儿童甲状腺癌60例临床分析

目的 探讨儿童甲状腺癌的临床特点、诊断、治疗及预后。方法 回顾性分析我校三个医院1975～2002年收治并获随访的儿童甲状腺癌60例。结果 在60例儿童甲状腺癌中，乳头状腺癌49例，滤泡状腺癌8例，髓样癌3例，伴颈部淋巴结转移36例。全组患者均手术治疗，其中患侧甲状腺加峡部切除20例(33．3％)，患侧甲状腺全切加对侧甲状腺次全切36例(60％)，甲状腺全切除4例(6．7％)。术后均服甲状腺素片。平均随访10．5年(1～20年)，5年生存率为93％，10年生存率为87．1％。结论 儿童甲状腺癌多分化良好，极少发生未分化癌。重视其临床特点是早期诊治的关键，合理选择术式及术后综合治疗可取得满意疗效。     

儿童及青少年甲状腺癌的临床特征与预后分析

背景与目的 尽管儿童及青少年甲状腺癌的发病率远低于成人,但仍呈现逐年升高的趋势,甲状腺癌已成为儿童及青少年中较为常见的恶性肿瘤之一。与成人相比,儿童及青少年甲状腺癌具有一些不同的临床特征,进一步了解这些特征,将更有助于加精准诊疗。因此,本研究通过回顾性分析探讨儿童及青少年甲状腺癌的临床病理特点与预后情况,以期为临床治疗决策提供参考。方法 收集湖南师范大学附属第一医院/湖南省人民医院2014年9月—2021年6月间68例因甲状腺疾病行手术治疗的儿童及青少年患者（年龄≤20岁）资料,将其中获随访的甲状腺癌患者纳入研究。另随机抽取22例成人甲状腺癌患者作为对照,比较两组甲状腺癌人群临床病理特征的异同。结果 68例儿童及青少年患者中病理确诊为甲状腺癌的24例（35.29%）,其中22例获随访3~72个月。22例患者中,女19例,男3例（6.33∶1）;年龄3~20岁,平均（16.73±4.52）岁;病程10 d至5年,平均为9.5个月;主要因触及颈部无痛性肿块就诊;术前甲状腺超声TI-RADS 4类及以上结节占比高（19/22,86.36%）;3例行患侧甲状腺腺叶切除术,1例行患侧甲状腺腺叶切除+对侧腺叶次全切除术,2例行患侧甲状腺腺叶切除+对侧腺叶近全切除术,余均行甲状腺全切术;21例行中央区淋巴结清扫,其中13例患者还行侧颈区淋巴结清扫,1例未行淋巴结清扫。术后病理示,甲状腺乳头状癌（PTC）18例（81.82%）,甲状腺微小乳头状癌（PTMC）3例（13.64%）,甲状腺髓样癌（MTC）1例（4.54%）。术后出现单侧喉返神经损伤者3例,喉头水肿者1例,甲状旁腺功能低下者2例,1例患者行左侧侧颈区淋巴结清扫术后出现乳糜漏。1例MTC患者术后3年余复发,再次双侧颈部淋巴结扩大清扫术,并行靶向药物治疗;余在访患者均未发现复发或转移征象。儿童及青少年甲状腺癌的性别分布与成人基本一致;儿童及青少年甲状腺癌与成人甲状腺癌病理类型均以PTC居多（95.45% vs. 100.00%）,但前者PTMC的比例明显低于后者（13.36% vs. 50.00%,P<0.05）;此外,儿童及青少年患者颈部淋巴结转移占77.27%（17/22）,且其双侧淋巴结转移比例明显高于成人患者（50.00% vs. 9.09%,P<0.05）。结论 儿童及青少年的甲状腺疾病中,甲状腺癌占比较高,发病性别与病理类型与成人相似,但确诊时肿瘤体积往往较成人更大,且更易出现双侧颈部淋巴结转移,但经手术等规范化治疗后,整体预后较好。     

侵犯前上纵隔的晚期甲状腺癌24例临床分析

为探讨甲状腺癌侵犯前上纵隔的机理，作者分析了１９６２～１９９４年治疗侵犯前上纵隔的晚期甲状腺癌２４例，其中乳头状腺癌１６例，滤泡样腺癌，髓样癌各３例，低分化癌２例，治疗方法均为甲状腺癌颈胸联合根治术，肿瘤完整切除１６例，肉眼残留８例，术后补充放疗９例，５年生存率６４．７％，１０年生存率４６．７％，生存５年以上者均为乳头状腺癌患者，提示影响预后的主要因素是病理类型。     

