甲状腺功能亢进症并发甲状腺癌12例的临床分析

目的 探讨甲状腺功能亢进症（甲亢）并发甲状腺癌患者诊治方法。方法 对1994－2000年收治的300例甲亢病例中同时并发甲状腺癌的12例患者行手术治疗及病理学检查，并对2种疾病临床资料及诊治经验进行分析。结果 本组甲亢与甲状腺癌的并存率为4％（12／300），术前确诊率为3％（1／300）。对12例甲状腺癌患者均行双侧甲状腺大部切除，其中7例再补切患侧残余腺体，2例行功能性颈淋巴结清扫术。术后随访9个月至6年，均无甲状腺癌复发。结论 甲亢并发甲状腺癌可能与免疫缺陷和内分泌功能失调有关。甲亢患者并发甲状腺结节者应常规作冰冻切片检查。     

Hyperthyroidism and concurrent thyroid malignancies

In a 17-year period 1848 patients with hyperthyroidism were operated on. Fourteen (0.76%) had a coexisting thyroid malignancy. Preoperative scintiscan and pathologic diagnoses were compared: 10 malignancies were in cold nodules, two were unidentifiable preoperatively due to small size, and two were in hot areas. Five patients had papillary cancer, four follicular, three anaplastic, and two medullary. Patients with uninodular toxic goiter had a low rate of associated malignancy (0.27%, 3/1108). In contrast, patients with multinodular toxic goiter had an incidence of 1.63% (11/676). No patient with Graves' disease (n = 64) had a carcinoma. Extensive use of fine-needle aspiration biopsy enabled preoperative diagnosis in a majority of the cases (9/14, 64%). We conclude that the incidence of coexisting thyroid malignancy and hyperthyroidism is rare in our endemic iodine-deficiency goiter area.     

原发性甲状腺功能亢进症合并甲状腺癌的诊断与治疗：附31例报告

目的：探讨甲状腺功能亢进症（甲亢）合并甲状腺癌（甲癌）的临床病理特点。 方法：回顾性分析吉林大学第一医院甲状腺外科2010年1月—2013年8月收治的甲亢合并甲癌患者临床资料,并结合文献比较。 结果：手术治疗甲亢患者85例,其中31例（36.5%）合并甲癌。术前结合临床表现和颈部超声结果甲亢合并甲癌确诊率80.6%（25/31）。31例患者待甲亢症状得到控制、甲状腺功能经检查恢复正常后行手术治疗,并根据具体情况选择术式,术后均顺利出院,未发生永久性医源性喉返神经损伤及甲状旁腺功能减退。经术后病理证实,1例为髓样癌,30例为甲状腺乳头状癌;17例（54.8%）侵及被膜者,9例（29.1%）中央区淋巴结转移,各项病理特点与文献报道的单纯甲癌比较,差异均无统计学意义（均P>0.05）。 结论：甲亢伴甲癌发病率有增高趋势,应强调颈部超声在该病早期诊断中的重要性,确诊后尽早行手术治疗并合理选择手术方式,预后较好。

     

甲状腺功能亢进合并甲状腺癌的诊断和外科治疗

目的 探讨甲状腺功能亢进合并甲状腺癌的诊断及治疗方法.方法 回顾性分析北京协和医院从1983年1月至2009年7月收治的并经外科手术治疗和病理证实的48例甲状腺功能亢进合并甲状腺癌患者的临床资料.结果 甲状腺功能亢进合并甲状腺癌患者占同期甲状腺功能亢进手术患者的2.02%(48/2378),占同期甲状腺癌手术患者的3.03%(48/1584).手术方式包括双侧甲状腺大部切除术(31例)、患侧全切对侧大部切除和区域性淋巴结清扫术(6例)、双侧全切及淋巴结清扫术(11例).术前超声诊断阳性率为61.3%,甲状腺核素显像的诊断阳性率为62.5%;48例患者中获随访40例,时间1～264个月,中位随访时间130.5个月.随访中无甲状腺功能亢进复发病例,2例患者术后第二年出现肺、骨转移.结论 超声检查和核素显像对于术前诊断有重要意义,甲状腺功能亢进合并甲状腺隐匿癌和微小癌的临床诊断较困难,多于手术后病理诊断.甲状腺功能亢进合并甲状腺乳头状癌的患者手术治疗效果良好,预后较好.     

