Objective To understand the latest research developments of the formation mechanism of psammoma body in human tumors and related issues. Methods Related domestic and foreign literatures were widely referred, analyzed, and reviewed. Results Psammoma body is unique pathological calcification in some tumors, which is arranged in concentric, laminar circles microscopically. Psammoma body is commonly seen in thyroid papillary carcinoma, meningiomas, ovarian serous papillary carcinoma, and so on. Conclusions Although arranged in concentric, laminar circles microscopically in tumor, the formation process of psammoma body is not entirely the same in different tumors. A comprehensive and objective understanding of psammoma body would be useful in cancer diagnosis and treatment.
目的 探讨甲状腺乳头状癌术后复发的相关影响因素，为降低再手术风险及提高临床疗效提供依据。方法 回顾性分析大连医科大学附属第二医院2005年1月至2008年12月期间收治的206例甲状腺乳头状癌患者的临床资料。本组患者均获访3～5年，平均4.1年，采用单因素及多因素分析方法对甲状腺乳头状癌术后复发与患者性别、年龄、肿瘤大小、甲状腺包膜有无浸润、淋巴结有无转移以及手术方式的相关性进行分析。结果 206例甲状腺乳头状癌患者中，术后复发18例。单因素分析结果显示，术后复发与患者性别、肿瘤大小、甲状腺包膜是否被浸润、手术方式及淋巴结转移情况均有关（P＜0.05）；多因素分析结果显示，肿瘤大小、淋巴结转移情况及手术方式与甲状腺乳头状癌术后复发密切相关。结论 肿瘤直径越大、有淋巴结转移和手术切除范围不足可能是甲状腺乳头状癌术后复发的高危因素。
Objective To explore the expressions of galectin-3 （Gal-3） and cytokeratin-19 （CK-19） in different tissues of Hashimoto thyroiditis （HT） complicated with papillary thyroid microcarcinoma （PTMC）. Methods The tumor tissue， 0.5 cm near tumor tissue， and opposite lateral lobe thyroid tissue in 25 HT with benign nodus patients， 25 PTMC patients， and 25 HT with PTMC patients were collected. The expressions of Gal-3 and CK-19 in these tissues were detected by immunohistochemical methods. Results ①The positive rates of Gal-3 and CK-19 expressions in the tumor tissueof HT with PTMC patients and PTMC patients were significantly higher than those of HT with benign nodus patients （P＜0.05）.②The positive rates of Gal-3 and CK-19 expressions in the opposite lateral lobe thyroid tissue of HT with PTMC patients and HT with benign nodus patients were significantly higher than those of PTMC patients （P＜0.05）．③The positive rates of Gal-3 and CK-19 expressions in the 0.5 cm near tumor tissue of HT with PTMC patients and HT with benign nodus patients were significantly higher than those of PTMC patients （P＜0.05）. ④The middle and b positive rates of Gal-3 and CK-19 expressions in the 0.5 cm near tumor tissue of HT with PTMC patients were significantly higher than those of HT with benign nodus patients and the PTMC patients （P＜0.05）．Conclusions ①Gal-3 and CK-19 protein are helpful to differentiate the benign thyroid tumor and malignant one. ② The expressions of Gal-3 and CK-19 protein in patients with HT are clear higher than those in patients without HT that means the prognosis evaluation in HT canceration. ③ Gal-3 combined with CK-19 protein are help for early diagnosis， the pathogenesis and prognosis evaluation in thyroid cancer. The b positive means canceration. ④ In HT with PTMC， it needs an operation therapy and a larger one， which is appropriate for lateral and opposite lobe partial resection or total resection.
Objective To explore the pattern and clinical influencing factors of cervical lymph node metastasis in papillary thyroid carcinoma （PTC）， and provide a basis for the choice of surgical approach for the PTC neck lymph node processing. Methods The clinical data of 98 patients with PTC treated in Affiliated Hospital of Guiyang Medical College from Jan. 2009 to Dec. 2011 were collected， and the pattern and clinical influencing factors of cervical lymph node metastasis were analyzed. Results Ninety eight consecutive patients underwent neck dissection in a total of 114 sides. The lymph node metastasis rate of cervical lymph node， districtⅥ， districtⅡ＋Ⅲ＋Ⅳ， and districtⅤwas 77.55% （76/98）， 74.49% （73/98）， 42.86% （42/98）， and 5.10% （5/98）， respectively. Results of univariate analysis showed that lymph node metastasis rates were higher in patients with diameter of tumor greater than 1 cm， tumor invaded thyroid capsule， multi-focal tumor， and old than 45 years （P＜0.05）. Results of multivariate analysis showed that the age of patients， diameter of tumor， tumor invaded thyroid capsule， and multifocal tumor were independent risk factors of cervical lymph node metastasis （P＜0.05）. Tumor invaded thyroid capsule， multifocal tumor， combined with districtⅥmetastasis， and combined with districtⅡ＋Ⅲ＋Ⅳ metastasis were independent risk factors of prelaryngeal lymph node metastasis （P＜0.05）. Tumor invaded thyroid capsule and multifocal tumor were independent risk factors of skip lymph node metastasis （P＜0.05）. Conclusions DistrictⅥ is found to be the predominant site for lymph node metastasis of PTC， the districtⅢ and the districtⅣinvolved in addition， so it is necessary to clean lymph nodes at districtⅥ routinely. The regularity of cervical lymph node metastasis can provide the basis for surgeon to choose a reasonable type of neck dissection.
