Locally aggressive differentiated thyroid carcinoma

Local infiltration of adjacent anatomic structures and soft tissues of the neck from well-differentiated carcinoma of the thyroid gland is a relatively infrequent occurrence. We report our experience with 21 such cases seen in our department over the past 20 years. All patients were treated by total thyroidectomy and total or partial excision of the infiltrated adjacent structures. Papillary carcinoma was the most frequent type of primary tumor seen. Following the definitive surgery, all patients were scanned with radioactive iodine (131I). In case of isotope entrapment, a curative dose 131I was given. All patients in our series were required to receive thyroid hormone replacement. Four patients died as a result of their disease. Uncontrolled local disease and distant metastases were present at the time of death. Three patients died of unrelated causes. Two-thirds of the patients are still alive (from 1 to 19 years after the treatment).     

^131I治疗老年分化型甲状腺癌肺转移的临床观察

目的观察^131I治疗老年分化型甲状腺癌（differentiated thyroid carcinoma,DTC）肺转移的疗效及不良反应。方法对31例老年DTC肺转移患者进行^131I治疗,并采用胸部CT、^131I显像及他变化综合判断疗效,并对可能影响^131I治疗DTC肺转移疗效的主要因素进行分析。结果^131I治疗的有效率为67．7％（21／31）;有无合并其他脏器远处转移（P=0．0059）及肺病灶类型（P=0.0271）为^131I治疗DTC肺转移疗效的主要影响因素;随访期内未出现由^131I治疗引起的肺纤维化、造血系统抑制、慢性涎腺炎和继发肿瘤。结论^131I治疗老年DTC肺转移有较好的疗效,不良反应低。     

调强放疗在局部晚期及复发甲状腺低分化癌中的应用

背景与目的：甲状腺低分化癌（poorly differentiated thyroid carcinoma,PDTC）是一种罕见恶性肿瘤,易发生侵袭及转移,目前尚缺乏有效的治疗方法。本研究旨在分析调强放疗对局部晚期及复发PDTC的疗效及安全性。方法：纳入2011年2月—2014年9月在复旦大学附属肿瘤医院接受调强放疗的8例局部晚期及复发PDTC患者（均经病理及影像学确诊为T_4a-b期PDTC）。1例术后无残留病灶但包膜侵犯的患者接受处方剂量60 Gy/30次的单纯放疗,其余患者甲状腺原发灶及淋巴结转移灶的处方剂量为66 Gy/33次,并接受顺铂为基础的联合化疗。结果：患者在放疗±化疗后,2例局部区域病灶完全缓解（complete response,CR）,1例部分缓解（partial response,PR）,5例保持疾病稳定（stable disease,SD）。截止末次随访或患者死亡时,局部区域控制率为87.5%（5例CR+1例PR+1例SD）。随访期间共有4例（50%）患者死亡,死亡原因分别为原发病灶进展（12.5%）和肺转移（37.5%）。大部分治疗相关不良反应为1~2级。结论：对于局部晚期及复发PDTC,调强放疗为基础的综合治疗能控制局部区域病灶,延长生存时间,不良反应可控,是一种有效且安全的治疗手段。     

分化型甲状腺癌二次手术安全性探讨

目的：探讨分化型甲状腺癌二次手术的安全性。方法：回顾分析2003年7月-2010年2月63例分化型甲状腺癌二次手术相关资料,对二次手术的并发症进行分析。结果：二次手术并发症发生率17.46%（11/63）,暂时性甲状旁腺损伤发生率为7.94%（5/63）,暂时喉返神经损伤发生率为4.76%（3/63）,2周后声音嘶哑逐步恢复,1例发生永久性喉返神经损伤,先行呼吸机正压给氧待患者呼吸困难好转再行声带成形手术后患者呼吸困难消失,气管损伤发生率为3.17%（2/63）。结论：分化型甲状腺癌二次手术因解剖组织结构改变,二次手术并发症发生率较高,进行二次手术应熟悉解剖、掌握术中操作技巧及谨慎操作。     

分化型甲状腺癌二次手术安全性探讨

目的:探讨分化型甲状腺癌二次手术的安全性。方法:回顾分析2003年7月-2010年2月63例分化型甲状腺癌二次手术相关资料,对二次手术的并发症进行分析。结果:二次手术并发症发生率17.46%(11/63),暂时性甲状旁腺损伤发生率为7.94%(5/63),暂时喉返神经损伤发生率为4.76%(3/63),2周后声音嘶哑逐步恢复,1例发生永久性喉返神经损伤,先行呼吸机正压给氧待患者呼吸困难好转再行声带成形手术后患者呼吸困难消失,气管损伤发生率为3.17%(2/63)。结论:分化型甲状腺癌二次手术因解剖组织结构改变,二次手术并发症发生率较高,进行二次手术应熟悉解剖、掌握术中操作技巧及谨慎操作。     