Fine needle aspiration biopsy of thyroid nodules

The clinical value of the fine needle aspiration of thyroid nodules was evaluated by comparing preoperative cytology to subsequent pathology in 109 patients undergoing thyroidectomy. Preoperative cytology was reported as insufficient cellular material (31 patients), benign goiter (27 patients), follicular neoplasm (22 patients), thyroiditis (12 patients), suspicious for papillary carcinoma (nine patients), Hurthle cell neoplasm (five patients), medullary carcinoma (one patient), lymphoma (one patient), and metastatic adenocarcinoma (one patient). Operative findings demonstrated that the overall sensitivity of fine needle aspiration in diagnosing thyroid neoplasia (carcinoma or adenoma) was 88% and its specificity was 80%. Operation verified the cytologic diagnosis of medullary carcinoma, lymphoma, metastatic adenocarcinoma, and seven of nine papillary carcinomas. Of the five patients with an aspiration biopsy diagnosis of Hurthle cell neoplasm, three patients had carcinoma and one had an adenoma. Four carcinomas and 12 follicular adenomas were found in patients with a cytologic diagnosis of follicular neoplasm. Thyroiditis was confirmed at operation in all 12 patients with this diagnosis on fine needle aspiration. One carcinoma was found in the 27 patients with benign goiter diagnosed on cytology. Fine needle aspiration is a valuable tool that can lead to earlier diagnosis and treatment of thyroid cancer. However, a negative aspiration does not supplant good clinical judgement in determining the need for thyroidectomy.     

超声引导下粗针穿刺活检在甲状腺疾病诊断中的应用

[摘要] 目的 探讨超声引导下粗针穿刺活检(ultrasound-guided Core-needle biopsy ,US-CNB) 在甲状腺疾病诊断中的应用。方法 对2004年5月～2013年3月在我院手术的146例甲状腺疾病患者共计152个甲状腺结节术前进行超声引导下粗针穿刺活检,将穿刺病理与手术病理结果进行对照,并分析其超声图像特点。结果 152个粗针穿刺病理报告中,恶性92个,术后病检证实其中90例确诊为甲状腺癌,2例为良性病变;甲状腺良性病变56个 ,术后病检其中2例为甲状腺癌;未明确诊断者4个,术后病检3例为良性,1例为甲状腺癌,USCNB对直径>0.7cm的结节穿刺确诊率较高,甲状腺粗针穿刺活检的敏感度、特异度、准确率分别为：96.7%、91.5%、94.7%。结论 USCNB对甲状腺疾病确诊率因结节直径大小不同而有差异,超声引导下甲状腺粗针穿刺活检操作简单,定位准确,创伤小,并发症少,准确性高,是非手术条件下取得病检的首选方法。     

The selective beta 1-blocking agent metoprolol compared with antithyroid drug and thyroxine as preoperative treatment of patients with hyperthyroidism. Results from a prospective, randomized study.

