甲状腺恶性纤维组织细胞瘤三例报告并文献复习

目的 对甲状腺恶性纤维组织细胞瘤(MFH)的临床特点、诊疗手段及预后进行探讨.方法 对我院2000年1月至2007年5月收治的3例甲状腺恶性纤维组织细胞瘤临床病例及随访资料,同时查阅国内外相关文献,进行分析.结果 甲状腺恶性纤维组织细胞瘤发病率低,占甲状腺恶性肿瘤的0.574%(3/523);进展迅速,易侵犯喉返神经和(或)伴有颈部淋巴结转移.该病诊断困难,难以与甲状腺癌相鉴别.免疫组化病理具有诊断价值,角蛋白(CK)阴性、甲状腺球蛋白(Tg)阴性、波形蛋白(Vimentin)阳性常用于与甲状腺癌的鉴别.该病的治疗以手术切除为主,切除范围应广泛彻底.病人多于术后2年内死于肿瘤复发及转移.结论 甲状腺恶性纤维组织细胞瘤是一种罕见的甲状腺原发肿瘤,恶性度高,预后差,其诊断主要依赖于免疫组化病理,手术切除是主要的治疗手段.

Three cases report of malignant fibrous histiocytoma of thyroid with reference review

Objective To investigate the clinical characteristics, diagnosis, treatment and prognosis of malignant fibrous histiocytoma (MFH) of thyroid. Methods The clinical case and follow-up data (n=3) of MFH of thyroid from our hospital between 2000 and 2007 was analyzed, with the correlating references reviewed. Results MFH of thyroid accounted for 0.574% (3/523) of malignant tumor of thyroid. MFH of thyroid progressed so fast as to invase recurrent laryngeal nerve (RLN) and /or cervical lymph nodes. Conclusions The diagnosis of MFH of thyroid is difficult, for it is easy to be misdiagnosed as thyroid carcinoma. Immunohistochemistry pathology can provide a good differential diagnostic value, with CK negative, Tg negative, and Vimentin positive to support the diagnosis of MFH. Extensive and thorough excision should be the main choice to treat MFH of thyroid. Patients of MFH of thyroid often died of recurrence or metastasis in 2 years after operation. MFH of thyroid is a kind of rare thyroid primary tumor, with malignancy of high grade and poor prognosis. The disgnosis of MFH of thyroid depends on immunohistochemistry staining, while excision should be the main choice for treatment.