甲状腺微小癌48例临床病理分析

目的 :探讨甲状腺微小癌的病理特征及临床特点。方法 :对 48例甲状腺微小癌进行临床病理分析 ,常规制片HE染色。结果 :48例均为乳头状癌。大体标本 :切面呈灰白色 ,有的灰白色放射状瘢痕样 ,质地中等 ,部分较脆 ,无包膜。随访 43例健在 ,5例失访。结论 :甲状腺微小癌不少见 ,术前大多难以确诊 ,常在术后标本检查时被偶然发现 ,手术切除后预后良好。以锐刀每 0 .2cm作扇形切开 ,取下全部灰白区或瘢痕样组织做病理切片 ,可避免漏诊     

Management of papillary microcarcinoma of the thyroid gland

DESIGN: To investigate the frequency, treatment and clinical behaviour of differentiated microcarcinoma of the thyroid gland (PTMC). PATIENTS AND METHODS: Out of 376 patients submitted to surgical treatment for differentiated thyroid cancer from June 1980 to October 2003, 77 had been identified has having a PTMC (63 females, 14 males; mean age 43+/-13 years). Sixty-seven patients (87%) met the AMES risk definition for low (group I) and 10 (13%) for high-risk (group II) definition. The surgical procedures were lobo-isthmusectomy (n=14) or subtotal thyroidectomy (n=20) and total thyroidectomy (n=43) with node dissection in 15 cases. Follow-up ranging from 9 to 274 months (mean 124+/-84). RESULTS: Overall patient survival rates were 100 and 94% at 20 years in groups I and II, respectively (p=ns). There were no significant differences in surgical complications and in survival in patients submitted to total thyroidectomy when compared to partial thyroid resection. The presence of cervical node metastasis did not affect patient survival (p=0.8). The overall mean survival time was 266 months. CONCLUSIONS: Despite the overall excellent prognosis, PTMC was associated with a 1% disease-related mortality, a 2.5% local recurrence rate, 1% lymph-node recurrence rate, and 1% distant metastasis rate. We recommend total thyroidectomy accompanied by modified neck dissection if enlarged nodes are diagnosed.     

Metastatic Lymph Node Ratio of Central Neck Compartment Has Predictive Values for Locoregional Recurrence in Papillary Thyroid Microcarcinoma

ObjectivesThis study aimed to evaluate the significance of metastatic lymph node ratio (the ratio between the metastatic lymph node and the harvested lymph nodes; MLNR) in the central neck for the prediction of locoregional recurrence in patients with papillary thyroid microcarcinoma.MethodsAfter reviewing medical records of papillary thyroid microcarcinoma patients who received total thyroidectomy with central neck node dissection, 573 consecutive adult patients were enrolled in this study, with a follow-up period of more than 36 months. Regarding the risk of recurrence, multivariate analyses were performed with the following variables; sex, age, multiplicity of the primary tumor, presence of pathological extrathyroidal extension, the level of postoperative stimulated serum thyroglobulin, the number of harvested lymph nodes, the number of lymph node metastasis and MLNR.ResultsThe MLNR showed a predictive significance for the locoregional recurrence (P<0.05). Most recurrences were occurred in the lateral neck (n=12, 80%) with a median interval of 20 months. The lowest cutoff value of the MLNR for a meaningful separation of disease recurrence was 0.44 (hazard ratio, 8.86; 95% confidence interval, 1.49 to 52.58; P=0.001).ConclusionWhen the MLNR is higher than 0.44, there is an increased risk of locoregional recurrence mostly in the lateral neck. Therefore, MLNR of the central neck in a permanent or frozen biopsy may be helpful in decision making in the extent of thyroidectomy and/or the need for contralateral central neck lymph nodes dissection.     

