);在两组病人的增强CT结果中,发生喉返神经旁淋巴结、胸部淋巴结肿大的比率差异明显,差异有统计学意义(P0.05);短径、RI值诊断颈部淋巴结转移的效能较好,ROC曲线下面积分别为0.823、0.694;Logistic回归分析发现,纵横比≥0.5、喉返神经旁淋巴结肿大为胸中上段食管癌病人发生颈部淋巴结转移的独立危险因素。结论食管胸中上段癌病人颈部淋巴结短径、纵横比、内部回声、RI值、喉返神经旁淋巴结、胸部淋巴结肿大是预测颈部淋巴结转移的重要指标,其中纵横比≥0.5、喉返神经旁淋巴结肿大为胸中上段食管癌病人发生颈部淋巴结转移的独立危险因素。     

甲状腺乳头状癌颈部淋巴结转移的危险因素分析

目的:分析影响甲状腺乳头状癌颈部淋巴结转移的临床特征,探讨颈部淋巴结转移发生的危险因素.方法:对2019年1月至2020年12月上海国际医学中心收治203例甲状腺乳头状癌病人的临床资料行回顾性分析,对可能影响颈部淋巴结转移的相关因素行单因素及多因素Logistic回归分析.结果:203例中,淋巴结转移率44.3％(90...     

甲状腺癌的颈淋巴结转移与血行转移

目的 探讨甲状腺颈淋巴结转移及血行转移的有关因素,提高甲状腺癌的诊断及治疗水平。方法 对１９８４年１月￣１９９２年１２月收治的２２５例甲状腺癌患者的临床特点、治疗方法及病理结果进行了回顾性分析总结。结果 甲状腺癌的淋巴结及血行转移主要现理类型和肿瘤局部浸润程度有关。乳头状癌、鳞状细胞癌主要表现为区域淋巴结转移,转移率分别为４４．７％、３／３,晚期出现血行转移。滤泡状腺癌虽然分化较好,但多表现有血行     

Occult well differentiated thyroid carcinoma presenting as cervical node disease

Records of 92 patients with differentiated thyroid carcinoma presenting as cervical adenopathy without a palpable mass were reviewed to identify prognostic factors and to evaluate therapy. Patients were treated between 1940 and 1990 and were observed for 3 to 48 years (median 18 years). Follow-up data were obtained by chart review, correspondence, and telephone contact. Among the group, 20 patients had unilateral and 72 bilateral thyroid lobectomy, with node dissection in 77. Thyroid hormone was used in 50 patients and radioactive iodine in 20. Patients were younger than the overall population of patients with differentiated thyroid carcinoma, with more men and more multifocal thyroid disease. Risk group defined by age and sex was the most important determinant of survival. All women 50 years of age or younger and all men 40 or younger (low risk group) survived independent of the type of initial operation or use of thyroid-stimulating hormone suppression or radioactive oidine. Of the low risk patients, 16% had recurrent disease but were treated successfully with surgery or radioactive iodine; 28% of the older patients (high risk) died of disease. A trend for better survival was noted in high risk patients undergoing bilateral thyroideetomy and in patients receiving thyroid suppression. Of the high risk patients, 26% had recurrent disease, with a 71% mortality rate. Age and sex are the primary determinants of survival. Therapy should be based on risk factors. Low risk patients should have conservative thyroid surgery and modified or limited node dissection. However, bilateral thyroid surgery may facilitate the use of radioactive iodine when required. Use of prophylactic radioactive iodine or thyroid suppression should be selective. For high risk patients, we suggest bilateral thyroidectomy, modified or limited node dissection, thyroid suppression, and radioactive iodine.