小儿甲状腺癌12例治疗分析

目的探讨与小儿甲状腺癌发病有关的因素、诊断与治疗方法。方法对我院1998年1月至2007年1月收治的12例小儿甲状腺癌结合有关文献进行分析。结果12例小儿甲状腺癌中，术前同位素扫描10例；冷、凉结节8例，其中1例3次手术后肿瘤复发，复查发现转变为温结节；温结节2例。染色体检查2例无异常。病理类型为乳头状腺癌7例，滤泡状腺癌3例，混合癌2例，合并颈淋巴结转移8例。全组均行手术治疗：双侧腺叶全切＋峡部切除2例。患侧腺叶全切＋峡部切除3例，患侧腺叶全切＋峡部切除＋对侧大部分切除6例，双侧腺叶部分切除＋峡部切除1例。全组均行功能性颈淋巴结清扫。术后随访10例，无死亡。结论小儿甲状腺癌分化良好，预后佳。甲状腺良性肿瘤术后反复复发或同位素扫描性质改变，应高度警惕恶变可能。手术方式应根据术中病理合理选择。     

双侧甲状腺癌10例分析

双侧甲状腺癌１０例分析徐光玮，刘宝珠，刘燕平我院自１９８０年至１９９２年间共收治双侧甲状腺癌１０例，现报告如下。临床资料１．性别和年龄：本组男性３例，女性７例，年龄最小２６岁，最大５５岁，平均年龄３９岁。２．症状：双侧甲状腺单个结节７例；双侧甲状腺多...     

546例分化型甲状腺癌手术治疗分析

目的 探讨分化型甲状腺癌的手术治疗方式.方法 回顾性分析2001年1月至2006年12月收治的546例行手术治疗的分化型甲状腺癌患者的临床资料,均行双侧甲状腺全切除术和选择性颈淋巴结清扫术.结果 全组无手术及住院期间死亡.颈部淋巴结转移阳性率为76,2%(358/470).单侧喉返神经损伤的发生率1.1%(6例),双侧喉返神经损伤0例;甲状旁腺部分损伤0.4%(2例),甲状旁腺完全损伤0例;喉上神经损伤0.7%(4例),术后出血0.6%(3例),食管损伤0.2%(1例).结论 对于分化型甲状腺癌患者,均应行双侧甲状腺全切除术;对于肿瘤直径＞1 cm的患者,还应行双侧中央组+患侧颈深组淋巴结清扫.     

儿童甲状腺癌的临床特点和治疗

目的探讨儿童甲状腺癌的临床病理特点及外科治疗方法。方法回顾性分析1990年1月~2005年12月南昌大学第二附属医院手术治疗的26例儿童甲状腺癌患儿的临床病理资料、特点及治疗方法。结果女性患儿15例,稍多于男性(11例)。患儿均经病理证实为甲状腺癌,其中乳头状癌14例,滤泡状癌9例,髓样癌2例,未分化癌1例。行肿瘤剔除手术1例;一侧腺叶及峡部切除加患侧中央区淋巴结清扫术5例,加单侧颈淋巴结清扫术15例;行甲状腺全切或近全切除加双侧颈淋巴结清扫术5例。颈淋巴结转移21例(80.8%)。术后3例患儿出现暂时性有症状性甲状旁腺机能减退,经治疗后缓解;全组未出现永久性甲状旁腺功能减退、无喉返神经麻痹及手术相关性死亡。5,7年总生存率为96.2%和91.6%。结论儿童甲状腺癌多为分化型甲状腺癌,手术治疗后预后较好。     

腔镜甲状腺癌手术临床进展

1996年Gagner率先将腔镜技术应用于甲状旁腺手术，自此开创了腔镜手术的新天地。此后许多外科医师尝试从不同径路完成腔镜甲状腺手术，如腋窝入路、乳晕入路、前胸壁入路等。2001年，Yamamoto等将乳晕径路甲状腺手术用于治疗Graves病；2002年Ikeda等报道应用前胸部径路和腋窝径路治疗甲状腺结节、良性或低级的滤泡性病损和Graves病。目前，腔镜技术适用于良性甲状腺疾病已获得广泛认可，但是许多外科医师仍不满足于此，尝试在腔镜下完成甲状腺的完整切除，进而可将其推广应用于甲状腺癌的手术治疗中。2002年，Miccoli等首次报道对一例甲状腺乳头状癌的病人成功施行了腔镜辅助下甲状腺次全切除术。     

