1例甲状腺髓样癌并发乳头状癌随访5年报告  

Simultaneous medullary and papillary thyroid cancer:A case report with a 5-year follow-up

作　　者：王冰[1] 王美祺 田文[1] 

机构地区：[1]解放军总医院普通外科,北京100853 [2]河北医科大学第四医院普通外科,河北石家庄050011

出　　处：《解放军医学院学报》2016年第10期1111-1113,共3页Academic Journal of Chinese PLA Medical School

基　　金：北京市科学技术委员会科技计划课题(Z141107002514102)~~

摘　　要：目的报告1例甲状腺髓样癌并发微小乳头状癌患者5年预后情况,探讨该病的病因、诊疗方法及预后等。方法 2011年7月解放军总医院接诊1例曾于省级三甲级医院行甲状腺癌根治术的甲状腺髓样癌并发微小乳头状癌女性患者,52岁,手术由该院有经验主刀医生完成,手术方式为右叶甲状腺及峡部切除术＋左叶甲状腺近全切除术＋颈部中央区淋巴结清扫术,术后常规病理为右侧甲状腺髓样癌,直径0.5 cm,伴甲状腺微小乳头状癌,直径〈0.1 cm,颈部中央区淋巴结未见癌转移（0/5）。经过5年随访,评估患者预后,并结合相关文献,对该疾病进行讨论。结果患者术后促甲状腺素（thyroidstimulating hormone,TSH）控制在0.006~0.289μIU/ml,血清降钙素0.52~0.79 pmol/L。最近一次复查：血清降钙素0.68pmol/L,血清癌胚抗原2.9μg/L,TSH 0.256μIU/ml,游离T3 4.91 pmol/L,游离T4 22.79 pmol/L。内分泌抑制治疗满意,颈部超声检查未见异常。患者已随访5年,无复发及转移迹象。结论手术是甲状腺髓样癌并发乳头状癌治疗的首选方法,该种病例较少见,本病例预后较好。Objective To report the prognosis of a patient with simultaneous medullary and papillary thyroid cancer after 5 years follow-up and discuss the pathogenesis, diagnosis, management and prognosis of this disease. Methods The patient with simultaneous medullary and papillary thyroid cancer was a 52-year-old female who had undergone thyroidectomy in a provincial third-grade class-A hospital in July 2011. The surgery was performed by an experienced surgeon and the surgical procedure was right lobe of thyroid and isthmus resection ＋left lobe of thyroid subtotal resection ＋central lymph node dissection. Postoperative routine pathologic diagnosis was medullary thyroid carcinoma with d=0.5cm and papillary carcinoma with d〈0.1 cm on the right lobe of the thyroid. Cancer metastasis lymph node was not found in central region of neck（0/5）. After 5 years of follow-up, the prognosis was evaluated and discussion was made based on its related literature review. Results Postoperative TSH was controlled within the range of 0.006-0.289 ？IU/ml, and serum calcitonin within 0.52-0.79 pmol/L. Latest reexamination showed that serum procalcitonin was 0.68 pmol/L, CEA of 2.9 ？g/L, TSH of 0.256 μIU/ml, FT3 of 4.91 pmol/L, and FT4 of 22.79 pmol/L. The result of endocrine suppression therapy was satisfying and the neck ultrasound results were normal. No recurrence and metastasis was found in 5-year follow-up. Conclusion Surgery is considered as the best treatment on simultaneous medullary and papillary thyroid cancer. This kind of case is rare, and the prognosis is good in this case.

关 键 词：甲状腺髓样癌 甲状腺乳头状癌 预后 

分 类 号：R736.1[医药卫生—肿瘤]