甲状腺乳头状癌颈部Ⅱb区淋巴结转移特点及相关因素分析

目的探讨甲状腺乳头状癌颈部Ⅱb区淋巴结转移规律及相关因素分析。方法回顾性分析2006年1月至2013年1月在广西医科大学附属肿瘤医院接受患侧同期颈淋巴结清扫术的甲状腺乳头状癌患者的临床资料,共纳入能够获得Ⅱa、Ⅱb、Ⅲ、Ⅳ、Ⅴ及Ⅵ区淋巴结转移情况的病人资料共61例,其中3例为双侧甲状腺乳头状癌伴双侧颈部淋巴结转移,共计算64侧颈各区淋巴结转移率,并分析各个临床指标,包括性别、年龄、T分期、颈部各区淋巴结转移率等与11b区转移的相关性。结果61例病人,共64侧颈Ⅱ、Ⅲ、Ⅳ、Ⅴ及Ⅵ区淋巴结转移率分别为34．4％（22／64）、43．8％（28／64）、42．2％（27／64）、25．0％（16／64）和48．4％（31／64）,其中Ⅱa和Ⅱb区淋巴结转移率分别是25．0％（16／64）和9．4％（6／64）。多因素分析显示Ⅱa区淋巴结转移是Ⅱb区淋巴结转移的独立危险因素。结论甲状腺乳头状癌颈部Ⅱb区淋巴结转移率较低,如果出现Ⅱa区淋巴结转移则Ⅱb区应行常规清扫。     

甲状腺乳头状癌淋巴结转移的风险因素分析

目的探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的临床病理学特征及淋巴结转移的风险因素。方法收集504例PTC手术标本,回顾性分析患者的临床资料及病理特点,通过单因素和多因素分析淋巴结转移的危险因素。结果(1)中央区淋巴转移中男性(47.58%)、年龄45岁(43.49%)、合并结节性甲状腺肿(46.20%)的患者转移率均显著增高;侧颈区淋巴结转移中男性(32.26%)、肿瘤最大径 1 cm(26.08%)、多发病灶(28.64%)、合并结节性甲状腺肿(32.28%)及合并淋巴细胞性甲状腺炎(36.73%)、双侧病变(33.08%)的患者转移率均显著增高。多因素分析显示,患者性别、结节性甲状腺肿是中央区淋巴结转移的独立危险因素;患者性别、肿瘤最大径、结节性甲状腺肿及病变位置(单/双侧)是侧颈区淋巴结转移的独立危险因素。(2)单因素分析显示,多个淋巴结转移中肿瘤最大径 1 cm(14.35%)、伴钙化(24.24%)、合并结节性甲状腺肿(18.35%)及合并淋巴细胞性甲状腺炎(28.30%)、双侧病变(17.78%)的患者转移率均显著增高。多因素分析显示,肿瘤最大径、合并淋巴细胞性甲状腺炎及结节性甲状腺肿是多个淋巴结转移的独立危险因素。结论 PTC患者的性别、年龄、肿瘤直径等临床病理学特征是淋巴结转移的危险因素,有望成为临床术前或术中诊断PTC依据,为制定合理的治疗方案提供帮助。     

乔本甲状腺炎合并甲状腺乳头状癌

乔本甲状腺炎合并甲状腺乳头状癌王家耀廖松林程秀英王维屏邹烨一、材料与方法１９８５～１９９５年期间山东省立医院原病理诊断为乔本甲状腺炎（Ｈａｓｈｉｍｏｔｏ′ｓｔｈｙｒｏｉｄｉｔｉｓ，ＨＴ）或甲状腺癌的手术切除标本１９８例，标本经常规切片，ＨＥ染色，光镜...     

右侧同时存在喉不返神经和喉返神经一例及文献复习

目的 报道甲状腺术中发现右侧同时存在喉不返神经及喉返神经的罕见变异一例,结合相关文献探讨其解剖特点及术中注意事项.方法 回顾分析江苏省苏北人民医院甲乳外科收治的一例右侧同时存在喉不返神经及喉返神经结节性甲状腺肿患者的临床资料.在万方数据库、中国知网、Pubmed中,以"喉不返神经(non-re-current lary...     

