原发性甲状腺鳞状细胞癌的临床特征与诊治：附7例报告

目的:探讨原发性甲状腺鳞状细胞癌(SCCT)的临床、超声及病理特征以及治疗和预后。方法:回顾性分析2010年1月—2015年12月收治的7例原发性SCCT患者的临床表现、超声声像图特征、术后病理结果和综合治疗效果。结果:7例原发性SCCT占同期全部甲状腺癌的0.96%(7/728),其中男3例,女4例,平均年龄62.7岁。所有患者均可触及颈部肿块,4例伴呼吸困难,2例伴声音嘶哑,1例伴吞咽困难。病灶超声声像图均表现为形态不规则的实性混合性回声光团,5例肿块侵透甲状腺被膜,2例伴有微钙化,4例有异常颈部淋巴结。手术治疗5例(甲状腺癌联合根治术2例,局部广泛切除术2例,姑息性切除术并同时行预防性气管切开1例),2例仅行粗针穿刺活检。患者病理均证实为SCCT,3例合并结节性甲状腺肿,2例合并甲状腺乳头状癌,7例肿瘤细胞P63免疫组化均阳性。5例手术患者术中,4例术后行放疗或放疗+化疗,1例未行综合治疗;2例粗针穿刺活检患者行单纯放疗或放疗+化疗。仅1例行根治性切除术联合术后放疗的患者生存期超过1年,其余均在半年内死亡。结论:原发性SCCT恶性程度高,病情发展迅速,预后差。其临床表现及超声声像图具有一定的特征性,有助于术前诊断,免疫组化对鉴别诊断非常重要,积极的综合治疗可能改善患者预后。

Clinical features, diagnosis and treatment of primary squamous cell carcinoma of thyroid: a report of 7 cases

Objective: To investigate the clinical, ultrasonic and pathologic characteristic as well as treatment and outcomes of primary squamous cell carcinoma of thyroid (SCCT). Methods: The clinical presentations, ultrasonic features, pathologic findings and results of comprehensive treatment of 7 primary SCCT patients admitted from January 2010 to December 2015 were retrospectively analyzed. Results: The 7 primary SCCT patients accounted for 0.96% (7/728) of the total number of thyroid cancer patients admitted during the same period, of whom, 3 cases were male and 4 cases were female, with an average age of 62.7 years. All patients had palpable neck mass that was associated with dyspnea in 4 cases, hoarseness in 2 cases and dysphagia in one case. All lesions in ultrasonographic images presented as irregular mixed echogenic solid mass, with thyroid capsule penetration in 5 lesions, microcalcification in 2 lesions and suspicious cervical lymph nodes in 4 lesions. Five patients underwent surgical treatment (thyroidectomy with neck dissection in 2 cases, wide local excision in 2 cases, and palliative resection with prophylactic tracheostomy in one case), and 2 patients underwent coarse needle biopsy only. All cases were confirmed as SCCT by pathology, which was combined with nodular goiter in 3 cases and with papillary thyroid carcinoma in 2 cases, and the immunohisochemical staining for P63 was positive in all cases. Of the 5 patients undergoing surgical treatment, 4 cases had postoperative radiotherapy or radiotherapy plus chemotherapy, and one case did not receive comprehensive therapy; 2 patients undergoing coarse needle biopsy only received radiotherapy or radiotherapy plus chemotherapy. Only one patient who underwent thyroidectomy with neck dissection plus postoperative radiotherapy survived more than one year, and all the remaining patients died within half a year. Conclusion: Primary SCCT is a highly malignant tumor with rapid progress and poor prognosis. Its clinical manifestations and ultrasound imaging have certain characteristics that may help the preoperative diagnosis. Immunohistochemical staining is important for its differential diagnosis, and aggresive comprehensive treatment may improve the prognosis of the patients.