甲状腺癌骨转移的影像学诊断

目的 分析甲状腺癌骨转移的临床及影像学表现,探讨其临床及影像特点和诊断价值。方法 经病理证实为甲状腺癌骨转移10例,对其X线、CT表现进行回顾性分析。10例均行X线平片检查,其中3例做CT扫描。结果 甲状腺癌具隐匿病史,在骨转移病例,先发现骨转移,后查出原发灶者3例,7例在原发灶或甲状腺结节的基础上出现骨转移。甲状腺癌骨转移以溶骨性转移为主,多发于上半身的骨骼,表现为膨胀性囊状破坏区,呈大片状、地图样骨缺损,范围大、广泛为其特点。结论 甲状腺癌可发生骨转移,以溶骨型为主,可有成骨性转移。     

前列腺癌骨转移20例临床及影像学分析

目的分析前列腺癌骨转移的临床及影像学表现,探讨其临床及影像学特点和诊断价值。方法经病理证实的前列腺癌骨转移病例共20例,年龄43~85岁,平均74·7岁,对其X线、CT、MRI表现进行回顾性分析。20例均做了X线平片检查,4例做了CT和MRI检查,6例做了骨核素扫描。结果在前列腺癌骨转移病例中,先发现骨转移,然后查出原发灶者16例,先发现原发灶,然后查出骨转移者4例。其中成骨型转移16例,混合型4例。结论前列腺癌属于亲骨性肿瘤,极易发生骨转移,成骨型多见。临床上以发病年龄较大,多数先发现转移病灶,后发现原发病灶为特点。影像特点以骨盆和脊柱为主的向心性转移多见。X线、MRI、核素扫描相结合对于诊断前列腺癌骨转移具有重要意义和价值。     

分化型甲状腺癌骨转移的临床特点及影像学诊断分析

目的探讨分化型甲状腺癌（DTC）骨转移的临床特征和影像学诊断。方法回顾性分析106例经131I治疗的DTC骨转移患者的发生率、发病年龄、临床症状、体征、病理类型、转移部位及合并其他转移的情况,并对131I全身扫描、99mTc-MDP骨扫描、MRI、X线和CT诊断DTC骨转移敏感性进行比较,总结其临床特征。结果骨转移发生率约占DTC患者的8.43%（106/1258）,好发部位以肋骨、髂骨和胸椎居多,以溶骨性骨转移为主;以骨转移为首发症状的DTC患者占19.81%;多发性骨转移多见。MRI、131I扫描、CT、X线、和99mTc-MDP骨扫描诊断甲状腺癌骨转移的敏感性依次为96.59%、93.84%、66.49%47.46%和38.19%,其中131I全身扫描与X线、CT和99mTc-MDP检查比较差异有统计学意义（P〈0.05）;131I全身扫描与MRI检查比较差异无统计学意义（P〉0.05）。结论骨转移以多发性溶骨性病变为主,MRI和131I全身扫描的敏感性较高,CT次之,全身骨扫描和X线的敏感性较低。     

分化型甲状腺癌骨转移的临床特点及影像学诊断分析

目的 探讨分化型甲状腺癌(DTC)骨转移的临床特征和影像学诊断.方法 回顾性分析106例经131I治疗的DTC骨转移患者的发生率、发病年龄、临床症状、体征、病理类型、转移部位及合并其他转移的情况,并对131I 全身扫描、99mTc-MDP骨扫描、MRI、X线和CT诊断DTC骨转移敏感性进行比较,总结其临床特征.结果 骨转移发生率约占DTC患者的8.43%(106/1258),好发部位以肋骨、髂骨和胸椎居多,以溶骨性骨转移为主;以骨转移为首发症状的DTC患者占19.81%;多发性骨转移多见.MRI、131I扫描、CT、X线、和99mTc-MDP骨扫描诊断甲状腺癌骨转移的敏感性依次为96.59%、93.84%、66.49%47.46%和38.19%,其中131I全身扫描与X线、CT和99mTc-MDP检查比较差异有统计学意义(P＜0.05);131I全身扫描与MRI检查比较差异无统计学意义(P＞0.05).结论 骨转移以多发性溶骨性病变为主,MRI和131I全身扫描的敏感性较高,CT次之,全身骨扫描和X线的敏感性较低.     