甲状腺乳头状癌颈部淋巴结转移特点及相关危险因素分析

目的 探讨甲状腺乳头状癌（PTC）临床病理特征及影响颈部淋巴结转移的危险因素。方法 回顾性分析我院2015年1月~2017年12月收治的515例PTC的临床资料,分析颈部淋巴结转移特点及相关危险因素。结果 PTC颈部淋巴结转移率为44.27%,中央组（Ⅵ区）淋巴结转移率高于侧区（P＜0.05）。单因素分析结果示性别、年龄、多灶、癌灶最大径、侵犯被膜和颈部淋巴结转移有关（P＜0.05）。多因素分析结果示男性、年龄＜55岁、多灶病变、癌灶最大径＞10 mm、被膜受侵犯是发生颈部淋巴结转移的独立危险因素（P＜0.05）。结论 Ⅵ区转移率最高,行颈淋巴结清扫时应将Ⅵ区作为常规清扫区域。对于男性、年轻、多灶病变、癌灶最大径＞10 mm、被膜受侵犯的患者应高度警惕颈部淋巴结转移的可能。     

甲状腺乳头状癌合并桥本甲状腺炎的临床病理特征及淋巴结转移因素分析

目的 探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)合并桥本甲状腺炎(Hashimoto's thyroiditis,HT)的临床病理特征、肿瘤免疫微环境类型及淋巴结转移的危险因素.方法 收集HT伴PTC(HT+PTC)标本89例,应用免疫组化CD8染色进行肿瘤免疫微环境分型,α-...     

1例左侧甲状腺乳头状癌伴左颈部淋巴结转移的临床分析

甲状腺乳头状癌是最常见、恶性度相对较低的癌。该肿瘤生长缓熳,可在甲状腺内局限数年不变,其病灶也可经腺内的淋巴管从原发部位扩散至腺体其他部位和局部淋巴结（多见于颈部淋巴结）,当甲状腺乳头状癌伴左颈部淋巴结转移时,其机体会出现明显的异常病症,严重时会导致病患全身淋巴结出现病症和变异,甚至死亡。本文就左侧甲状腺乳头状癌伴左颈部淋巴结转移的临床特点,作出了相关的探讨与观察,现报告如下。     

常规解剖喉返神经在甲状腺手术中的作用

目的 探讨在甲状腺手术中解剖喉返神经从而防止喉返神经损伤的作用.方法 在143例甲状腺手术中常规解剖喉返神经.结果 共解剖喉返神经206条,3例病例术后声嘶,术后1～3月后均恢复,无永久性喉返神经损伤.结论 甲状腺手术中解剖喉返神经能有效避免喉返神经损伤,建议在甲状腺手术中常规解剖喉返神经.     

预防性颈中央区淋巴结清扫对cN0期甲状腺乳头状癌疗效的Meta分析

目的 探讨预防性颈中央区淋巴结清扫术(PCND)在cN0期甲状腺乳头状癌(PTC)患者手术治疗中的临床应用价值。方法 分别以“甲状腺乳头状癌、预防性颈中央区淋巴结清扫、复发、并发症”和“papillary thyroid carcinoma、prophylactic central neck dissection/prophylactic central cervical lymph node dissection、recurrence、complication”为中英文检索词,检索PubMed、EMbase、The Cochrane Library、CNKI、万方数据库、中国生物医学文献数据库,限定文献发表年限为2007—2017年,纳入比较单纯行甲状腺乳头状癌原发灶手术治疗(对照组)和同时加行预防性颈中央区淋巴结清扫(观察组)临床疗效的队列研究,由两名研究者独立筛选文献与提取数据,并进行质量评价。计数资料采用优势比(OR)及95%可信区间(CI)表示。采用I²进行异质性分析。结果 共纳入符合筛选标准的文献10篇,均为回顾性队列研究,共3 383个研究对象,其中对照组1 797例,观察组1 586例。Meta分析结果显示:观察组与对照组局部复发率之间的差异无统计学意义(OR=0.97,95%CI 0.63～1.50, P=0.90)。与对照组相比,观察组术后暂时性低钙血症(OR=2.20,95%CI 1.81～2.68, P＜0.000 01)、永久性低钙血症(OR=3.02,95%CI 1.97～4.61,P＜0.000 01)、暂时性喉返神经损伤(OR=1.58,95%CI 1.06～2.34, P=0.02)、永久性喉返神经损伤(OR=1.90,95%CI 1.10～3.58, P=0.05)的发生率均增高,且差异均有统计学意义。结论 对于cN0期PTC患者,在原发灶手术治疗的同时行PCND并不能降低肿瘤的局部复发率,但却能明显增加手术并发症风险;因此,不推荐临床常规实施该术式。     