颅内转移瘤放射治疗方案的优化

目的:探讨颅内转移瘤放射治疗的优化方案。方法:回顾性分析2005年7月-2008年7月收治的50例颅内转移瘤患者。原发灶均得到控制,30例采用全脑放疗+立体定向放射外科(联合组),20例采用单纯立体定向放射外科(单一组)。立体定向放射外科处方剂量均采用45%-75%等剂量线包绕计划靶区,边缘剂量15-20Gy,中心剂量30-45Gy,一次完成。全脑放疗每次分割剂量为2Gy,1次/d,5次/w,总剂量40Gy/4w。结果:联合组的有效率明显高于单一组(P<0.05)。两组1年、2年生存率比较无差异(P>0.05)。两组均无生存3年以上患者。按病灶数进行分层研究:1年生存率单发病灶两组差异无显著性(P=0.212),1年生存率多发病灶联合组明显优于单一组(P=0.001),2年生存率两组差异无显著性。结论:对于多发颅内转移瘤患者,全脑放疗联合立体定向放射外科是比较优化的选择方案,而对于单发的颅内转移瘤患者,则可以先全脑放疗加立体定向放射外科或者直接立体定向放射外科治疗。     

超声对低分化和未分化甲状腺癌的诊断价值

目的 探讨超声对低分化甲状腺癌(PDTC)和未分化(间变性)甲状腺癌(UTC)的诊断价值.方法 应用彩色多普勒超声对22例PDTC和UTC的甲状腺形态、大小、回声、边界、内部砂粒、血流分布等声像图表现及其内部血流状况进行观察,并与手术、活组织病理检查病理结果对照;扫查颈部及气管食管沟区淋巴结.根据甲状腺双叶或单叶弥漫性病变及局部淋巴结的超声表现,结合临床表现,判断甲状腺病变的性质.结果 术前或活组织病理检查前超声检出甲状腺单叶肿物16例,左甲9例,右甲7例.双叶肿物6例.超声提示UTC 2例,甲状旁腺癌1例,慢性淋巴细胞性甲状腺炎1例,其余提示甲状腺恶性肿瘤.结论 超声检查可提高PDTC和UTC的检出率和诊断率.     

^131I治疗分化型甲状腺癌肺转移的疗效及影响因素

^131I治疗能部分或完全消除分化型甲状腺癌（DTC）肺转移病灶，^131I已成为治疗DTC肺转移的一种有效手段0TMI治疗DTC肺转移的疗效受年龄、性别、肿瘤病理学类型、有无颈部淋巴结转移、有无远处转移（除肺外）、有无胸片显示、肺转移灶的大小及转移灶摄取^131I的能力等多种因素的影响，其中有无除肺之外的远处转移、转移灶大小及转移灶摄取^131I的能力是影响DTC肺转移^131I治疗效果的主要因素。^131I治疗DTC肺转移不良反应小，基本不影响血常规、肺功能和唾液腺功能等，仅少数单次大剂量或累积剂量较大的^131I治疗引起严重的不良反应，如骨髓抑制、肺纤维化或放射性肺炎、唾液腺功能损害等。通过对^131I治疗DTC肺转移疗效、不良反应和影响因素的研究总结，对DTC肺转移^131I治疗前评价其治疗效果和确定其治疗方案有较好的指导意义。     

An unusual pattern of metastases from Merkel cell carcinoma

An unusual case of Merkel cell carcinoma is presented in which the time course to development of nodal and haematogenous metastases was protracted and the predominant site of metastatic disease was small bowel.     