前列腺癌骨转移的影像学分析

目的 分析前列腺癌骨转移的影像学表现,探讨其影像学的特点及诊断价值。方法 经病理证实的前列腺癌病例共19例,对其X线、CT、核素扫描的表现进行分析。结果 在以上病例当中,先发现转移灶,然后发现原发灶的共17例;先发现原发灶然后查出骨转移的共2例,其中成骨型16例,混合型3例。结论 前列腺癌极易发生骨转移,以成骨型多见,患者的年龄较大,且多数为先发现转移灶,然后发现原发灶的临床特点。故影像学检查有助于对该病的诊断。     

颅盖骨转移瘤的CT诊断（附23例分析）

目的：探讨颅盖骨转移瘤的CT表现及诊断价值。方法；对经临床工病理证实的23例颅盖骨转移瘤病人进行回顾性分析，23例均作有CT及X线平片检查。结果：CT表现主要呈溶骨性骨质破坏18例（78．3％），也可见成骨性2例（8．7％）或混合性3例（13％）骨质改变。X线平片阳性14例（60．9％）。转移部位以顶骨（40．7％）和枕骨（27．1％）常见，颞骨（11．9％）较少。结论：CT扫描显示病变明显优于X线平片，具有特征性，能对多数病变作出正确诊断。     

60例肺癌骨转移的临床分析

目的探讨肺癌骨转移的临床病理特点。方法回顾性分析60例患者的临床资料。结果肺癌骨转移单发者点31.50%,多发者68.50%。肺癌骨转移患者中腺癌50.00%,鳞癌25.00%,小细胞未分化癌16.67%,腺鳞癌8.00%。骨转移部位为肋骨37.00%,胸椎23.00%,骨盆20.00%,腰椎11.00%,其余为肩岬骨、胸骨、四肢等。腺癌以胸椎、骨盆转移为主,小细胞以肋骨、骨盆、胸椎转移为主。在行X线、CT、MRI检查的病人中,骨转移以溶骨性破坏56.42%,在骨性破坏26.28%,混合性避孕药破坏16.30%。结论肺癌骨转移以多发性、溶骨性骨破坏为特征。腺癌骨转移发生率最高,其次为鳞癌和小细胞肺癌。     

60例肺癌骨转移的临床分析

目的 探讨肺癌骨转移的临床病理特点.方法 回顾性分析60例患者的临床资料.结果 肺癌骨转移单发者占31.5%,多发者68.5%.肺癌骨转移患者中腺癌50.00%,鳞癌25.00%,小细胞未分化癌16.67%,腺鳞癌8.00%.骨转移部位为肋骨37.00%,胸椎23.00%,骨盆20.00%,腰椎11.00%,其余为肩岬骨、胸骨、四肢骨等.腺癌以胸椎、骨盆转移为主,小细胞肺癌以肋骨、骨盆、胸椎转移为主.在行X线、CT、MRI检查的病人中,骨转移以溶骨性破坏56.42%,成骨性破坏26.28%,混合性骨破坏16.30%.结论 肺癌骨转移以多发性、溶骨性骨破坏为特征.腺癌骨转移发生率最高,其次为鳞癌和小细胞肺癌.     