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Resumen Se revisaron las historias clínicas de 92 pacientes con carcinoma diferenciado de tiroides que se presentaron como adenopatía cervical sin masas palpables a fin de identificar factores de pronóstico y de evaluar la terapia. Los pacientes fueron tratados en el período entre 1940 y 1990 y fueron observados por 3 a 48 años (media, 18 años). Los datos de seguimiento se obtuvieron mediante revisión de la historia, correspondencia y contacto telefónico. En 20 pacientes se practicó lobectomía unilateral, 72 tiroidectomí bilateral y en 77 disección ganglionar. Se utilizó hormona tiroidea en 50 pacientes y yodo radioactivo en 20. Los pacientes de esta serie aparecieron más jóvenes, con mayor incidencia de hombres y más predominio de enfermedad multifocal, en comparación con la población general de pacientes con carcinoma diferenciado de tíroides. El grupo de riesgo definido por edad y sexo, fue el factor determinante de sobrevida de mayor importancia. Todas las mujeres de 50 años de edad o menores y todos los hombres de 40 años o menores, que constituyen el grupo de bajo riesgo, sobrevivieron en forma independiente del tipo de operación inicial o del régimen de supresión de la hormona tiroide-estimulante o del uso del yodo radioactivo. De los pacientes de bajo riesgo, 16% presentaron enfermedad recurrente pero fueron tratados exitosamente con cirugía o con yodo radioactivo; 28% de los pacientes de mayor edad, o sea el grupo de alto riesgo, murieron por causa de la enfermedad. Se observó una tendencia hacia mejor sobrevida en los pacientes de alto riesgo que fureon sometidos a tiroidectomía bilateral y en los pacientes recibieron supresión tiroidea. De los pacientes de alto riesgo, el 26% tuvo enfermedad recurrente con una mortalidad de 71%. La edad y el sexo son los factores determinantes primarios de sobrevida y la terapia debe ser basada en los factores de riesgo. Los pacientes de bajo riesgo deben ser sometidos a cirugía tiroidea conservadora y a disección ganglionar modíficada o limitada. Sin embargo, la tiroidectomía bilateral puede facilitar el uso del yodo radioactivo en los casos en que éste sea necesario. El uso del yodo radioactivo profiláctico o de la supresión tiroidea debe ser selectivo. Para los pacientes de alto riesgo, sugerimos tiroidectomía bilateral, disección ganglionar modificada o limitada, supresión tiroidea y yodo radioactivo.

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Résumé Les dossiers de 92 patients ayant un cancer de la thyroïde différencié révélé par une adénopathie sans tumeur thyroïdienne palpable ont été analysés afin d'identifier des facteurs pronostiques et une attitude thérapeutique. Parmi des patients traités entre 1940 ct 1990, la durée de surveillance a varié entre 3 et 48 ans (médian 18 ans). Le suivi a été obtenu par analyse retrospective des dossiers par correspondance et par téléphone. Vingt patients ont eu une lobectomie unilatéral, 72, une thyroïdectomie bilatérale, associée à un curage chez 77. L'hormonothérapie a été utilisée chez 50 patients, et l'iode radioactif chez 20. Comparés à la population générale des patients ayant un cancer bien différencié de la thyroïde, ces patients étaient plus jeunes, avec plus d'hommes et plus de maladie multifocale. L'âge et le sexe étaint les éléments déterminants les plus importants pour définir la population à risque. Les femmes de 50 ans ou plus jeunes et tous les hommes de 40 ans ou moins (groupe à risque peu élevé) ont survécu indépendamment du type d'intervention initiale ou de la thérapeutique hormonale ou radioactive. Parmi ces patients, 16% avaient une récidivce mais celle-ci a pu être traitée avec succès soit par la chirurgie soit par l'iode radioactif. 28% des patients plus âgés (risque élevé) sont décédés de leur maladie. Parmi ces patients à risque élevé, on note une meilleure survie lorsqu'ils ont eu une thyroïdectomie bilatérale, et quandils ont reçu une thérapeutique suppressive. 26% de ces patients ont eu une récidive avec une mortalité de 71%. L'âge et le sexe étaient déterminants dans la survie. Nous recommandons une attitude thérapeutique basée sur ces données. Chez le patient à risque peu élevé, on peut pratiquer une chirurgie conservatrice avec une lymphadénectomie limitée ou modifiée. La thyroïdectomie bilatérale peut, cependant, être indiquée pour faciliter l'utilisation de l'iode radioactif lorsqu'elle est indiquée. Chez le patient à risque, nous suggérons de pratiquer une thyroïdectomie bilatérale, un curage limité ou modifié, une thérapeutique hormonosuppressive et l'iode radioactif.