Despite the increasing use of beta-blocking agents alone as preoperative treatment of patients with hyperthyroidism, there are no controlled clinical studies in which this regimen has been compared with a more conventional preoperative treatment. Thirty patients with newly diagnosed and untreated hyperthyroidism were randomized to preoperative treatment with methimazole in combination with thyroxine (Group I) or the beta 1-blocking agent metoprolol (Group II). Metoprolol was used since it has been demonstrated that the beneficial effect of beta-blockade in hyperthyroidism is mainly due to beta 1-blockade. The preoperative, intraoperative, and postoperative courses in the two groups were compared, and patients were followed up for 1 year after thyroidectomy. At the time of diagnosis, serum concentration of triiodothyronine (T3) was 6.1 +/- 0.59 nmol/L in Group I and 5.7 +/- 0.66 nmol/L in Group II (reference interval 1.5-3.0 nmol/L). Clinical improvement during preoperative treatment was similar in the two groups of patients, but serum T3 was normalized only in Group I. The median length of preoperative treatment was 12 weeks in Group I and 5 weeks in Group II (p less than 0.01). There were no serious adverse effects of the drugs during preoperative preparation in either treatment group. Operating time, consistency and vascularity of the thyroid gland, and intraoperative blood loss were similar in the two groups. No anesthesiologic or cardiovascular complications occurred during operation in either group. One patient in Group I (7%) and three patients in Group II (20%) had clinical signs of hyperthyroid function during the first postoperative day. These symptoms were abolished by the administration of small doses of metoprolol, and no case of thyroid storm occurred. Postoperative hypocalcemia or recurrent laryngeal nerve paralysis did not occur in either group. During the first postoperative year, hypothyroidism developed in two patients in Group I (13%) and in six patients in Group II (40%). No patient had recurrent hyperthyroidism. The results suggest that metoprolol can be used as sole preoperative treatment of patients with hyperthyroidism without serious intra- or postoperative complications. Although the data indicate that the risk of postoperative hypothyroidism is higher after preoperative treatment with metoprolol than with an antithyroid drug, a longer follow-up period than 1 year is needed to draw conclusions regarding late results.     

超声引导下微创组织活检技术在甲状腺外科的应用

目的 探讨超声引导下微创组织活检技术在甲状腺疾病诊治中的指导意义.方法 总结吉林大学中日联谊医院甲状腺外科2008年10月至2009年7月间,117例(共131个结节,结节直径大小在0.5～1.5 cm之间,平均直径约0.8 cm)甲状腺疾病患者,行超声引导微创组织活检的临床资料并进行分析.结果 117例患者,活检取材满意,行组织活检后均未出现明显不适及活检后并发症.其中59例患者活检后行手术治疗,仅有2例术前活检病理与术后石蜡病理未完全符合;未行手术治疗的58例患者,结合症状、查体、甲状腺功能和彩色多普勒超声等辅助检查,行对症治疗并定期复查,症状及彩色多普勒超声下影像均有明显好转,治疗效果良好.117例微创组织活检患者中8例同时行颈部肿大淋巴结活检,活检病理与术后石蜡病理结果一致(7例为转移癌,1例为反应性增生),准确率为100%.结论 超声引导下微创组织活检术对甲状腺疾病的诊治有重要的指导意义,临床符合率高,特别是对于微小结节的术前诊断具有较高的价值,既可避免不必要的过度治疗,又可减少甲状腺癌的漏诊,同时本技术具有简便易行、安全准确的优点,在甲状腺外科具有一定的临床应用价值.     

Sentinel node biopsy for nonpalpable breast tumors requires a preoperative diagnosis of invasive breast cancer

A sentinel node biopsy done at the time of initial tumor resection allows for a one-stage surgical procedure. In addition, sentinel node identification may be impaired when done after a previous tumor excision. This study evaluates the sentinel node biopsy in patients with nonpalpable breast cancer and assesses whether a sentinel node biopsy for mammographically suspect breast lesions is justified when preoperative needle biopsy is inconclusive for invasive malignancy. A sentinel node biopsy was done in 67 patients with nonpalpable breast lesions after injection of radioactive tracer (intraparenchymal in 35 and subdermal in 32) and blue dye (para-areolar). A preoperative core needle biopsy was positive for malignancy in 42 patients. Thirteen patients had positive cytology or ductal carcinoma in situ (DCIS). In 12 patients the needle biopsy was nondiagnostic, but the lesions remained highly suggestive of malignancy on mammography. Sentinel node biopsy was successful in 64 patients (96%). In these, the sentinel node was both radioactive and blue in 58 patients (91%). Only 4 of 13 patients with positive cytology or DCIS on preoperative needle biopsy and only 5 of 12 patients without a preoperative diagnosis had an invasive cancer after resection. Sentinel nodes were positive for nodal metastases in 9 of 49 patients (18%) with a successful sentinel node biopsy for invasive malignancy. None of the eight patients with DCIS had nodal metastases. The sentinel node procedure avoids the potential morbidity of an axillary dissection in more than 80% of patients with nonpalpable breast cancer. A sentinel node biopsy for mammographically detected suspect breast lesions is not justified without a preoperative histologic diagnosis of invasive breast cancer.     