Papillary Thyroid Microcarcinomas Are Different from Latent Papillary Thyroid Carcinomas at Autopsy

The aim of this study was to review the literature of latent papillary thyroid carcinomas (PTCs) discovered at autopsy and describe the available pathologic and demographic differences from a group of papillary thyroid microcarcinomas (PTMCs) the reported in a previous publication. We searched the PubMed for published articles describing latent thyroid carcinomas detected at autopsy. Meta-analysis was performed to identify differences between the clinicopathologic features of PTMCs analyzed previously in our institution (Group I) and those of latent PTCs described in autopsy studies (Group II). We identified 1,355 patients with PTMC (Group I) and 989 with latent PTCs (Group II). Mean patient age was 47.3 yr in Group I and 64.5 yr in Group II. The male:female ratio was 1:10.9 in Group I and 1:1 in Group II. Most PTMCs (67.6%) were larger than 0.5 cm in size, whereas most latent PTCs were <1-3 mm in diameter. The rates of multifocality were 24.7% in Group I and 30.5% in Group II, and the rates of cervical lymph node metastasis were 33.4% in Group I and 10.0% in Group II. Currently available data indicated that clinically evident PTMCs differ from latent PTCs detected at autopsy. Therefore, these two entities should be regarded as different.     

Cytokeratin-19、Fibronectin-1、HBME-1和Galectin-3在甲状腺微小乳头状癌中的应用价值

目的 分析甲状腺微小乳头状癌（papillary thyroid micro carcinoma,PTMC）的临床病理学特征,观察CK19、HBME-l、Galectin-3和Fibronectin-1在甲状腺微小乳头状癌和良性甲状腺病变中的表达差异及其在甲状腺良恶性病变鉴别诊断中的意义.方法 回顾性分析我院2006~2011年98例PTMC患者的临床病理学资料,采用免疫组化方法检测半乳凝素-3（Galectin-3）,纤维粘连蛋白- 1（Fibronectin-1）,细胞角蛋白-19（CK19）和HBME 1在98例PTMC及98例甲状腺良性病变（35例乳头状增生、42例结节性甲状腺肿、5例甲状腺腺瘤、11例淋巴细胞性甲状腺炎、5例亚急性甲状腺炎）中的表达情况.结果 98例PTMC患者中,有85例（86.7%）同时出现CK19、HBME-l、Galectin-3、FN1中到强阳性表达,而良性病变（乳头状增生、结节性甲状腺肿、甲状腺腺瘤、淋巴细胞性甲状腺炎、亚急性甲状腺炎）,患者未见同时出现CK19、HBME-l、Galectin-3和FN1中、强阳性表达.结论 CK19、HBME-1、Galectin-3和FN1均呈中、强阳性表达是鉴别甲状腺良恶性病变的重要参考指标.     

甲状腺微小癌的临床研究

目的 探讨甲状腺微小癌的临床特征及治疗原则.方法 回顾分析1997年1月至2006年12月收治的311例甲状腺微小癌的临床资料.结果 181例患者以结节性甲状腺肿、甲状腺瘤等良性病变为首发症状(偶发组),130例患者以甲状腺癌结节或体检B超怀疑恶性病变或以颈部淋巴结转移为首发症状(显性组).两组平均年龄分别为47岁及42岁(F=15.545,P=0.000).显性组恶性程度高于偶发组,其需行颈淋巴结清扫的比例分别为48.5%(63/130)及30.9%(56/181),颈部淋巴结转移率分别为27.7%(36/130)及10.5%(19/181),肿瘤两叶多发病灶分别为18.5%(24/130)及9.4%(17/181).结论 将甲状腺微小癌分为"偶发癌"和"显性癌"两个亚型对认识微小癌的发生、发展及指导临床治疗具有实际意义.对"显性癌"患者,患侧腺叶切除或甲状腺全切除应视为标准术式;而对"偶发癌"患者,在保证安全切缘的前提下,甲状腺次全或腺叶切除都可视为手术选择.同时应常规探查Ⅵ区淋巴结,肿大者应予以清扫,体检及B超提示颈淋巴结转移者需再加颈侧清扫.     