     

Occult distant metastases of well-differentiated thyroid carcinoma

Background. The tendency of well-differentiated thyroid carcinoma to remain localized and its slow progression have supported the belief that this disease behaves as a low-grade malignancy. Consequently, a conservative approach in the management of the well-differentiated thyroid carcinoma has existed during the years. Occult distant metastases of thyroid cancer is an occasional finding considered of ominous significance. Methods. In a retrospective study, we reviewed the records of 187 adult patients with well-differentiated thyroid carcinoma treated by total thyroidectomy. These cases were found among 1,240 thyroidectomies performed in our department between 1982 and 1993. Occult distant skeletal and lung metastases disclosed by total body¹³¹I scans, after total thyroidectomy, were present at the time of initial treatment in 11 patients (11/187). This group included 9 women and 2 men ranging in age from 36 to 70 years, with a mean age of 47 years. Seven patients had papillary carcinoma, whereas follicular malignancy was found in four. Review of the surgical specimens showed total involvement of the gland in 5 cases, with extracapsular tumoral spread in 3 patients. Multicentric disease was present in 6 specimens. Patient follow-up revealed a mortality rate of 64% (7/11) during the first 3 postoperative years. Conclusions. Analysis of this population confirms that well-differentiated thyroid carcinoma with distant metastases is an aggressive disease with lethal consequence. Early detection and therapy of occult distant metastases present at the time of initial treatment is possible only after total thyroid ablation, because otherwise the radioactive iodine is trapped by the gland's remnants. © 1994 John Wiley & Sons, Inc.     

Minimal thyroid carcinoma: A report of nine cases discovered by cervical lymph node metastases

From 1962 to 1983, nine patients with minimal carcinoma of the thyroid were referred to Aichi Cancer Center Hospital and to Aichi Medical University Hospital for evaluation of enlarged lymph nodes in the neck. The radiographic study and scintigraphy of the thyroid were useful in detection of small thyroid lesions. In two cases, a lymph node biopsy was required for confirmation of the diagnosis. The thyroid lesions were histologically papillary carcinoma, in all the cases. A modified neck dissection with total thyroidectomy was carried out in five patients and modified neck dissection with thyroid lobectomy was done in four cases. Nine patients were followed for 6 months to 20 years and all the patients except one are alive.     

甲状腺癌颈淋巴结清扫术后淋巴瘘的防治:附九例报道

目的 探讨甲状腺癌颈淋巴结清扫术后淋巴瘘的防治措施.方法 回顾性分析吉林大学中日联谊医院2004年1月至2009年4月9例颈清扫术后淋巴瘘患者的临床资料.结果 9例患者中表现为左侧乳糜瘘3例,右侧乳糜瘘1例,乳糜胸1例,颈部淋巴瘘伴胸腔淋巴积液1例,其他3例均为淡黄色淋巴液,均通过保守治疗治愈.结论 熟悉颈部淋巴管道的...     

C MET蛋白在有颈部淋巴结转移的甲状腺癌中的表达和意义

目的探讨C-MET蛋白在有或无颈部淋巴结转移的甲状腺乳头状癌、甲状腺滤泡状癌及良性甲状腺组织中的表达及其临床意义。方法采用免疫组织化学方法检测有颈部淋巴结转移的甲状腺乳头状腺癌（PTC1组）62例，无颈部淋巴结转移的甲状腺乳头状腺癌（PTC2组）50例，甲状腺滤泡状腺癌（FTC组）l0例及良性甲状腺组织（良性组）30例中的C—MET蛋白的表达。结果PTCI组的C—MET表达明显高于其它3组（P〈0．001）。两两比较C—MET表达结果：PTC1组与PTC2组比较，P〈0．001；PTC1组与FTC组比较，P〈0．001；PTC1组与良性组比较，P〈0．001；PTC2组与FTC组比较，P=0．002；PTC2组与良性组比较，P〈0．001；皆有显著性差异。结论C—MET的表达是甲状腺乳头状癌是否有淋巴结转移的预测因子，是肿瘤的囊外扩展和直接侵犯的标记。该指标对甲状腺乳头状癌淋巴结转移的术前评估，决定手术方式均有一定指导意义。     

Pattern of cervical lymph node metastases from papillary carcinoma of the thyroid