Defining the role of fine-needle aspiration of thyroid nodules in male patients: is it necessary?

BACKGROUND: The purpose of this investigation was to show that fine-needle aspiration (FNA) of thyroid nodules in male patients may not be necessary in diagnosing thyroid cancer. METHODS: We performed a retrospective review of 130 adult male patients who underwent total thyroidectomy from January 2000 to January 2006 at a single institution. The preoperative FNA data for these subjects were reviewed and compared with the surgical pathology reports. RESULTS: During the study period, 70 of 130 (54%) had FNA, whereas 60 of 130 (46%) did not have FNA. Among all patients, 66 of 130 (51%) had a final pathology diagnosis of thyroid cancer and FNA was performed in 41 of 66 (62%) of these patients. The FNA pathology then was compared with the final pathology. CONCLUSIONS: In our study there was a high false-negative rate for FNA biopsy in the detection of thyroid malignancy in males. An alternative to FNA biopsy in male patients with thyroid nodules may be to go directly to surgery.     

CD147 检测对细针穿刺细胞学可疑恶性的甲状腺结节的诊断价值

目的：探讨CD147检测在细针穿刺活检未能明确细胞学诊断的甲状腺结节中的临床应用价值。 方法：选择2013年10月—12月收治的甲状腺结节患者，对术后手术标本进行细针穿刺涂片，用Bethesda甲状腺细胞学报告系统评价腺细胞病理学，选择36例“可疑恶性肿瘤”标本行免疫组化CD147染色分析。CD147阳性者作恶性诊断，结果与手术后石蜡病理结果比较。 结果：CD147检测诊断良性病变19例（52.78%），恶性病变17例（47.22%），术后病理检查诊断良性病变16例（44.44%），恶性病变20例（55.56%）；甲状腺恶性标本中CD147的阳性表达率明显高于良性标本（P<0.05）。CD147的表达与甲状腺结节是否钙化（CD147阳性率89.47%）及淋巴转移（CD147阳性率100%）有关（P<0.05）。细针穿刺细胞学联合CD147免疫组化染色鉴别甲状腺结节良、恶性的准确性和敏感度分别为91.67%和85.0%。 结论：CD147可以作为甲状腺肿瘤细胞学诊断分子生物学标志物，细针穿刺细胞学联合CD147免疫组化分析，有助于提高甲状腺癌的术前检出率。     

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探讨原发性甲状腺功能亢进症合并甲状腺癌的临床发病关系及其诊断,治疗和预后。方法对１９７３－１９９９年收治的经外手术后病理证实为原发性甲亢合并甲状腺癌（甲癌）２５例,结合文献复习进行临床分析。结果 本组发病率约３．５６％。结论近年来原发性甲亢合并甲癌发病率有上升趋势,临床诊断较困难。多数病例靠术后病理诊断 。例题的手术治疗效果良好,预后较好。     

Differentiated thyroid carcinoma and hyperthyroidism: a frequent association?

The relationship between hyperthyroidism and thyroid carcinoma remains controversial. In hyperthyroid patients the incidence of thyroid cancer varies considerably from 0.1% to 21%. We analyzed the frequency of coexisting hyperthyroidism and thyroid malignancy in our experience. From September 2002 to June 2004, 450 patients were submitted to total thyroidectomy in our surgical department. Hyperthyroidism was observed in 71 cases and thyroid carcinoma in 110 (107 differentiated). The association of hyperthyroidism and thyroid cancer was observed in 15 patients (14% of differentiated carcinomas and 21.1% of hyperthyroid patients). All patients were submitted to total thyroidectomy and are alive and disease-free. Seven cases of transitory hypoparathyroidism were observed (46.6%). There was no other morbidity. The association of thyroid cancer and hyperthyroidism is by no means rare. Careful exami- nation of hyperthyroid patients is always necessary to exclude the presence of carcinoma. These results confirm that the operation should be total thyroidectomy when surgery is performed in patients with hyperthyroidism.     