甲状腺乳头状微小癌的诊治分析

目的探讨甲状腺乳头状微小癌的临床特征、诊断及治疗方式。方法回顾性分析1985～ 2 0 0 2年间我院收治并经病理证实的甲状腺乳头状微小癌 89例患者的临床资料。结果随访 89例 ,时间 5～ 196个月 ,平均 6 8 9个月。复发 5例 ,无死亡 ,未发现远处转移。因甲状腺良性病变手术而发现微小癌 38例 ,另 5 1例术前怀疑为癌 ,经活检发现微小癌。颈部淋巴结转移 4 0例 ,最多发生在颈深上、中组和气管食管沟组淋巴结。腺叶多发结节转移的发生率显著高于单发结节。不同大小的原发肿瘤 (≤ 5mm ;>5mm)在颈部淋巴结转移的发生率其差异有显著性。是否可触及肿大淋巴结对局部复发率的影响差异有显著性。结论术前触诊、B超检查、术中探查及冰冻组织切片对提高甲状腺乳头状微小癌的诊断非常重要。根据病情选择不同的切除范围 ,疗效是同样的。建议区分两类甲状腺乳头状微小癌 :一类良性进展 ,应以保守性手术为主 ;另一类侵袭性进展 ,有不良预后 ,应行积极的手术方式。     

Stages in the evolution of squamous cell carcinoma of the uterine cervix: a critique of the concepts of "dysplasia" and "cancer"

A clinically detectable, frankly invasive, squamous cell carcinoma of the uterine cervix evolves through a series of step-like stages, at any one of which, except the last, its progress can be arrested. These stages are intraepithelial neoplasia, early stromal invasion, microcarcinoma and, eventually and irreversibly, invasive squamous cell carcinoma. Crucial to this concept of a series of plateaus in tumour development is the recognition that "dysplasia" is a differentiated intraepithelial neoplasm and the discarding of the term "cancer" in favour of the less emotionally loaded expression "neoplastic process".     

甲状腺微小乳头状癌的超声图像特点

目的探讨甲状腺微小乳头状癌的超声声像图特点。方法收集经手术及病理证实的59例甲状腺微小乳头状癌患者,回顾分析其二维及彩色多普勒超声检查结果,包括甲状腺结节内部回声的特点、结节的形态、边界、钙化、结节内血流情况以及颈部淋巴结转移情况。结果59例甲状腺微小乳头状癌患者中,结节共67个,低回声结节62个(92.5%),高回声结节4个,混合回声结节1个;结节边界不清晰30个(44.8%);形态不规则38个(56.7%);30个(44.8%)结节内部有点状或沙砾样的微小钙化;颈部淋巴结转移15例(25.4%);37个(55.2%)结节探及彩色血流信号。结论甲状腺微小乳头状癌的超声表现具有一定的特征性,多个指标综合分析能提高微小乳头状癌的检出率,如果发现颈部淋巴结异常,则高度怀疑为恶性结节。     

Contralateral papillary thyroid cancer: does size matter?

Background

The optimal extent of thyroidectomy for papillary thyroid cancer (PTC) <1 cm is controversial. Our aim was to identify the rate and factors predictive of contralateral PTC in these patients.

Methods

We examined 228 patients with PTC who underwent either completion or total thyroidectomy and analyzed the predictive value of tumor size, histology, margin status, capsular invasion, extrathyroid extension, multifocality, and node metastases.

Results

We observed no differences in the rate of contralateral disease in patients with primary PTC ≥1 cm compared with those having disease <1 cm, 30% versus 24%, respectively (P = .43). Multifocality was the only factor predictive of contralateral PTC in patients with tumors <1 cm (P = .02). Patients with tumors <.5 cm also had a comparable rate of contralateral disease (27%).

Conclusions

The presence of contralateral PTC appears to be unrelated to the size of the primary tumor. Furthermore, in patients with PTC <1 cm, multifocality is a risk factor for PTC in the contralateral lobe.