1018例甲状腺癌临床病理分析

目的 探讨吉林大学第一医院甲状腺外科收治患者中甲状腺癌的发病状况及病理学特征.方法 回顾性分析吉林大学第一医院2000年1月-2010年7月收治的1018例甲状腺癌患者的临床病理资料.结果 2008年、2009年收治的甲状腺癌患者比之前8年总数高73%以上,2009年1月至2010年7月一年半收治的甲状腺癌患者比之前9年的总数高48%以上;男女发病比例约为1∶4.0;1018例甲状腺癌患者中病理类型明确者976例,其中乳头状癌897例(91.91%),滤泡状癌43例(4.41%),髓样癌22例(2.25%),未分化癌6例(0.61%);1018例甲状腺癌患者中淋巴结转移情况明确者804例,男、女淋巴结转移率分别为39.24%、28.64%,二者差异有统计学意义(χ2=6.71,P＜0.05),45岁以下(不包括45岁)及45岁以上患者淋巴结转移率分别为37.65%、23.26%,二者差异有统计学意义(χ2=19.54,P＜0.05).结论 过去的10年半我院收治的甲状腺癌患者逐年增多,以乳头状癌患者升高最明显,女性患者数明显多于男性,男女发病年龄高峰均为30～59岁.淋巴结转移率男性大于女性,45岁以下患者多于45岁以上患者.

Abstract：

Objective To explore the incidence and pathologic feature of patients with thyroid carcinoma treated at the First Hospital of Jilin University. Methods From January 2000 to July 2010,clinicopathologic data of 1018 patients with thyroid carcinoma treated in the First Hospital of Jilin University were retrospectively analyzed. Results The cases of thyroid carcinoma between 2008 and 2010 were more than 73% higher than that in the preceding 8 years. Cancer cases from January 2009 to July 2010 were more1018 cases reviewed, 976 cases were clearly classified pathologically. Papillary thyroid carcinoma, follicular thyroid carcinoma, medullary thyroid carcinoma and anaplastic thyroid carcinoma were present in 897 (91.91%), 43(4. 41% ), 22(2. 25% ) and 6(0. 61% ) cases respectively. Of the 1018 cases reviewed,804 cases were recorded with or without lymphnode metastasis. The rate of lymphnode metastasis of male and female patient were 39. 24% and 28. 64% respectively and the difference was significant( χ2 = 6. 71 ,P ＜0. 05). The rate of lymphnode metastasis of age ＜45 years and age ≥45 years were 37.65% and 23. 26%respectively and the difference was significant ( χ2 = 19. 54, P ＜ 0. 05 ). Conclusions In the past ten and a half years, the number of the thyroid carcinoma patients treated in the First Hospital of Jilin University increased year by year. The increase of papillary thyroid carcinoma was the most obvious. Thyroid carcinoma was more common among females. The peak incidence age of males and females was 30 -59. The rate of lymphnode metastasis of males was larger than that of females. The rate of lymphnode metastasis of age ＜45years was larger than that of age≥45 years.     

Thyroid calcification and its association with thyroid carcinoma

AIM: Calcification within the thyroid gland may occur in both benign and malignant thyroid disease, and its detection on ultrasonography is frequently dismissed by many clinicians as an incidental finding of little significance. As a tertiary referral center, most of our thyroid patients will have had thyroid ultrasonography before being referred to us, and in our experience, the incidence of malignancy in a thyroid nodule containing calcification seems to be higher than that in the average thyroid nodule. To assess this risk, we conducted this retrospective review. MATERIALS AND METHODS: Our analysis included 462 consecutive patients who underwent thyroid surgery at our institution between 1995 and 1999. We reviewed all the patients' charts for data regarding clinical findings, preoperative diagnostic investigations, and histopathologic diagnosis. Of the 462 patients, 361 (78.1%) had thyroid ultrasonography before surgery, and 49 (13.6%) of these ultrasounds showed intrathyroidal calcification. RESULTS: Of the 49 patients whose ultrasounds showed intrathyroidal calcification, 29 (59.2%) were found on histopathologic examination to have thyroid carcinoma. Twelve of the remaining 20 patients had multinodular goiters. Of the 29 patients with malignancy, seven (24.1%) had preoperative fine-needle aspirates that were reported as benign. After excluding patients who were initially seen with multinodular disease, in the subset of 37 patients who presented with a solitary thyroid lesion with calcification, 28 (75.7%) were found to have carcinoma. CONCLUSIONS: When calcification is noted within a solitary thyroid nodule, the risk of malignancy is very high. Surgery should be recommended regardless of the result of fine-needle aspiration cytologic findings.     