右侧喉不返神经1例及文献回顾

<正>从1996至2008年,我们共解剖了144具尸体,仅在1具成年男尸上发现了右侧喉不返神经的存在,左侧喉返神经的行程是正常的。用游标卡尺测量,右迷走神经的直径为2.45mm,右侧喉     

Mutations of the BRAF gene in papillary thyroid carcinoma and in Hashimoto's thyroiditis

The purpose of the present study was to investigate the frequency of BRAF mutations in human papillary thyroid carcinoma (PTC) and Hashimoto's thyroiditis (HT) and to evaluate the association of the BRAF mutation with the clinicopathological features of both of these thyroid disorders. A total of 51 PTC with no HT, 28 PTC with HT and 27 HT with no PTC were evaluated using DNA extracted from paraffin-embedded specimens. BRAF mutations were analyzed by direct DNA sequencing of the polymerase chain reaction (PCR)-amplified exon 15. The BRAF missense mutation at codon 599 (T1796A) was present in 46 of 51 PTC (90%) with no HT, 18 of 28 PTC (64%) with HT, four of 28 HT (14%) with PTC, and zero of 27 HT with no PTC. The BRAF mutation at codon 600 (A1798G) was not detected in any case. Clinicopathological examination of 106 patients with either PTC or HT showed that the BRAF mutation was significantly correlated with patient age. These data indicate that the BRAF mutation is associated with a valuable biological property of PTC and may participate in the pathogenesis of PTC arising in HT. These results indicate that the detection of the BRAF mutation in HT can be helpful for prediction of progress to PTC.     

Correlation analysis on central lymph node metastasis in 276 patients with cN0 papillary thyroid carcinoma

Objective: To explore the relationship between sex, age, capsule invasion, tumor size, tumor location, number and central lymph node metastasis. Methods: Correlation analysis was conducted on clinical data of 276 patients with cN0 papillary thyroid carcinoma who underwent central lymph node dissection. Results: There was significant difference between patients less than 45 years old and greater than or equal 45 years old (P<0.05), between patients with capsule invasion and without capsule invasion (P<0.05); there were significant differences in the central lymph node metastasis rate between group with Φ≤0.5cm as well as Φ>2cm and the other three groups (P<0.05), and there was significant difference between upper pole group and middle/lower pole group (P<0.05) while no significant difference was found between middle pole and lower pole (P>0.05); there was also no significant difference in the central lymph node metastasis rate between groups with 1 tumor and greater as well as equal 2 (P>0.05). Conclusion: We considered the tumor located in middle and lower pole, Φ>0.5cm of tumor size, less than 45 years old and the present of capsule invasion were high risk factors of central lymph node metastasis, so we strongly recommend performing central lymph node dissection in synchronization.     

Hashimoto's thyroiditis shares features with early papillary thyroid carcinoma

Neoplastic transformation is a multistep process that results in a continuous spectrum from the normal (physiological) state to a fully established neoplasm. The gold standard for diagnosis of papillary thyroid carcinoma is conventional histology, the essential element being the characteristic nuclear features, regardless of whether papillary structures are present or not. However, other criteria are being used increasingly in the diagnosis of neoplasms, including immunohistochemical staining and molecular profile. The RET/PTC gene rearrangement is highly specific for papillary thyroid carcinoma and is associated with the characteristic nuclear features seen in papillary thyroid carcinoma. There is an overlap in the morphological features, immunohistochemical staining pattern, and most importantly, molecular profile between papillary thyroid carcinoma and Hashimoto's thyroiditis. Although considered a 'benign' condition, Hashimoto's thyroiditis almost always harbours a genetic rearrangement that is strongly associated with and is highly specific for papillary thyroid carcinoma. Submicroscopic foci of papillary thyroid carcinoma must be present in Hashimoto's thyroiditis, although the clinical behaviour is still benign. Further studies are required to predict which foci will progress to papillary thyroid carcinoma.     