Objective To investigate the expression level and methylation level of micro RNA-34b（miR-34b） gene in papillary thyroid carcinoma （PTC）， and to analyze the relationship between methylation and clinicopathological characters of PTC. Methods PTC tissues and tumor adjacent tissues were collected from 25 patients with PTC who underwent operation in Huai’an First People’s Hospital of Nanjing Medical University from Sep. 2008 to Oct. 2010. Expression of miR-34b gene and level of methylation in gene promoter were detected by real time PCR and methylation-specific PCR in the 2 kinds of tissues， respectively. Results The expression value of miR-34b mRNA in PTC tissues was 0.85±0.05， which was significantly lower than those of tumor adjacent tissues （1.62±0.09）， P=0.030. There were methylation in 18 （72%，18/25） PTC tissues， and 10 （40%，10/25） in tumor adjacent tissues， and the ratio of methylation was higher in PTC tissues （P=0.021）. In PTC tissues， methylation was not related to age， gender， tumor size， TNM stage， and invasion of the capsule （P＞0.05）， but was related to lymph node metastasis （P＜0.05）. Ratio of methylation in patients with lymph node metastasis was significantly higher than those of patients with no lymph node metastasis. Conclusion Methylation of miR-34b gene promoter is one of the reasons for inactivation of PTC， and it may be related to the development and metastasis of PTC， which needs to be further investigated.
Objective To assess the applied significance of carbon nanoparticles in central compartment lymph node dissection in treatment of cN0 papillary thyroid carcinoma. Methods Sixty-eight patients with cN0 papillary thyroid carcinoma who were treated in Tongji Hospital of Tongji Medical College from May. to Oct. in 2012 were randomly allocated to the control group （n=32） and the carbon nanoparticles trace group （tracer group， n=36）， receiving non-carbon nanoparticles trace and carbon nanoparticles trace respectively. All patients were received total resection of thyroid plus the affected side and （or） contralateral side central compartment lymph node dissection. The lymph node-related indexes（including number of dissected lymph node at Ⅵarea and lymph node metastasis rate at Ⅵarea） and operative indexs （including operation time， blood loss， drainage time， complication， and hospital stay） were collected and compared between the 2 groups. Results There were 205 and 324 dissected lymph node at central compartment in control group and tracer group respectively. The results of postoperative pathology showed that the number of lymph node in central compartment of the tracer group was much more than those of control group （8.99±2.24 vs. 6.41±1.56， P＜0.001）. The metastasis rate of central compartment lymph node were 40.6% （13/32） in control group and 47.2% （17/36） in tracer group， but there was no significant difference between the 2 groups （P=0.762）. But in medial area of laryngeal recurrent nerve， the metastasis rate in the tracer group （38.9%， 14/36） was much higher than those of control group （12.5%， 4/32）， P=0.029. There were no significant differences in the operation time， blood loss， drainage time， hospital stay， and complication incidence such as bleeding， temporary hypocalcemia， and injury of superior laryngeal nerve between 2 groups （P＞0.05）. All the patients in 2 groups had followed-up for 6 months without death， recurrence， and metastasis.Conclusions The lymphatic tracer technique of carbon nanoparticles may improve the number of dissected lymph nodes in central region of cN0 papillary thyroid carcinoma， without increasing （or prolonging） operation time， intraoperative blood loss， and postoperative hospital stay， and can accurately represent the metastasis of lymph node， thus to make the staging of the tumor accurately and guide postoperative treatment.