INTRODUCTION: The management of cervical metastases from papillary thyroid carcinoma ranges from selective removal (berry picking) to a formal comprehensive neck dissection. Without a clear understanding of the distribution of nodes at risk, the formulation of strategies on how best to manage the clinically positive neck is difficult. This study reports on observations made in patients who underwent a therapeutic comprehensive neck dissection for metastatic papillary thyroid carcinoma by defining lymph node involvement with respect to neck level. METHODS: The clinical records and pathological reports of 75 consecutive patients who underwent a neck dissection for cervical metastases from papillary thyroid carcinoma over a 10-year period were reviewed. All dissections were therapeutic in nature, being performed in patients with clinically positive neck nodes. Eighty neck dissection specimens were obtained and analyses were divided into three groups by virtue of the type of dissection performed: a bilateral comprehensive neck dissection, unilateral radical neck dissection and unilateral comprehensive neck dissection. The relative involvement of cervical nodes was analysed with reference to node levels I-V. RESULTS: Patients in the anterolateral group (levels II, III and IV) were at greatest risk of metastatic disease, with level III nodes consistently the most frequently involved, across all treatment groups. Only three patients exhibited level I involvement, all of whom had extensive neck disease involving all or almost all neck levels. CONCLUSION: The majority of patients present with multiple level node disease, with the anterolateral group at greatest risk. A comprehensive neck dissection is recommended for all patients with palpable cervical lymphadenopathy.     

Bilateral cervical lymph node metastases in well-differentiated thyroid cancer

We analyzed the regional lymph node metastases of 98 patients with thyroid cancer who underwent bilateral modified neck dissection. Bilateral jugular lymph node metastases were frequent in patients with papillary carcinoma of the thyroid, especially in those patients with obvious carcinoma in both lobes of the gland, cancer arising in the isthmus, clinically detectable bilateral lymphadenopathy, and recurrent thyroid cancer. In patients whose cancer was clinically confined to one lobe, and where there were no obviously enlarged contralateral lymph nodes, the occurrence of contralateral jugular lymph node metastasis was significantly correlated with the contralateral paratracheal lymph node metastasis. The bilateral lymphadenectomy appears to be appropriate in these instances.     

Regional lymph node metastases in well-differentiated thyroid carcinoma

The status of regional lymph node metastases was assessed in 171 patients with thyroid cancer who underwent a variety of thyroidectomy procedures with regional lymph node dissection at Kanazawa University, from January 1979 to March 1986. The rates of regional lymph node metastasis in minimal and ordinary thyroid cancer were 57% and 84% respectively. Since the rates of lymph node metastasis were high not only in the central cervical compartment but also in the lateral jugular compartment, modified radical neck dissection in the ipsilateral neck is at least recommended in patients with these thyroid cancers. Furthermore, high frequencies of bilateral regional lymph node metastases were found in patients with obviously widespread involvement of the bilateral lobes, with cancer located in the isthmus, with clinically detectable bilateral or contralateral jugular lymph node metastases and with histological involvement in the contralateral paratracheal lymph nodes. Bilateral modified radical neck dissection is recommended in these patients.     

Unusual brain metastases from papillary thyroid carcinoma: case report

OBJECTIVE AND IMPORTANCE: Brain metastases from papillary carcinoma of the thyroid gland are unusual. No consensus regarding management has yet been reached. We report a case, review the current literature, and explain our approach on the basis of clinical, pathological, and radiological data. CLINICAL PRESENTATION: A 33-year-old woman presented with signs of intracranial hypertension. The diagnostic evaluation included chest tomography, head computed tomography, brain magnetic resonance imaging with and without contrast enhancement, total-body scanning, and cerebral scintigraphy. Multiple supratentorial lesions and one right cerebellopontine angle lesion were observed. Histopathological analysis of the surgical specimen confirmed papillary carcinoma of the thyroid gland. INTERVENTION: A ventriculoperitoneal shunt was placed and a right suboccipital craniotomy was performed, with complete removal of the cerebellopontine angle tumor. Total-brain irradiation with 40 Gy/lesion followed the initial operation. One year after surgery, the patient presented with signs of increased intracranial pressure. A new left frontal lobe lesion with massive peritumoral edema was identified on magnetic resonance imaging scans. The edema was treated clinically and a left frontal craniotomy was performed, with complete resection of the tumor. The patient is currently faring well, with residual expressive aphasia. CONCLUSION: Surgery followed by radiotherapy seems to be a good alternative for the treatment of this specific type of metastasis. Thorough clinical and radiological evaluation, followed by genetic analysis of the surgical specimen, particularly with respect to the potential for tumor invasion under specific conditions, is recommended. The information obtained contributes to better management and better overall long-term outcomes for these patients.