Risk factors for central lymph node metastasis of patients with papillary thyroid microcarcinoma: a meta-analysis

Objective: To evaluate the risk factors of central lymph node metastasis of papillary thyroid microcarcinoma. Method: Published articles about papillary thyroid microcarcinoma were searched in PubMed, MEDLINE and EMBASE until October 2013 to examine the risky factors of central lymph node metastasis. Software RevMan 5.0 was used for meta-analysis. Results: Within the patients suffering papillary thyroid microcarcinoma underwent thyroidectomy plus prophylactic central lymph node dissection, tumor size, multifocality and capsular invasion have statistically relevant association with central lymph node metastasis, but no relation was observed associated with sex and age. Conclusion: The papillary thyroid microcarcinoma should be considered central lymph node metastasis when tumor size ≥0.5 cm, multifocality and have capsular invasion.     

Overexpression of cytokeratin 17 is associated with the development of papillary thyroid carcinoma and the presence of lymph node metastasis

Cytokeratin 17 (CK17), a basal/myoepithelial cell keratin, appears to play an important role in the progression of several human malignancies. Increased CK17 expression has previously described in cases of papillary thyroid carcinoma (PTC). However, no studies to date have investigated the clinical significance of CK17 expression in patients with PTC. The aim of this study was to compare the expression of CK17 in patients with PTC with that observed in normal thyroid tissue and benign thyroid lesions, and to examine the relationship between CK17 expression and clinicopathologic characteristics of patients with PTC. CK17 protein expression was evaluated by immunohistochemistry on tissue microarrays containing thyroid tissue samples from 108 PTCs, 16 nodular goiters, and 81 healthy controls. Sixty-five of the 108 (60.2%) PTC tissue samples exhibited positive CK17 expression, whereas all nodular goiters and normal thyroid tissue samples showed a complete absence of CK17 immunoreactivity. The difference in frequency of CK17 positivity between PTC (65/108, 60.2%), normal thyroid tissue (0/81, 0.0%), and benign thyroid lesions (0/16, 0.0%) was statistically significant (P<0.001). Positive CK17 expression in PTC was significantly associated with the presence of lymph node metastasis (P=0.024) and higher pN stage (P=0.028). Expression of CK17 is significantly increased in cases of PTC compared to normal tissue and benign thyroid lesions, and CK17 overexpression is associated with the presence of lymph node metastasis in patients with PTC. These findings suggest that CK17 is involved in the development and metastasis of PTC.     

Risk factors for predicting central lymph node metastasis in papillary thyroid microcarcinoma

Objectives: We aimed to determine the predictive factors for central compartment lymph node metastasis (LNM) in papillary thyroid microcarcinoma (PTMC). The outcome of the current study could assist greatly in decision-making regarding further treatment. Methods: Retrospective analysis of PTMC treated at the First Affiliated Hospital of Harbin Medical University. The predictive risk factors for central lymph node metastases (CLNM) were analyzed with respect to age, sex, tumor size, multifocal and capsular affection. Results: CLNM are common in thyroid microcarcinoma patients. The factors correlated with neoplasm size greater than 5 mm (odds ratio, 0.520; P = 0.001), tumor bilateral (odds ratio, 0.342; P = 0.020), and capsule invasion (odds ratio, 2.539; P = 0.000) were independently predictive of CLNM. In patients with a solitary primary tumor, tumor location in the lower third of the thyroid lobe was associated with a higher risk of CLNM. Conclusions: The risk factors such as male gender, tumor size > 5 mm, bilateral, multifocal location, lower third of the thyroid lobe and capsule invasion that can be identified preoperatively or intraoperatively, be considered for determination of prophylactic CLND in patients with PTMC.     