Clinical and morphological characteristics and peculiarities of differentiated thyroid gland cancer course]

221 patients were operated for cancer of the thyroid gland during the last 12 years. Adequate preoperative diagnosis including ultrasound examination, and fine needle aspiration biopsy made it possible to operate 88.7% of patients at earlier (I and II) stages of the disease. Long term results of radical surgical treatment have been studied in 197 (89.1%) patients followed up 5 to 16 years, 49.2% of patients being followed up for no less than 10 years. Majority of patients (95.9%) had differentiated forms of tumors, medullar cancer was detected in 4.1% of patients. Clinical and morphological analysis of differentiated thyroid cancer was carried out in 212 patients. Metastases to lymph nodes of the neck occur more frequently in younger patients, and extracapsular spread of the tumor was revealed in aged persons. Risk factors were male sex, old age, follicular cancer and growth of the tumor through the capsule of the gland. The minimal procedure in case of location of the differentiated tumor in a single lobe of thyroid is extrafascial hemithyreoidectomy with resection of the istmus. Prognosis in radically operated patients is relatively favourable, 5-year survival rate made up 97.5%.     

Outcome of Patients Surgically Treated for Various Forms of Hyperthyroidism with Differentiated Thyroid Cancer: Experience at an Endocrine Center in Italy

Purpose The incidence and aggressiveness of thyroid cancer associated with hyperthyroidism remains a subject of much controversy. The aim of this study was to analyze the frequency of coexisting hyperthyroidism and thyroid cancer, and to determine whether cancer becomes more aggressive with different forms of hyperthyroidism. Methods We retrospectively studied 2 449 patients assessed for hyperthyroidism between 1985 and 2001. All patients with a “cold” nodule on scintigraphy, such as those with Graves' disease and a concomitant solid nodule, underwent fine-needle aspiration biopsy (FNAB). Criteria for surgery were cytological findings indicative of malignancy, goiter with signs of tracheal or esophageal compression, side effects of antithyroid drug therapy, or Graves' disease with multiple relapses after therapy withdrawal or responsiveness to antithyroid drugs. Results Thyroid cancer was diagnosed more frequently in patients with Graves' disease (6.5%) than in those with uninodular toxic goiter (UTG) (4.4%) or multinodular toxic goiter (MTG) (3.9%). Lymph node involvement was found in 56% of the patients with Graves' disease, in 23% of those with MTG, and in none of those with UTG. Distant metastases were found in one patient with Graves' disease. Conclusions Cancers associated with Graves' disease seems to be more aggressive than those associated with MTG or UTG. Thus, we suggest that patients with Graves' disease be carefully monitored for the detection of thyroid nodules. Ultrasonography seems to be the best modality to detect such nodules.     

甲状腺微小癌临床诊治：附28例报告

目的:探讨当前甲状腺微小癌(TMC)的诊断及治疗现状,并为进一步规范外科术式的选择提供临床依据。方法:回顾2013年2月—2015年2月间28例手术和病理均证实为TMC患者的临床资料,对其诊断、手术方式及预后等进行分析。结果:28例TMC患者术前彩超检查均发现病灶,15例彩超下细针穿刺确诊者4例(26.7%),术中冷冻切片确诊者27例(96.4%),术后病理确诊者1例(3.6%)。所有患者行手术治疗,包括甲状腺全切除术8例(28.6%)、甲状腺次全切除术7例(25.0%)、甲状腺患侧腺叶+峡部切除术10例(35.7%)、患侧腺叶切除术3例(10.7%)。术后均获随访,无复发、转移或死亡者。结论:TMC的检出率有增高趋势,目前的术前明确诊断仍较为困难,外科手术是主要治疗手段;如何提高术前诊断率与规范化手术治疗已成为当务之急。     

