1 例具特殊影像特征甲状腺髓样癌的诊治体会并文献复习_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

张广 , 雒毅强 , 于天宇 ,  孙辉

吉林大学中日联谊医院甲状腺外科吉林省外科转化医学重点实验室（长春 130033）;

Corresponding author：

孙辉, Email: sunhui1229@163.com

Keywords：

甲状腺髓样癌; 诊断; 治疗; 文献复习

DOI：

10.7507/1007-9424.201702027

Video：

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目的探讨具特殊影像特征的甲状腺髓样癌（MTC）的临床诊治策略。方法回顾性分析笔者所在医院于 2016 年 11 月收治的 1 例 MTC 病例的临床资料和诊治经过，并进行文献复习。结果该例患者的颈部超声检查表现为甲状腺腺瘤征象，术前血清降钙素（Ctn）检查结果异常升高，复查 Ctn的同时行血清癌胚抗原（CEA）、细针穿刺细胞学检查（FNA）及洗脱液 Ctn 检查，结果均提示 MTC 可能。根据术前影像学检查和术中病理检查结果行甲状腺癌根治术，术后病理确诊为 MTC。结论超声检查下不典型征象结节往往是 MTC 误诊的主要原因，故对于尚不能排除 MTC 可能者应该考虑进一步行血清 Ctn、血清 CEA、FNA、洗脱液 Ctn 等检查以明确诊断，避免延误治疗。

Citation： 张广, 雒毅强, 于天宇, 孙辉. 1 例具特殊影像特征甲状腺髓样癌的诊治体会并文献复习. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(6): 743-746. doi: 10.7507/1007-9424.201702027 Copy