脊柱转移瘤CT诊断与X线平片对照(附30例分析)

本文 30例脊柱转移瘤均经病理证实 ,CT扫描表现溶骨性破坏 19例 ,成骨性破坏 3例 ,混合性破坏8例。原发灶以肺癌最多见 ,其次为鼻咽癌和胃癌。本组 30例备有正侧位X线平片检查 ,平片发现或可疑破坏 16例 ,而CT扫描 10 0 %,CT扫描发现和估价病变方面较平片X检查优越敏感 ,本文对脊柱转移瘤的CT诊断 ,鉴别诊断的价值进行探讨。     

脊柱转移瘤的X线与CT诊断

目的 :探讨脊柱转移瘤的 X线与 CT表现及临床意义。方法 :回顾分析脊柱转移瘤 2 8例的 X线与 CT影像资料并加以总结。结果 :2 8例脊柱转移瘤中 2 5例为溶骨性转移 ,占 89.2 9% ;3例为混合性转移 ,占 10 .71%。其中胸腰椎骨转移多见为2 4例 ,占 85 .71%。合并骨盆骨转移 5例 ,占 17.87%。合并肩胛骨、肱骨转移各 1例 ,占 3.5 7%。结论 :脊柱为转移性骨肿瘤的好发部位 ,认识其影像学表现 ,熟悉其诊断与鉴别诊断具有重要的临床意义     

肾细胞癌甲状腺转移一例及文献复习

目的探讨肾细胞癌甲状腺转移的临床表现及影像学特点。方法回顾性分析一例肾细胞癌甲状腺转移患者的相关临床资料及影像学检查,并复习有关文献。结果肾细胞癌甲状腺转移为临床罕见病,发病隐匿,发病机制不明,临床诊断极其困难,明确诊断主要依靠病史、病理组织学及免疫组化检查等。超声声像图主要表现为甲状腺内的局灶性病变,形态不规则,分界清楚,呈实性低回声,无囊状结构,无包膜结构及强回声钙化斑,肿块内血流信号丰富。可出现颈部淋巴结转移及颈内静脉癌栓。结论肾细胞癌甲状腺转移影像学具有一定的特点,但无明显特异性征象,确诊主要依靠病理组织学及免疫组化,如果甲状腺是唯一的转移部位,必须进行甲状腺切除术。     

S100A4蛋白在甲状腺不同组织中的表达及与甲状腺癌转移的关系

目的:探讨S100A4蛋白的表达及与甲状腺癌转移的关系。方法:用免疫组化检测130份(例)甲状腺石蜡标本的S100A4蛋白表达情况,其中甲状腺癌80份(例)(乳头状癌55例、滤泡癌15例、髓样癌10例);甲状腺良性肿瘤50份(例)(结节性甲状腺肿、甲状腺滤泡型腺瘤各25例);癌旁甲状腺组织30例;正常甲状腺组织5例(对照)。结果:S100A4蛋白表达甲状腺癌组织阳性率77.5%(62/80),甲状腺良性肿瘤阳性率16.0%(8/50),癌旁甲状腺组织、甲状腺正常组织均呈阴性。甲状腺癌组织与后三者比,S100A4蛋白的表达均有统计学意义(P<0.01)。有、无淋巴结转移的癌组织S100A4蛋白表达阳性率分别为83.3%(25/30)和74.0%(37/50)(P<0.05)。有配对淋巴结转移的30例甲状腺癌中,S100A4表达率淋巴结转移癌高于相应原发灶(P<0.01)。结论:S100A4蛋白在甲状腺癌组织中过表达与转移有关,有希望成为一个能够预测肿瘤病情发展及指导临床治疗的标记物。     