Surgery for lymph node metastases of medullary thyroid carcinoma: A review

Medullary thyroid carcinoma (MTC) is a neuroendocrine malignancy of the thyroid C cells that occurs in hereditary and sporadic clinical settings. Metastatic spread commonly occurs to cervical and mediastinal lymph nodes. MTC cells do not concentrate radioactive iodine and are not sensitive to hormonal manipulation, and therefore surgery is the most effective option for curative therapy, reduction in tumor burden, or effective palliation. In patients undergoing preventative surgery for hereditary MTC, central lymph node dissection should be considered if the calcitonin level is elevated. Preservation of parathyroid function in these young patients is of paramount importance. In patients with established primary tumors, systematic surgical removal of lymph node basins (compartmental dissection) should be guided by ultrasound mapping of lymph node metastases and level of serum calcitonin. A “berry‐picking” approach is discouraged. Newly approved targeted molecular therapies offer wider treatment options for patients with progressive or metastatic disease. Cancer 2016;122:358–366. © 2015 American Cancer Society.     

Management of brain metastases from ovarian and endometrial carcinoma with stereotactic radiosurgery

BACKGROUND

Metastases to the brain from ovarian and endometrial carcinoma are uncommon and to the authors' knowledge consensus regarding optimal management is lacking. Stereotactic radiosurgery (SRS) has proven useful for the treatment of many benign and malignant brain tumors. In the current study, the authors evaluated outcomes after SRS in patients with ovarian and endometrial carcinoma.

METHODS

Twenty‐seven patients with brain metastases underwent gamma–knife SRS. Six patients had endometrial carcinoma, whereas 21 patients had ovarian carcinoma. Eighteen patients also received whole–brain radiotherapy. A total of 68 tumors were treated with gamma–knife SRS.

RESULTS

At the time of last follow–up, 1 patient was still alive and 26 had died. The median survival was 7 months after the initial diagnosis of brain metastasis and 5 months after SRS. The 1‐year survival rate after radiosurgery was 15% and that from the diagnosis of brain metastases was 22%. On final imaging, all tumors were controlled without further growth. Two patients (7.4%) developed new or progressive neurologic deficits after SRS.

CONCLUSIONS

SRS is an acceptable choice for the treatment of brain metastases resulting from ovarian and endometrial carcinoma, and provides local tumor control with limited morbidity. Careful patient selection is warranted in the setting of patients with uncontrolled systemic disease in whom a limited survival benefit is expected. Cancer 2008. © 2008 American Cancer Society.     

Family history of cancer and risk of sporadic differentiated thyroid carcinoma

BACKGROUND:

Thyroid cancer incidence in the United States, particularly in women, has increased dramatically since the 1980s. Although the causes of thyroid cancer in most patients remain largely unknown, evidence suggests the existence of an inherited predisposition to development of differentiated thyroid carcinoma (DTC). Therefore, the authors explored the association between sporadic DTC and family history of cancer.

METHODS:

In a retrospective hospital‐based case‐control study of prospectively recruited subjects who completed the study questionnaire upon enrollment, unconditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) as estimates of the DTC risk associated with first‐degree family history of cancer.

RESULTS:

The study included 288 patients with sporadic DTC and 591 cancer‐free controls. Family history of thyroid cancer in first‐degree relatives was associated with increased DTC risk (adjusted OR, 4.1; 95% CI, 1.7‐9.9). All DTC cases in patients with a first‐degree family history of thyroid cancer were cases of papillary thyroid carcinoma (PTC) (adjusted OR, 4.6; 95% CI, 1.9‐11.1). Notably, the risk of PTC was highest in subjects with a family history of thyroid cancer in siblings (OR, 7.4; 95% CI, 1.8‐30.4). In addition, multifocal primary tumor was more common among PTC patients with first‐degree family history of thyroid cancer than among PTC patients with no first‐degree family history of thyroid cancer (68.8% vs 35.5%, P = .01).

CONCLUSIONS:

The study suggests that family history of thyroid cancer in first‐degree relatives, particularly in siblings, is associated with an increased risk of sporadic PTC. Cancer 2012;. © 2011 American Cancer Society.     

224例分化型甲状腺癌放射性碘治疗分析

目的:对在我科8年来治疗的分化型甲状腺癌(DTC)患者进行回顾性分析,了解DTC发病规律,并证明131碘治疗DTC的疗效。方法:2002至2010年确诊为DTC并有颈部淋巴结转移的患者,进行甲状腺近全切除,并进行颈部淋巴结清扫,术后131碘治疗。131碘治疗后,每半年随访一次。随访指标:颈部超声检查;血清TSH、FT4、FT3;血清Tg、TgAb检查;全身放射性碘扫描;胸部CT或MRI。疗效判定:当血清Tg、TgAb阴性,颈部超声未见肿大淋巴结,全身放射性碘扫描未见放射性浓聚时,为DTC治愈。当上述指标为阳性时,则进行再次131碘治疗。用SPSS软件进行统计学处理。结果:DTC患者数逐年明显增加;乳头癌与滤泡癌的比例约为12(207):1(17),女性患者远多于男性,男:女患者患病比例约为1(57):3(167);DTC在20-55岁之间为高发年龄段,峰值在25-35岁之间;131碘治疗对DTC治愈率约达90%,近10%的顽固性DTC患者多次131碘治疗效果欠佳。结论:分化型甲状腺癌患病率有明显增加趋势,25-35岁为高发年龄,女性多于男性,早期诊断及早期治疗是关键。手术切除甲状腺后进行131碘治疗对DTC治愈率达90%。近10%的患者131碘治疗效果欠佳,需寻求更好的治疗方法。     