1.	Kwon H, Kim WG, Sung TY, et al. Changing trends in the clinicopathological features and clinical outcomes of medullary thyroid carcinoma. J Surg Oncol, 2016, 113(2): 152-158.
2.	Wang JY, Zhang B, Liu WS, et al. Screening of RET gene mutations in Chinese patients with medullary thyroid carcinoma and their relatives. Fam Cancer, 2016, 15(1): 99-104.
3.	Ceolin L, Siqueira DR, Romotti M, et al. Molecular basis of medullary thyroid carcinoma: the role of RET polymorphisms. Int J Mol Sci, 2012, 13(1): 221-39.
4.	张相民, 蓝小林, 李荣, 等. 甲状腺髓样癌 17 例临床分析. 中华实用诊断与治疗杂志, 2013, 27(10): 1032-1033.
5.	滕卫平, 刘永锋, 高明, 等. 甲状腺结节和分化型甲状腺癌诊治指南. 中国肿瘤临床, 2012, 39(17): 1249-1272.
6.	Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid, 2016, 26(1): 1-133.
7.	Trimboli P, Giovanella L, Valabrega S, et al. Ultrasound features of medullary thyroid carcinoma correlate with cancer aggressiveness: a retrospective multicenter study. J Exp Clin Cancer Res, 2014, 33: 87.
8.	Woliński K, Rewaj-Łosyk M, Ruchała M. Sonographic features of medullary thyroid carcinomas—a systematic review and meta-analysis. Endokrynol Pol, 2014, 65(4): 314-318.
9.	Kim SH, Kim BS, Jung SL, et al. Ultrasonographic findings of medullary thyroid carcinoma: a comparison with papillary thyroid carcinoma. Korean J Radiol, 2009, 10(2): 101-105.
10.	周黎光, 张华伟, 粱波, 等. 甲状腺髓样癌的超声诊断. 医学影像学杂志, 2013, 23(12): 1897-1900.
11.	王满立, 李妙珊, 冯占武, 等. 甲状腺髓样癌超声特征与病理结果对比分析. 实用医学杂志, 2015, 31(5): 799-801.
12.	Trimboli P, Nasrollah N, Amendola S, et al. Should we use ultrasound features associated with papillary thyroid cancer in diagnosing medullary thyroid cancer? Endocr J, 2012, 59(6): 503-508.
13.	Wells SA Jr, Asa SL, Dralle H, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid, 2015, 25(6): 567-610.
14.	American Thyroid Association Guidelines Task Force; Kloos RT, Eng C, et al. Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid, 2009, 19(6): 565-612.
15.	Roman S, Mehta P, Sosa JA. Medullary thyroid cancer: early detec-tion and novel treatments. Curr Opin Oncol, 2009, 21(1): 5-10.
16.	Costante G, Filetti S. Early diagnosis of medullary thyroid carci-noma: is systematic calcitonin screening appropriate in patients with nodular thyroid disease? Oncologist, 2011, 16(1): 49-52.
17.	Roy M, Chen H, Sippel RS. Current understanding and management of medullary thyroid cancer. Oncologist, 2013, 18(10): 1093-1100.
18.	Mendelsohn G, Wells SA Jr, Baylin SB. Relationship of tissue carcinoembryonic antigen and calcitonin to tumor virulence in medullary thyroid carcinoma. An immunohistochemical study in early, localized, and virulent disseminated stages of disease. Cancer, 1984, 54(4): 657-662.
19.	Trimboli P, Giovanella L, Crescenzi A, et al. Medullary thyroid cancer diagnosis: an appraisal. Head Neck, 2014, 36(8): 1216-1223.
20.	Costante G, Meringolo D, Durante C, et al. Predictive value of serum calcitonin levels for preoperative diagnosis of medullary thyroid carcinoma in a cohort of 5817 consecutive patients with thyroid nodules. J Clin Endocrinol Metab, 2007, 92(2): 450-455.
21.	Trimboli P, Cremonini N, Ceriani L, et al. Calcitonin measurement in aspiration needle washout fluids has higher sensitivity than cytology in detecting medullary thyroid cancer: a retrospective multicentre study. Clin Endocrinol (Oxf), 2014, 80(1): 135-140.
22.	王军铁, 张彬, 鄢丹桂, 等. 73 例初治甲状腺髓样癌术式探讨. 中国肿瘤临床, 2012, 39(7): 410-413.
23.	张再兴, 李正江, 唐平章, 等. 甲状腺髓样癌的外科治疗及预后分析. 中华耳鼻咽喉头颈外科杂志, 2011, 46(3): 209-213.
24.	赵自然, 康维明. 甲状腺髓样癌外科诊治. 中华临床医师杂志(电子版), 2012, 6(5): 1249-1252.
25.	陈晓红. 甲状腺髓样癌的治疗策略. 临床耳鼻咽喉头颈外科杂志, 2016, 30(21): 1667-1671.
26.	龚进发, 陈曦. 甲状腺髓样癌的诊治. 外科理论与实践, 2014, 19(3): 195-200.
27.	Hadoux J, Pacini F, Tuttle RM, et al. Management of advanced medullary thyroid cancer. Lancet Diabetes Endocrinol, 2016, 4(1): 64-71.

