甲状腺滤泡癌下颌骨转移1例报道及文献复习  

Metastatic follicular thyroid carcinoma to the mandible: a case report and literature review

作　　者：陈子和 黄志权[2] 李伟 

机构地区：[1]广州市番禺区何贤纪念医院口腔科,广东广州511400 [2]中山大学孙逸仙纪念医院口腔颌面外科

出　　处：《广东牙病防治》2013年第10期535-539,共5页Journal of Dental Prevention and Treatment

摘　　要：目的探讨甲状腺滤泡癌发生下颌骨转移的临床病理学特征、诊断、鉴别诊断及治疗方法。方法报道1例甲状腺滤泡癌术后3年发生下颌骨转移患者的临床特征、病理学检查及治疗方法,并复习文献。结果女性患者49岁,右下颌面部巨大肿物,张口受限,吞咽困难,影响进食。全景片示左侧下颌角区及升支区骨质透射影,CT检查示下颌骨升支、下颌角骨质破坏,左侧咽旁间隙受压变窄,考虑为甲状腺癌骨转移可能性大。行"左下颌骨次全切除术和左下颌骨巨大肿物扩大切除术"。手术标本病理学检查,显微镜下瘤细胞呈梁索状或滤泡样结构,滤泡内有胶质。瘤细胞呈圆形,胞浆丰富红染,核小、颗粒状,核分裂象不多见。免疫组织化学表型显示甲状腺转录因子1(+)、甲状腺球蛋白(+)、细胞角蛋白20(-)、降钙素(-)、嗜铬粒蛋白A(-)、突触素(-),提示甲状腺滤泡癌的下颌骨转移。术后患者恢复良好,颌面部疼痛缓解,进食明显改善,术后1周出院。结论甲状腺滤泡癌易于发生血运传播,对于下颌骨转移的病灶,可行挽救性手术切除,以减轻患者症状,改善其生活质量。对于已发生远处转移病例,其预后通常较差。Objective To explore the clinicopathological characteristics, differential diagnosis and the therapeutic method of metastatic follicular thyroid carcinoma （FTC） to the mandible. Methods A case report of metastatic follicular thyroid carcinoma to the mandible was reported and the relevant literatures were reviewed. Results The patient was a 49-year-old woman. A gigantic swelling was located in the lower right side of the face. Histopathologically. follicular or block-like structure lined with circular cells The oncocyte with abundant amount of cytoplasm and small nuclei, mitotic figures were not obvious. Immunohistochemically, tumour ceils expressed TrF-1, TG. Yet CK20, Calcitonin, CgA, Syn were negative. Conclusion FTC is prone to spread hematogenously, when it transfer to the mandible, in order to release the patient＇ s symptom and improve her quality of life to a proper level, a sal- vage operation should be taken into account. The outcome may be poor when the metastasis occured.

关 键 词：甲状腺滤泡癌 转移癌 下颌骨 

分 类 号：R319.8[医药卫生—基础医学]