分化型甲状腺癌手术方式选择及复发因素探讨

目的探讨分化型甲状腺癌外科手术的方式及影响其复发的因素。方法回顾性分析我院行手术治疗的149例分化型甲状腺癌,研究其治疗方法并进行随访,根据不同病理类型、临床分期及手术方式分组,计算复发率及生存率,观察影响预后的因素。结果行患侧腺叶切除加峡部切除29例,患侧腺叶切除加峡部切除加颈清扫40例,患侧腺叶、峡部加对侧腺叶次全切除16例,患侧腺叶、峡部加对侧腺叶次全切除加颈部淋巴结清扫46例,甲状腺全切加颈清扫13例,姑息性切除5例。1年、3年、5年和10年生存率分别为100%、95.9%、92.6%和87.2%。获得随访的98例中,除6例姑息性切除病例外,其余92例中癌肿复发16例(17.4%),其中颈淋巴结复发12例,甲状腺复发4例,合并远处转移2例。统计学分析显示,癌肿复发与性别、手术方式无相关性(P>0.05),但与年龄、临床分期、辅助治疗密切相关(P<0.05)。结论分化型甲状腺癌手术应根据病理类型、临床分期行患侧叶、峡部切除加对侧叶次全切,或全甲状腺切除术。有颈淋巴结转移者应行颈清扫术。其预后与年龄、临床分期、术后是否放疗、是否长期服用甲状腺素密切相关。     

224例分化型甲状腺癌放射性碘治疗分析

目的：对在我科8年来治疗的分化型甲状腺癌（DTC）患者进行回顾性分析,了解DTC发病规律,并证明131碘治疗DTC的疗效。方法：2002至2010年确诊为DTC并有颈部淋巴结转移的患者,进行甲状腺近全切除,并进行颈部淋巴结清扫,术后^131碘治疗。^131碘治疗后,每半年随访一次。随访指标：颈部超声检查;血清TSH、FT4、FT3;血清Tg、TgAb检查;全身放射性碘扫描;胸部CT或MRI。疗效判定：当血清Tg、TgAb阴性,颈部超声未见肿大淋巴结,全身放射性碘扫描未见放射性浓聚时,为DTC治愈。当上述指标为阳性时,则进行再次^131碘治疗。用SPSS软件进行统计学处理。结果：DTC患者数逐年明显增加;乳头癌与滤泡癌的比例约为12（207）：1（17）,女性患者远多于男性,男：女患者患病比例约为1（57）：3（167）;DTC在20-55岁之间为高发年龄段,峰值在25-35岁之间;^131碘治疗对DTC治愈率约达90%,近10%的顽固性DTC患者多次^131碘治疗效果欠佳。结论：分化型甲状腺癌患病率有明显增加趋势,25-35岁为高发年龄,女性多于男性,早期诊断及早期治疗是关键。手术切除甲状腺后进行^131碘治疗对DTC治愈率达90%。近10%的患者^131碘治疗效果欠佳,需寻求更好的治疗方法。     

Metastatic iodophilic carcinoma of thyroid to a hand bone

A case of follicular carcinoma of the thyroid is presented with two unusual features: 1) metastatic tumor in a phalanx; and 2) all iodophilic metastases, making possible treatment with radioiodine. The possible mechanism of metastases to reach the systemic arterial circulation is discussed.     

Cytomorphologic features of poorly differentiated thyroid carcinoma

BACKGROUND:

Poorly differentiated thyroid carcinoma (PDTC) is an uncommon and aggressive malignancy. Despite the significant clinical implications of a diagnosis of PDTC, its cytomorphologic features have not been well defined. Statistical analysis was applied to a series of 40 PDTCs to identify a specific set of cytomorphologic features that characterized these tumors on fine‐needle aspiration biopsy (FNAB).

