1例甲状腺混合性髓样-乳头状癌伴颈部淋巴结髓样癌转移病例报道并文献复习

doi:10.3969/j.issn.1009-976X.2024.05.010

摘要/Abstract

摘要： 回顾1例甲状腺混合性髓样-乳头状癌患者的诊疗过程,对该患者的临床资料、病理以及免疫组化结果予以回顾分析,并结合国内外文献对该病症展开分析探讨,为临床诊治提供参考。对文献报道病例资料的总结表明,甲状腺混合性髓样-乳头状癌发病率罕见,病理上以髓样癌与乳头状癌混合存在为显著特征,治疗方式参照甲状腺髓样癌,总体预后逊于乳头状癌但优于甲状腺髓样癌。当术前FNA考虑乳头状癌,而血清降钙素升高,这种细胞学和肿瘤标志物不一致时,应该警惕此类疾病。

关键词: 甲状腺癌, 混合性髓样-乳头状癌, 甲状腺髓样癌

Abstract: This paper reviewed the diagnosis and treatment process of a patient with mixed medullary-papillary thyroid carcinoma, to review and analyse the clinical data, pathology and immunohistochemistry results of the patient, and to analyse and discuss the disease with the domestic and international literature to provide reference for clinical diagnosis and treatment. A summary of case data reported in the literature showed that mixed medullary-papillary thyroid carcinoma is rare in incidence, is pathologically characterised by the presence of a mixture of medullary and papillary carcinoma, is treated in the same way as medullary thyroid carcinoma, and has an overall prognosis inferior to that of papillary thyroid carcinoma but superior to that of medullary thyroid carcinoma. Theer should be alert to this type of disease when preoperative FNA is considered papillary carcinoma and serum calcitonin is elevated, a cytological and tumour marker inconsistency.

Key words: thyroid cancer, mixed medullary-papillary carcinoma, thyroid medullary carcinoma

中图分类号:

R736.1

艾青, 黄志恒, 翁煜景, 陈伟春. 1例甲状腺混合性髓样-乳头状癌伴颈部淋巴结髓样癌转移病例报道并文献复习[J]. 岭南现代临床外科, 2024, 24(05): 326-329.

AI Qing, HUANG Zhi-heng, WENG Yu-jing, CHEN Wei-chun. A case report of mixed medullary-papillary carcinoma of the thyroid with medullary carcinoma metastasis in the cervical lymph nodes and review of the literature[J]. Lingnan Modern Clinics In Surgery, 2024, 24(05): 326-329.

参考文献

[1] 魏松锋,王萍萍,程润芬,等. 甲状腺混合性髓样-乳头状癌与甲状腺髓样癌合并乳头状癌的临床病理特征比较[J]. 中华普通外科杂,2021,36(6):405409.
[2] 万政, 刘梅, 郗洪庆, 等. 混合性甲状腺癌预后因素及病理特征分析[J]. 中华内分泌外科杂志, 2021, 15(2): 147-153.
[3] Nangue C, Bron L, Portmann L, et al.Mixed medullary-papillary carcinoma of the thyroid: report of a case and review of the literature[J]. Head Neck, 2009, 31(7): 968-974.
[4] 中华医学会内分泌学分会,中华医学会外科学分会甲状腺及代谢外科学组,中国抗癌协会头颈肿瘤专业委员会,等. 甲状腺结节和分化型甲状腺癌诊治指南(第二版)[J]. 中华内分泌代谢杂志,2023,39(3):181-226.
[5] Kim WG, Gong G, Kim EY, et al.Concurrent occurrence of medullary thyroid carcinoma and papillary thyroid carcinoma in the same thyroid should be considered as coincidental[J]. Clin Endocrinol (Oxf), 2010, 72(2): 256-263.
[6] Rossi S, Fugazzola L, De Pasquale L, et al.Medullary and papillary carcinoma of the thyroid gland occurring as a collision tumour: report of three cases with molecular analysis and review of the literature[J]. Endocr Relat Cancer, 2005, 12(2): 281-289.
[7] Hanna AN, Michael CW, Jing X.Mixed medullary-follicular carcinoma of the thyroid: diagnostic dilemmas in fine-needle aspiration cytology[J]. Diagn Cytopathol, 2011, 39(11): 862-865.
[8] 张竞轶,王建华,黄驰,等. 甲状腺混合性髓样-乳头状癌伴混合性淋巴结转移1例报道并文献复习[J]. 中国普外基础与临床杂志,2023,30(7):849-854.
[9] Wang M, Chen H, Wang Y, et al.Diagnostic value and costeffectiveness of FNA-CT versus FNAC for medullary thyroid carcinoma[J]. Clin Endocrinol (Oxf), 2023, 98(5): 709-718.
[10] Wells SA Jr, Asa SL, Dralle H, et al.Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma[J]. Thyroid, 2015, 25(6): 567-610.
[11] 中国医师协会外科医师分会甲状腺外科医师委员会,中国抗癌协会甲状腺癌专业委员会,中国研究型医院学会甲状腺疾病专业委员会. 甲状腺髓样癌诊断与治疗中国专家共识(2020版)[J]. 中国实用外科杂志,2020,40(9):1012-1020.
[12] Sandilos G, Lou J, Butchy MV, et al.Features of mixed medullary thyroid tumors: An NCDB analysis of clinicopathologic characteristics and survival[J]. Am J Surg, 2023, 226(1): 53-58.

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