肿瘤研究与临床
腫瘤研究與臨床
종류연구여림상
CANCER RESEARCH AND CLINIC
2008年
9期
620-622
,共3页
苏兆花%王刚平%牟翠玲%苏彤%张作峰
囌兆花%王剛平%牟翠玲%囌彤%張作峰
소조화%왕강평%모취령%소동%장작봉
甲状腺炎,自身免疫性%甲状腺肿瘤%癌,乳头状%病理学,临床
甲狀腺炎,自身免疫性%甲狀腺腫瘤%癌,乳頭狀%病理學,臨床
갑상선염,자신면역성%갑상선종류%암,유두상%병이학,림상
Thyroiditis,autoimmune%Thyroid neoplasms%Carcinoma,papillary%Pathology,clinical
目的 探讨慢性淋巴细胞性甲状腺炎(HT)合并隐匿性甲状腺乳头状癌(occult PTC)的临床病理特征,以提高诊疗水平.方法 选取1999年7月至2005年7月经手术切除病理证实的HT合并occult PTC患者28例,对其临床表现、促甲状腺激素(TSH)结果、影像学及病理特征进行回顾性分析并随访.复习HE切片,用免疫组织化学EnVision二步法检测CK19、galectin-3(Gal-3)及bcl-2.结果 189例HT合并甲状腺乳头状癌34例(17.9%),occult PTC28例(14.8%);女19例,男9例;平均年龄36.7岁;TSH正常11例(39.3%),增高8例(28.6%),降低9例(32.1%);癌肿直径均<0.8 cm,其中0.2～0.5 cm 16例,>0.5 cm 12例;彩色超声和CT发现斑片状钙化(非沙砾体)6例(21.4%),未发现淋巴结;术前临床均未明确诊断;随访2～7年,28例均健在,均未复发或转移.结论 HT合并occultPTC,好发于中年女性,预后良好,无临床特异性征象,TSH检测对诊断无帮助,HT纤维化、钙化者应高度重视,宜选择术中快速病理,HT合并occult PTC确诊依靠病理.
目的 探討慢性淋巴細胞性甲狀腺炎(HT)閤併隱匿性甲狀腺乳頭狀癌(occult PTC)的臨床病理特徵,以提高診療水平.方法 選取1999年7月至2005年7月經手術切除病理證實的HT閤併occult PTC患者28例,對其臨床錶現、促甲狀腺激素(TSH)結果、影像學及病理特徵進行迴顧性分析併隨訪.複習HE切片,用免疫組織化學EnVision二步法檢測CK19、galectin-3(Gal-3)及bcl-2.結果 189例HT閤併甲狀腺乳頭狀癌34例(17.9%),occult PTC28例(14.8%);女19例,男9例;平均年齡36.7歲;TSH正常11例(39.3%),增高8例(28.6%),降低9例(32.1%);癌腫直徑均<0.8 cm,其中0.2～0.5 cm 16例,>0.5 cm 12例;綵色超聲和CT髮現斑片狀鈣化(非沙礫體)6例(21.4%),未髮現淋巴結;術前臨床均未明確診斷;隨訪2～7年,28例均健在,均未複髮或轉移.結論 HT閤併occultPTC,好髮于中年女性,預後良好,無臨床特異性徵象,TSH檢測對診斷無幫助,HT纖維化、鈣化者應高度重視,宜選擇術中快速病理,HT閤併occult PTC確診依靠病理.
목적 탐토만성림파세포성갑상선염(HT)합병은닉성갑상선유두상암(occult PTC)적림상병리특정,이제고진료수평.방법 선취1999년7월지2005년7월경수술절제병리증실적HT합병occult PTC환자28례,대기림상표현、촉갑상선격소(TSH)결과、영상학급병리특정진행회고성분석병수방.복습HE절편,용면역조직화학EnVision이보법검측CK19、galectin-3(Gal-3)급bcl-2.결과 189례HT합병갑상선유두상암34례(17.9%),occult PTC28례(14.8%);녀19례,남9례;평균년령36.7세;TSH정상11례(39.3%),증고8례(28.6%),강저9례(32.1%);암종직경균<0.8 cm,기중0.2～0.5 cm 16례,>0.5 cm 12례;채색초성화CT발현반편상개화(비사력체)6례(21.4%),미발현림파결;술전림상균미명학진단;수방2～7년,28례균건재,균미복발혹전이.결론 HT합병occultPTC,호발우중년녀성,예후량호,무림상특이성정상,TSH검측대진단무방조,HT섬유화、개화자응고도중시,의선택술중쾌속병리,HT합병occult PTC학진의고병리.
Objective To study the clinicopathology characteristics of chronic lymphocytic thyroiditis (Hashimoto's thymiditis, HT) with occult papillary thyroid carcinoma (occult PTC) in order to improve its diagnostic and therapeutic accuracy. Methods A restrospective analysis was done on the clinical materials of 28 cases of HT with occult PTC from July 1999 to July 2005. All cases were confirmed by operation and pathologic biopsy. Clinical and gross findings were collected. All HE slides were reexamined and immunostains for CK19, galectin-3,and bcl-2 were performed (Envision method). Results In total 189 cases of chronic lymphocytic thyroiditis,28cases (14.8%,28/189)had coexistent occult papillary thyroid carcinoma. There were 19 females and 9 males with median age of 36.7 years old. Normal TSH presented in 11cases (39.3%), high in 8 cases(28.6%), and low in 9cases (32.1%). All tumor diameter was counted for <0.8 cm, 16 cases (57.1%) tumor diameter 0.2～0.5 cm, 12 cases (42.9%) >0.5 cm. Coarse calcification was seen in 6 cases(21.4%) in color ultrasonic exam and CT scans. Follow-up data showed that 28 patients were all alive with no evidence of recurrence or metastasis for 2 to 7 years by December 2007. Conclusion There are no special clinical characteristics in coexistent HT with occult PTC.Coarse calcification in HT in the group of middle-aged women increase the likelihood of the diagnosis. But the diagnosis depends on pathology. Because of the high incidence of occult PTC in HT population, it would be necessary to keep an eye on this particular type of thyroid carcinoma, and multiple sampling in suspected area of HT specimen is advised in the hope not to miss any small tumor in clinical practice.