METHODS:

In total, 40 thyroid FNABs that were highly diagnosed histologically as PDTC (19 insular carcinomas and 21 noninsular carcinomas) comprised the study group. A control group of 40 well differentiated thyroid neoplasms were selected for comparison. All FNABs were reviewed and scored for a series of 32 cytomorphologic features. The results were evaluated using univariate and stepwise logistic regression (SLR) analyses.

RESULTS:

In univariate analysis, 17 cytomorphologic features were identified that characterized the 40 PDTCs: insular, solid, or trabecular cytoarchitecture (P < .001); high cellularity (P = .007); necrosis (P = .025) or background debris (P = .025); plasmacytoid appearance (P = .0007); single cells (P < .0001); high nuclear/cytoplasmic ratio (P < .0001); scant cytoplasm (P = .03); nuclear atypia (P < .0001), including nuclear pleomorphism (P = .0052) and anisokaryosis (P < .0001); granular/coarse chromatin (P = .026); naked nuclei (P = .01); mitotic activity (P = .0001) and apoptosis (P < .0001); endothelial wrapping (P = .0053); and severe crowding (P < .0001). In logistic regression analysis, severe crowding (P = .0008) and cytoarchitecture (P < .0001) were identified as the most significant cytomorphologic features of PDTCs, and the combination of cytoarchitecture, severe crowding, single cells, and high nuclear/cytoplasmic ratio was the most predictive of PDTC.

CONCLUSIONS:

PDTCs have characteristic cytomorphologic features. By using logistic regression analysis, the features that were identified as the most predictive of PDTC were severe crowding, insular/solid/trabecular morphology, single cells, and high nuclear/cytoplasmic ratio. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.     

Fractionated stereotactic radiotherapy of brain metastases from renal cell carcinoma

Purpose: To retrospectively evaluate the effectiveness of fractionated stereotactic radiotherapy (FSRT) for brain metastases from renal cell carcinoma (RCC).

Methods and Materials: From May 1983 to September 1998, 35 patients with brain metastases from RCC underwent radiotherapy at the National Cancer Center Hospital, Tokyo; 10 patients treated initially with FSRT (FSRT group); 11 with surgery followed by conventional radiotherapy (S/CR group); and 14 with conventional radiotherapy (CR group). Survival and local control rates were determined for patients who had an ECOG performance status of 0–2.

Results: Overall median survival rate was 18 months, and actuarial 1- and 2-year survival rates were 57.6% and 31.0%, respectively. Median survival rates were 25.6 months for the FSRT group, 18.7 months for the S/CR group, and 4.3 months for the CR group. Significant prognostic factors associated with survival were age less than 60 years and good performance status. In patients treated with FSRT, imaging studies revealed that 21 of 24 tumors (88%) were locally controlled during a median follow-up time of 5.2 months (range 0.5–68). Actuarial 1- and 2-year local control rates were 89.6% and 55.2%, respectively. No patient suffered from acute or late complications during and following FSRT.

Conclusions: FSRT offers better tumor control and prolonged survival over the S/CR or CR groups, and should be considered as primary treatment for brain metastases from RCC. Patients under 60-years-old and those with a good performance status at the beginning of radiotherapy had a better prognosis.     

Prospective study of stereotactic radiosurgery without whole brain radiotherapy in patients with four or less brain metastases: incidence of intracranial progression and salvage radiotherapy

This prospective study was conducted to evaluate the treatment outcome after stereotactic radiosurgery (SRS) alone with special attention to its influence on intracranial freedom from progression (FFP), local control, time to whole brain radiotherapy (WBRT), and survival. Forty-one patients with brain metastases who met the inclusion criteria were enrolled in this prospective cohort and treated by SRS alone between January 1998 and September 2001. The overall local control rate was 76%. The one year actuarial intracranial FFP was 33%. Ten patients (24%) had relapse at treated site. Twenty-three patients (56%) had intracranial progression with a median time of 4.25 months (1–24.6). Salvage radiotherapy was given in 21 patients (51%). Only 12 (29%) patients required WBRT with the median time to WBRT after SRS of 4.85 months. Nine patients (22%) underwent additional SRS at the median time of 5 months after the first procedure. The median survival was 10 months. At the time of follow up, 16 patients (39%) were still alive with a range of 6–31 months. This prospective study suggests that the omission of WBRT in the initial treatment of patients with SRS for four or less brain metastases may allow up to 70% of patients to avoid WBRT.