Thyroid carcinoma in an endemic area rresenting as solitary thyroid nodules

A retrospective analysis of 66 cases of thyroid cancer presenting as a solitary thyroid nodule (STN) from an endemic area is presented herein. The workup included TSH estimation and radionuclide scanning and patients were divided into two groups. Group A included cases of STN carcinoma diagnosed histologically in patients clinically presenting as a benign STN. Of all the patients who presented with a benign STN, malignancy was found more frequently in ‘cold’ nodules (13.5 per cent), than in nodules with a different presentation on scintiscanning (0–9.5 per cent). Cancers occurred in 5 per cent of the females and in 19.5 per cent of the males. Group B included patients with overt signs of malignancy. In both groups, the clinical behaviour was determined by the stage at presentation according to TNM classification. TNM staging was found to be a good prognostic indicator, comparable to histopathology. Thus, locoregional recurrence and mortality were found to be higher in advanced T3 lesions and in Group B patients. On the basis of these findings it is suggested that STN cancers may either be an earlier stage of the disease or that the STN cancers in the two groups may be separate disease entities.     

Thyroid cancer in children: Report of three cases and a review of the Japanese literature

We experienced three cases of thyroid cancer in children less than 15 years of age between 1982 and 1995. We herein present these three cases with a review of 141 reported cases of childhood thyroid cancer in Japan. Our patients were 6, 13, and 14 years old. The patients, all girls, were diagnosed as having thyroid cancer based on diagnostic imaging. One of them was also diagnosed by a fine-needle aspiration biopsy (FNAB). One of them underwent subtotal thyroidectomy, and the other two underwent lobectomy. Modified neck dissections were performed on all three. Pathologically, the tumors were all papillary carcinomas. Multiple lymph node metastases were present in all patients. However, the postoperative courses have been good, and there have been no signs of recurrence, 10, 8, and 2 years after their respective operations. In 144 reported cases of childhood thyroid cancer in Japan including ours, the youngest patient was a 2-year-old boy, and the female to male ratio was 2.1:1. FNAB was performed in 25 cases, and 23 (92%) of the tumors were diagnosed as malignant. Histologically, 76% were papillary carcinoma and 20% follicular carcinoma. At operation, lymph node metastases were found in 80% of the cases and lung metastases in 17%. For treatment, 88% of the patients received a more extensive operation than a lobectomy. Of the 144 patients, 8 died.     

青少年甲状腺癌临床特点和治疗选择

青少年分化型甲状腺癌发病率不高,但与成人相比具有一些鲜明的特征：通常表现为甲状腺结节,诊断时多出现颈部淋巴结或远处转移,预后较好,总体存活率高。 青少年分化型甲状腺癌宜行甲状腺全切除或近全切除术。对临床上已触及转移颈部淋巴结或超声检查阳性病例,首次手术应同时做颈部中央区淋巴结清扫。对颈侧区淋巴结活检阳性者,则应行改良的颈淋巴结清扫术,经典的颈淋巴结清扫术应避免。131I放射碘治疗是青少年分化型甲状腺癌的主要辅助治疗手段,应用左旋甲状腺素抑制治疗是青少年甲状腺癌术后的标准方法,但促甲状腺激素（TSH）最佳水平留有争论。     

自身免疫性甲状腺疾病并发分化型甲状腺癌的研究进展

目的总结自身免疫性甲状腺疾病（ATD）并发分化型甲状腺癌（DTC）的研究进展。方法收集国内外有关ATD并发DTC的文献并作综述。结果桥本病（HD）并发DTC在国内外报道得越来越多。合并HD或其他ATD是否影响甲状腺乳头状癌（PTC）的预后仍是一个具有争议性的话题。HD与DTC（以PTC为主）具有一些相同的流行病学和分子学特点。结论更好的了解并发ATD的DTC的临床病理和分子学特点可以为DTC的免疫疗法提供一些新见解。     

Thyroid carcinoma with extensive tumor thrombus in the atrium

To our knowledge, only a few cases of thyroid carcinoma with an extensive tumor thrombus in the atrium have been reported in literature. We describe a unique case of papillary carcinoma of the thyroid with extensive tumor thrombus in the atrium. A 74-year-old man consulted our hospital because of thyroid carcinoma with an extensive tumor thrombus in the atrium. Computed tomography (CT) revealed a 2-cm tumor with extensive continuous tumor thrombus in the left jugular vein, innominate vein, superior vena cava, and atrium. The tumor was resected to reduce the risk of sudden death from tumor embolism into the pulmonary arteries. Histologically, the diagnosis was papillary carcinoma of the thyroid. Thyroid carcinoma, especially papillary carcinoma, rarely develops a macroscopic tumor thrombus. Patients with an extensive tumor thrombus generally have poor prognoses and high mortality. This patient has been followed for 7 months after successful operation without recurrence.