RADIOIODINE THERAPY FOR DIFFERENTIATED THYROID CARCINOMA : INHS ASVINI EXPERIENCE

During last 17 years, 175 patients of carcinoma thyroid were treated in this centre. Hundred patients (57%) of papillary carcinoma formed majority. Fifty four patients (31%) were follicular carcinoma and 15 (8.5%) were mixed variety. Two (1.3%) were medullary carcinoma, 3 (1.7%) anaplastic type and 1 (0.5%) hurthle cell carcinoma. After surgery these patients were assessed for radio iodine uptake, residual thyroid tissue and distant metastasis which determined the dose of radioiodine for ablation. Fifty two per cent (91) patients presented as multi nodular goitre, 22.3 per cent (39) as solitary nodule, 13.7 per cent (24) had lymph node metastasis, 5.7 per cent (10) bone metastasis, 2.5 per cent (4) had lung metastasis and 3.8 per cent (7) presented as thyrotoxicosis. Average number of therapy for complete ablation in papillary carcinoma was 1.5, follicular 1.78 and mixed variety 1.5. 72.6 per cent cases (127) needed single dose for ablation, 14.9 per cent (26) needed 2 doses and 5.7 per cent (10) required 3 doses. Only 6.8 per cent (12) cases needed 4 to 8 doses. Average dose of I⁻¹³¹ administered for ablation was 157 mci in males and 124 mci in females of papillary carcinoma thyroid. Males in follicular variety required 204 mci and females needed only 120 mci. In mixed variety males required 177 mci and females required 62.5 mci for complete ablation. 144 patients (82.3%) were followed up to 5 years and remaining patients from 6 to 17 years. These patients are followed up once in a year or alternate years. Follow-up and medical record keeping for defence personnel is done with meticulous care, therefore followup results are very encouraging.KEYWORDS: Differentiated thyroid cancer, Radio iodine therapy, Thyroid ablation     

BONE METASTASIS IN CARCINOMA OF THE URINARY BLADDER

In carcinoma of the urinary bladder bone metastasis is rare. Ewing (1) stated that metastases though uncotmnon m malignant papilloma uf the urinary bladder had been observed in liver, lung, pleura, kidney, and inguinal and axillary lymph nodes. Bone metastasis was not men tioned. Colston (2) conceded that mctastasis to the bone from carcinoma of the urinary bladder did undoubtcdLy occur, but in his experience it was rare. Cabot (3) believed that mclas:asis in carcinoma of the urinary bladder was a late event, and thu it occurred primarily in the regional lymph nodes. Widespread mctastases to r!:e honcs, lungs, liver and pcri- toneum, were less frequent, and the bony structures of the pelvis and lumbar spine were probably afTected by retrograde lymphatic invasion and not distribution through the blood stream. Moore (4) in a study of 65 cases of metastatic growth in bone, found none primary in v.he urinary bladder. Spooncr (5) analyzerl 163 cases of carcinoma of the urinary bladder in Mayo Clinic and listed the order of frequcncy of metastasis as follows: liver, lung, suprarenal gIand, kidney, heart, spleen, pancrcas, thyroid gland, stomach and bonc.     

甲状腺乳头状癌并发颈部淋巴结结核的超声影像学特征

目的：探讨甲状腺乳头状癌并发颈部淋巴结结核的超声影像学特征,阐明其超声诊断要点,并与甲状腺乳头状癌颈部淋巴结转移进行鉴别。方法：收集15例经临床手术病理证实的甲状腺乳头状癌并发颈部淋巴结结核患者的资料,其中6例同时并发淋巴结转移,分析肿大淋巴结超声表现,比较结核性淋巴结和转移性淋巴结的超声特征,包括发生的部位、钙化特征、液化情况及血流分布特征等。结果：甲状腺乳头状癌并发淋巴结结核多分布于颈部Ⅲ区、Ⅳ区及Ⅴ区,以Ⅴ区显著,淋巴结回声紊乱,结内钙化呈片状不均匀分布,液化部分透声极差,可见絮状弱回声,血流信号表现为周边或内部散在点状分布,淋巴结周围软组织回声增强、紊乱。结论：超声检查可疑甲状腺癌并发颈部淋巴结肿大患者时,应结合病史、分析其超声特征并观察淋巴结周围软组织病变后进行综合诊断。     