1. Kwon H, Kim WG, Sung TY, et al. Changing trends in the clinicopathological features and clinical outcomes of medullary thyroid carcinoma. J Surg Oncol, 2016, 113(2): 152-158.
2. Wang JY, Zhang B, Liu WS, et al. Screening of RET gene mutations in Chinese patients with medullary thyroid carcinoma and their relatives. Fam Cancer, 2016, 15(1): 99-104.
3. Ceolin L, Siqueira DR, Romotti M, et al. Molecular basis of medullary thyroid carcinoma: the role of RET polymorphisms. Int J Mol Sci, 2012, 13(1): 221-39.
4. 张相民, 蓝小林, 李荣, 等. 甲状腺髓样癌 17 例临床分析. 中华实用诊断与治疗杂志, 2013, 27(10): 1032-1033.
5. 滕卫平, 刘永锋, 高明, 等. 甲状腺结节和分化型甲状腺癌诊治指南. 中国肿瘤临床, 2012, 39(17): 1249-1272.
6. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid, 2016, 26(1): 1-133.
7. Trimboli P, Giovanella L, Valabrega S, et al. Ultrasound features of medullary thyroid carcinoma correlate with cancer aggressiveness: a retrospective multicenter study. J Exp Clin Cancer Res, 2014, 33: 87.
8. Woliński K, Rewaj-Łosyk M, Ruchała M. Sonographic features of medullary thyroid carcinomas—a systematic review and meta-analysis. Endokrynol Pol, 2014, 65(4): 314-318.
9. Kim SH, Kim BS, Jung SL, et al. Ultrasonographic findings of medullary thyroid carcinoma: a comparison with papillary thyroid carcinoma. Korean J Radiol, 2009, 10(2): 101-105.
10. 周黎光, 张华伟, 粱波, 等. 甲状腺髓样癌的超声诊断. 医学影像学杂志, 2013, 23(12): 1897-1900.
11. 王满立, 李妙珊, 冯占武, 等. 甲状腺髓样癌超声特征与病理结果对比分析. 实用医学杂志, 2015, 31(5): 799-801.
12. Trimboli P, Nasrollah N, Amendola S, et al. Should we use ultrasound features associated with papillary thyroid cancer in diagnosing medullary thyroid cancer? Endocr J, 2012, 59(6): 503-508.
13. Wells SA Jr, Asa SL, Dralle H, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid, 2015, 25(6): 567-610.
14. American Thyroid Association Guidelines Task Force; Kloos RT, Eng C, et al. Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid, 2009, 19(6): 565-612.
15. Roman S, Mehta P, Sosa JA. Medullary thyroid cancer: early detec-tion and novel treatments. Curr Opin Oncol, 2009, 21(1): 5-10.
16. Costante G, Filetti S. Early diagnosis of medullary thyroid carci-noma: is systematic calcitonin screening appropriate in patients with nodular thyroid disease? Oncologist, 2011, 16(1): 49-52.
17. Roy M, Chen H, Sippel RS. Current understanding and management of medullary thyroid cancer. Oncologist, 2013, 18(10): 1093-1100.
18. Mendelsohn G, Wells SA Jr, Baylin SB. Relationship of tissue carcinoembryonic antigen and calcitonin to tumor virulence in medullary thyroid carcinoma. An immunohistochemical study in early, localized, and virulent disseminated stages of disease. Cancer, 1984, 54(4): 657-662.
19. Trimboli P, Giovanella L, Crescenzi A, et al. Medullary thyroid cancer diagnosis: an appraisal. Head Neck, 2014, 36(8): 1216-1223.
20. Costante G, Meringolo D, Durante C, et al. Predictive value of serum calcitonin levels for preoperative diagnosis of medullary thyroid carcinoma in a cohort of 5817 consecutive patients with thyroid nodules. J Clin Endocrinol Metab, 2007, 92(2): 450-455.
21. Trimboli P, Cremonini N, Ceriani L, et al. Calcitonin measurement in aspiration needle washout fluids has higher sensitivity than cytology in detecting medullary thyroid cancer: a retrospective multicentre study. Clin Endocrinol (Oxf), 2014, 80(1): 135-140.
22. 王军铁, 张彬, 鄢丹桂, 等. 73 例初治甲状腺髓样癌术式探讨. 中国肿瘤临床, 2012, 39(7): 410-413.
23. 张再兴, 李正江, 唐平章, 等. 甲状腺髓样癌的外科治疗及预后分析. 中华耳鼻咽喉头颈外科杂志, 2011, 46(3): 209-213.
24. 赵自然, 康维明. 甲状腺髓样癌外科诊治. 中华临床医师杂志(电子版), 2012, 6(5): 1249-1252.
25. 陈晓红. 甲状腺髓样癌的治疗策略. 临床耳鼻咽喉头颈外科杂志, 2016, 30(21): 1667-1671.
26. 龚进发, 陈曦. 甲状腺髓样癌的诊治. 外科理论与实践, 2014, 19(3): 195-200.
27. Hadoux J, Pacini F, Tuttle RM, et al. Management of advanced medullary thyroid cancer. Lancet Diabetes Endocrinol, 2016, 4(1): 64-71.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

1 例具特殊影像特征甲状腺髓样癌的诊治体会并文献复习

Abstract Full text Figures/Tables Video References Cited by

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