Increased expression of integrin beta-4 in papillary thyroid carcinoma with gross lymph node metastasis

Although the prognosis is generally good for patients with papillary thyroid carcinoma, gross nodal metastasis of carcinoma has a poor prognosis. It is necessary to clarify how carcinoma progresses to gross nodal metastasis in order to establish a cure. The adhesion molecule integrin beta-4 is considered to be related to cell migration and metastasis in many carcinomas. In the present study, we examined integrin beta-4 expression in 65 cases of human papillary thyroid carcinoma using immunohistochemical methods. Expression of integrin beta-4 was found in all papillary carcinomas, but in few normal thyrocytes. Interestingly, integrin beta-4 expression in the carcinomas with gross (> or =3 cm) lymph node metastasis was significantly higher than that in carcinomas with small (<3 cm) or no lymph node metastasis. These results suggest that integrin beta-4 expression in thyroid carcinoma may play a role in the development of gross lymph node metastasis of papillary carcinomas.     

Mixed medullary and follicular cell carcinoma of the thyroid with lymph node metastasis in a 7-year-old child

A 7-year-old boy presented with midline swelling in the neck. On fine-needle aspiration cytology it was diagnosed as papillary carcinoma of the thyroid. The patient underwent total thyroidectomy. Histopathological examination, immunohistochemistry and electron microscopy revealed the presence of two intermingled components: medullary carcinoma and papillary carcinoma. One of the submandibular lymph nodes had metastasis of both the components. The case was diagnosed as 'mixed medullary and follicular cell carcinoma' with papillary carcinoma pattern and lymph node metastasis. Mixed medullary and follicular cell carcinoma with intermingling of medullary and papillary carcinoma components is a rare tumor. In adults, only eight such cases with lymph node metastasis have been published. To the best of the authors' knowledge no pediatric case has previously been reported in the English-language literature.     

MRI纹理联合Cripto-1与SOX2蛋白对甲状腺乳头状癌颈部淋巴结转移的诊断价值

目的:分析磁共振成像（MRI）T2加权成像（T2WI）纹理联合Cripto-1与SOX2蛋白在甲状腺乳头状癌（PTC）颈部淋巴结转移（LNM）中的诊断价值。方法:选择82例PTC患者,并留取患者根治术标本进行后期免疫组化研究。根据入选患者病理诊断结果,将42例LNM阳性者分为观察组,40例LNM阴性者分为对照组。分析MRI纹理参数联合Cripto-1与SOX2蛋白诊断PTC伴LNM的敏感度、特异度及符合率的临床价值。结果:Cripto-1蛋白在伴LNM的PTC中的阳性表达显著强于未伴LNM的PTC中的阳性表达（P<0.05）。Cripto-1蛋白免疫组化染色阳性表达多位于肿瘤周围组织,表现为棕黄色颗粒,主要位于细胞膜上,且Cripto-1蛋白在伴LNM的PTC中染色强度显著强于未伴LNM的PTC。SOX2蛋白在伴LNM的PTC中的阳性表达显著强于未伴LNM的PTC中的阳性表达（P<0.05）。SOX2蛋白免疫组化染色阳性表达多位于肿瘤周围组织,表现为棕黄色颗粒,主要位于细胞核上,且SOX2蛋白在伴LNM的PTC中染色强度显著强于未伴LNM的PTC。两组T2WI图像纹理分析的熵、角二阶矩以及相关间具有统计学意义（P<0.05）,而逆差矩、偏度、对比、峰度以及均值间均无统计学意义（P>0.05）。预测PTC伴LNM的熵、角二阶矩以及相关对应AUC分别为0.884、0.783、0.718,敏感度分别为97.13%、79.42%、44.14%,特异度分别为70.00%、60.00%、90.00%。MRI纹理参数对PTC伴LNM的诊断价值稍优于Cripto-1蛋白,差异无统计学意义（P＞0.05）;而MRI纹理参数联合Cripto-1与SOX2蛋白诊断在敏感度、特异度及符合率方面均显著优于单独诊断（P<0.05）。结论:MRI纹理联合Cripto-1与SOX2蛋白诊断PTC伴LNM的敏感度、特异度及符合率均高于单独MRI纹理参数或Cripto-1蛋白的检查。此外,其有望为PTC患者预后及其治疗决策提供更可靠、准确的依据。