晚期甲状腺癌局部侵犯的临床特点

目的 :探讨晚期甲状腺癌局部侵犯的临床特点。方法 :回顾分析 1988年 1月至 2 0 0 1年 10月收治的 2 5例晚期甲状腺癌患者的临床资料 ,其中 16例为原发性肿瘤 ,9例为复发癌。结果 :晚期甲状腺癌累及颈部组织的顺序为颈段气管、喉返神经、颈段食管、喉、颈内静脉及胸锁乳突肌等。 2 1例喉气管受累 (84 .0 % ) ,14例病理证实存在肿瘤转移。结论 :晚期甲状腺癌治疗对喉、气管受累及颈淋巴结转移的处理是必须要考虑的问题     

Histopathological profile of childhood thyroid carcinoma in Ibadan,Southwestern Nigeria

BackgroundThyroid carcinoma is a common endocrine malignancy. It is however rare in childhood and often occurs as a result of radiation exposure or inherited genetic mutations. Most childhood thyroid carcinomas are well differentiated. There are very few epidemiological studies of this disease in Nigeria and our study aimed to determine the frequency in a subset of our population. The study aimed to determine the prevalence and histopathological characteristics of childhood thyroid carcinoma in our environment.MethodsThis was a retrospective review of histopathologically diagnosed thyroid carcinoma in children less than 18 years of age in the Department of Pathology, University College Hospital, Ibadan over a 40-year period. Histopathological diagnosis, age, sex and other relevant clinical information were extracted from the hospital records and surgical pathology records of the department. All cases of patients under18 years old had their slides re-examined and reclassified by two pathologists according to the World Health Organization histopathological classification of thyroid tumours.ResultsThere were 25 cases of thyroid carcinomas seen in children within the study period. Papillary thyroid carcinoma was the most common, accounting for 80% of the cases. Follicular carcinoma accounted for 12%, and medullary and anaplastic carcinoma accounted for 4% each. The mean age at presentation was 13 years. There was a female preponderance with females accounting for 60% of cases. Tumours with distant metastasis made up 20% of the cases.ConclusionChildhood thyroid carcinomas are rare in our environment, with a minority of cases presenting with metastases.     

甲状腺乳头状癌108例外科治疗分析

目的探索甲状腺乳头状癌外科手术治疗的方法。方法搜集2004年1月-2010年10黄山市人民医院外科诊治108例甲状腺乳头状癌临床资料,对手术方式、效果进行分析。甲状腺患叶切除＋峡部切除76例,患叶甲状腺切除＋峡部全切＋对侧大部分切除22例,双侧甲状腺全切除6例,均行中央区淋巴结清扫,14例有侧淋巴结转移的行功能性淋巴结清扫,患叶甲状腺全切除＋峡部全切＋双侧功能性淋巴结清扫2例,始息手术2例。结果术后低钙血症3例为2．7％,喉返神经永久性损伤2例为1．8％,暂时性声音嘶哑3例为2．7％,侧颈部淋巴结转移8例为7．4％,中央区淋巴结转移58例为53％,术后随访1个月-6年,无死亡病例,未发生远处转移。结论甲状腺乳头状癌手术方式应根据病变的部位、大小、淋巴结转移情况行个体化的治疗,术中正确辨认喉返神经可减少喉返神经损伤。     

分化型甲状腺癌83例手术治疗分析

目的:探讨分化型甲状腺癌手术方法和经验。方法:采用回顾性分析83例分化型甲状腺癌手术治疗患者的临床资料、手术资料以及随访资料进行统计分析。结果:83例患者无手术期间死亡,1例患者发生暂时性喉返神经损伤。81例患者随访3～6年。术后3年对侧腺叶复发1例,再手术后至今无瘤生存。术后后2、2.5、3和4年,同侧颈淋巴结转移4例,再手术后至今无瘤生存。1例患者术后1年死于肺转移。结论:对于分化型甲状腺癌的治疗以手术为主,并在术后辅助内分泌治疗可获得良好的治疗效果。