甲状腺结节患者常规行血清降钙素检查对早期发现甲状腺髓样癌的临床价值

目的:探讨甲状腺结节患者血清降钙素(Ct)检测对甲状腺髓样癌(MTC)的诊断价值。方法:回顾性分析2016年10月—2017年8月1922例因甲状腺结节就诊于郑州大学第一附属医院甲状腺外科并行手术治疗的患者资料。所有患者术前均常规行血清Ct检测,术后均有明确的常规病理结果。分析Ct水平与MTC的关系、用受试者工作特征曲线分析Ct对MTC的诊断效能。结果:在1922例甲状腺结节患者中,新发现的MTC患者有12例(0.62%)。在术前血清Ct值为10~100pg/mL的155例、100~500pg/mL的12例和500pg/mL的10例中,术后确诊为MTC的分别为1例(0.65%)、1例(8.33%)和9例(90.00%)。在血清Ct500pg/mL的9例MTC患者中,有8例(88.89%)出现了不同程度的颈部淋巴结转移。血清Ct诊断MTC的截断值为258.5pg/mL,敏感性为90.91%,特异性为96.99%。结论:术前常规检测血清Ct有助于MTC的早期诊断,对患者接受彻底的手术治疗,避免二次手术有十分重要的意义。     

甲状腺结核的诊治--附1例报告并国内87例临床分析

目的:探讨甲状腺结核的早期诊断和治疗.方法:报告1例误诊长达7月的甲状腺结核,回顾分析国内经针刺细胞学或术后病理确诊为甲状腺结核的87例患者的临床资料.结果:15例行针刺细胞学检查,余均经手术病理确诊.术前大多数误诊为甲状腺癌、甲状腺腺瘤,少数误诊为地方性甲状腺肿、结节性甲状腺肿、甲亢等.结论:甲状腺肿块伴发热及结核史者应考虑甲状腺结核的可能,细针穿刺活检是协助诊断简便有效的方法.病灶清除及抗结核抗药物局部灌洗、正规抗痨治疗预后好.     

CDFI在甲状腺疾病诊断中的临床应用价值探讨

目的探讨CDFI在甲状腺疾病诊断中的临床应用价值。方法笔者所在医院2006年1月～2010年6月应用CDFI检查甲状腺疾病132例,总结分析常见的甲状腺疾病如甲状腺腺瘤、甲状腺囊腺瘤、结节性甲状腺肿、甲状腺癌、甲状腺功能亢进症、亚急性甲状腺炎、桥本甲状腺炎的超声声像图表现及CDFI显示情况。结果 132例中经病理或实验室确诊124例,超声诊断符合率93.9%。甲状腺腺瘤、甲状腺囊腺瘤、结节性甲状腺肿、甲状腺癌、甲状腺功能亢进症、亚急性甲状腺炎、桥本甲状腺炎的超声声像图表现及CDFI显示各具特点。结论 CDFI能清晰显示甲状腺病变的大小、位置、囊实性变等,彩色多普勒超声及CDFI的应用提高了对甲状腺疾病的诊断率。     

Video-assisted thoracoscopic surgery for diagnosis, staging, and management of lung cancer with suspected mediastinal lymphadenopathy

The aim of this report was to evaluate the effectiveness of video-assisted thoracoscopic surgery (VATS) in staging, diagnosis, and treatment of lung cancer. Fifty-two patients were scheduled for mediastinal lymph node VATS biopsy at the Oncologic Thoracic Surgery Department of the National Cancer Institute in Milan. Fifty patients underwent lymph nodal thoracoscopic biopsy (96%), whereas for the other 2 patients, histologic diagnosis was done by pleural metastatic nodule thoracoscopic biopsy (4%). We performed 17 lymph nodal biopsies in level 5 (33%), 14 in level 6 (27%), 12 in level 7 (23%), and 7 in level 8 (13%). No postoperative complications were observed, and 19 subjects (36%) underwent open lung resection. The histologic diagnosis was adenocarcinoma in 25 cases (48%), epidermoid carcinoma in 14 (27%), microcytoma in 9 (17%), and giant-cell lung carcinoma in 4 (8%); 10 patients were at stage I (19%), 9 at stage II (17%), 31 at stage III (60%), and 2 at stage IV (4%). The use of VATS allowed diagnosis of the suspected involved mediastinal lymph nodes in lung cancer patients and obviated the need for painful thoracotomy, enabling accurate staging and thus selection of the optimal treatment.