Objective To explore the manifestations and features of multi-slice spiral CT （MSCT） in the diagnosisof papillary thyroid carcinoma （PTC）. Methods Preoperative MSCT data of 35 cases of PTC proved by operation and pathology in our hospital form May. to Jun. in 2013 were observed retrospectively， to analyze the manifestations and characteristics of MSCT for it. Results Of 35 patients with PTC， MSCT totally showed 48 lesions， 68.6% （24/35） of patients with single lesion， 31.4% （11/35） of patients with 2-3 lesions， and 62.9% （22/35） of patients with lymph node metastasis. Of the 48 lesions， 29.2% （14/48） of lesions located in the left lobe， 70.8% （34/48） of lesions located in the right lobe；the lesions’ maximum diameter were 0.4-5.8cm， with the average maximum diameter of 1.3cm. There were 39.6% （19/48） of lesions with uneven density， 25.0% （12/48） of lesions with irregular shape， 47.9% （23/48） of lesions with blurred edges， 18.8% （9/48） of lesions had papillary enhanced tumor nodules， 10.4% （5/48） of lesions had peritumoral incomplete enhanced ring sign， 22.9% （11/48） of lesions invaded surrounding tissue or organs. There were 35.4% （17/48） of lesions had calcification， in which 76.4% （13/17） of lesions were fine granular calcification， 11.8% （2/17） of lesions were mixed calcification， and 11.8% （2/17） of lesions were coarse calcification. Conclusion MSCT manifestations of PTC have certain characteristics， which can provide imaging basis for clinical treatment options.
Objective To summarize the relationship between IgG4 and IgG4 related thyroid diseases. Methods Domestic and international publications involving the pathological features of IgG4-related thyroid diseases and relationship with IgG4 were retrieved and reviewed. Results IgG4-related disease was a newly recognized class of chronic and systemic lymphocytes disease， which may be solitary or involving multiple body organs， as well as thyroid. The expression of IgG4 was found in leisons of Hashimoto thyroiditis， Riedel thyroiditis， and papillary thyroid carcinoma. Conclusions IgG4-related thyroid disease is a new concept of thyroiditis. The knowledge of this new disease will provide appropriate treatment for patients with thyroiditis.
Objective To explore the expression of chemokine receptor CCR7 in thyroid papillary microcarcinoma tissues and the relationship with clinicopathological features. Methods The CCR7 expressions in 31 cases of thyroid papillary microcarcinoma, 34 cases of thyroid papillary carcinoma which diameter＞1cm, 34 cases of nodular goiter, and 12 cases of thyroid papillary microcarcinoma contralateral normal thyroid tissues were detected by using immunohistochemistry S-P method. Results The expression positive rates of CCR7 in thyroid papillary microcarcinoma and papillary thyroid carcinoma which diameter＞ 1cm were both 100%, the difference had not statistically significant （P＞0.05）. In nodular goiter and normal thyroid tissues, the expression positive rate of CCR7 was 64.7% and 33.3%, respectively, and compared with thyroid papillary microcarcinoma, the difference had statistically significant （P＜0.05）. There were not relations between the expression of CCR7 and patient’s gender, age, capsule invasion, and lymph node metastasis （P＞0.05）. Conclusions The CCR7 in thyroid papillary microcarcinoma and thyroid papillary carcinoma which diameter＞ 1cm are both high expressions, and have the same bionomics, both prone to cervical lymph node meta-stasis, and the radical neck dissection （central area） are both need to take.
Objective To explore the expression of matrix metalloproteinase （MMP）-2 in patients with papillary thyroid cancer （PTC） recurrence or residuum and its value of clinical application. Methods The serums from 68 patients with thyroid disease underwent operation and 15 health examinations under stomachs empty from March 2009 to December2009 in this hospital were gathered. Sixty-eight patients with thyroid disease were divided into PTC with lymph node metastasis （LNM） group （n=19），PTC recurrence or residuum with LNM group （n=17），PTC without LNM group （n=10），and benign thyroid disease group （n=22） according to the postoperative pathological findings，15 health examinations as control group. The expression of MMP-2 of serum sample was detected by ELISA method. The difference of the expression of MMP-2 in each group was analyzed. Results The expressions of MMP-2 in the PTC recurrence or residuum with LNM group，PTC with LNM group，PTC without LNM group， benign thyroid disease group，and the control group were （1 724.00±762.24） ng/ml，（1 329.16±776.59） ng/ml，（1 489.61±546.53） ng/ml，（1 264.87±817.27） ng/ml，and （608.43±88.63） ng/ml，respectively. The expressions of MMP-2 in the PTC with LNM group and PTC recurrence or residuum with LNM group were significantly higher than those in the benign thyroid disease group （P＜0.05） and the control group （P＜0.05），respectively，which in the PTC without LNM group was significantly higher than that in the control group （P＜0.05）. There was no significant difference of MMP-2 expression of serum between the benign thyroid disease group and the control group （P＞0.05），which were no significant difference among the other threemalignant disease groups （P＞0.05）. The MMP-2 positive expression rates were 79%，76%，80%，41%，and 20% in the PTC with LNM，PTC recurrence or residue with LNM group，PTC without LNM group，benign thyroid disease group，and control group，respectively. The MMP-2 positive expressions rates of serums were not significantly different among three malignant disease groups （P＞0.05），but which were significantly higher than those of the benign thyroid disease group （P＜0.01） and control group （P＜0.01），respectively. Conclusions The MMP-2 level of serum can be used as an index to judge preoperative thyroid nodules，which can not be use to determine whether PTC metastasis or not.