隐匿性甲状腺癌:82例临床分析  

Occult thyroid carcinoma:A review of 82 cases

作　　者：徐闻博[1] 胡文献[2] 滕荣跃[2] XU Wenbo;HU Wenxian;TENG Rongyue(Department of Surgical Oncology,Sir Run Run Shaw Hospital Xiasha Campus,Zhejiang University School of Medicine,Hangzhou 310018,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院下沙院区肿瘤外科,浙江杭州310018 [2]浙江大学医学院附属邵逸夫医院肿瘤外科

出　　处：《全科医学临床与教育》2021年第5期428-431,443,共5页Clinical Education of General Practice

摘　　要：目的探讨隐匿性甲状腺癌(OTC)这一罕见疾病的临床诊治。方法以本次研究报道1例以颈部淋巴结转移为首发症状的OTC患者,经过详尽的术前检查及术后病理切片均未发现原发病灶,综合文献报道的病例,并结合美国国立癌症研究所数据库的资料,汇总分析了82例颈部淋巴结转移或远处脏器转移的OTC临床病理学特点及诊治方法。结果82例OTC患者中男女比例1∶1.27,中位年龄55.56岁,中位随访时间45个月,62例患者仅有颈部淋巴结转移而无远处转移,51例(62.20%)患者行甲状腺全切加颈部淋巴结清扫手术,仅有4例(7.84%)死亡,而未行手术或未行甲状腺全切手术的患者死亡比例为35.48%(11/31)。对于OTC,诊治流程包括术前完善影像学检查,转移灶穿刺病理学检查,同时甲状腺球蛋白、甲状腺转录因子-1(TTF-1)及BRAF基因等检测可帮助明确OTC的诊断,并指导制定合适的治疗方案。结合本次研究对既往病例报道的治疗经验,甲状腺全切加颈部淋巴结清扫为OTC的主要手术方式,总体预后良好。结论OTC临床上非常罕见,目前相关治疗策略尚无定论,行甲状腺全切加颈部淋巴结清扫可能是OTC的优选手术方式。Objective To investigate the diagnosis and treatment process of occult thyroid carcinoma(OTC).Methods We reported a case of OTC with cervical lymph node metastasis as the first symptom.After detailed pre-operative examination and subsequent total thyroidectomy,no primary thyroid tumor was found in imaging data or pathological sections.We searched similar cases reported in the literature as well as the data of SEER database,and a total of 82 cases of metastatic thyroid carcinoma including regional lymph node metastasis and distant organ metastasis with occult primary tumor focus were analyzed.Results The male to female ratio of 82 OTC patients was 1∶1.27,and the median age was 55.56 years old.The median follow-up time was 45 months.Totally 62 patients had only cervical lymph node metastasis but no distant metastasis.51 cases(62.20%)underwent total thyroidectomy and neck dissection,and only 4(7.84%)patients died.The death rate of patients without operation or total thyroidectomy was 35.48%(11/31).For the OTC,the diagnosis and treatment process included detailed imaging examination,preoperative pathological examination of metastatic lesions.At meanwhile,detection of thyroglobulin,TTF-1 and BRAF genes cloud help to make the diagnosis of thyroid carcinoma and guide clinic treatment.Learning form experiences of previous case reports,the overall prognosis of the OTC patients who underwent total thyroidectomy and neck dissection are good.Conclusion OTC is very rare in clinic,and the standard treatment strategy is still unclear.Total thyroidectomy and neck dissection maybe the optimal surgical treatment for OTC patients.

关 键 词：隐匿性甲状腺癌 转移性 甲状腺恶性肿瘤 

分 类 号：R736.1[医药卫生—肿瘤]