1 例具特殊影像特征甲狀腺髓樣癌的診治體會并文獻復習_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

張廣 , 雒毅強 , 于天宇 ,  孫輝

吉林大學中日聯誼醫院甲狀腺外科吉林省外科轉化醫學重點實驗室（長春 130033）;

Corresponding?author：

孫輝, Email: sunhui1229@163.com

Keywords：

甲狀腺髓樣癌; 診斷; 治療; 文獻復習

DOI：

10.7507/1007-9424.201702027

Video：

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目的探討具特殊影像特征的甲狀腺髓樣癌（MTC）的臨床診治策略。方法回顧性分析筆者所在醫院于 2016 年 11 月收治的 1 例 MTC 病例的臨床資料和診治經過，并進行文獻復習。結果該例患者的頸部超聲檢查表現為甲狀腺腺瘤征象，術前血清降鈣素（Ctn）檢查結果異常升高，復查 Ctn的同時行血清癌胚抗原（CEA）、細針穿刺細胞學檢查（FNA）及洗脫液 Ctn 檢查，結果均提示 MTC 可能。根據術前影像學檢查和術中病理檢查結果行甲狀腺癌根治術，術后病理確診為 MTC。結論超聲檢查下不典型征象結節往往是 MTC 誤診的主要原因，故對于尚不能排除 MTC 可能者應該考慮進一步行血清 Ctn、血清 CEA、FNA、洗脫液 Ctn 等檢查以明確診斷，避免延誤治療。

Citation： 張廣, 雒毅強, 于天宇, 孫輝. 1 例具特殊影像特征甲狀腺髓樣癌的診治體會并文獻復習. 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.	張相民, 藍小林, 李榮, 等. 甲狀腺髓樣癌 17 例臨床分析. 中華實用診斷與治療雜志, 2013, 27(10): 1032-1033.
5.	滕衛平, 劉永鋒, 高明, 等. 甲狀腺結節和分化型甲狀腺癌診治指南. 中國腫瘤臨床, 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-?osyk M, Rucha?a 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, 張華偉, 粱波, 等. 甲狀腺髓樣癌的超聲診斷. 醫學影像學雜志, 2013, 23(12): 1897-1900.
11.	王滿立, 李妙珊, 馮占武, 等. 甲狀腺髓樣癌超聲特征與病理結果對比分析. 實用醫學雜志, 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.	王軍鐵, 張彬, 鄢丹桂, 等. 73 例初治甲狀腺髓樣癌術式探討. 中國腫瘤臨床, 2012, 39(7): 410-413.
23.	張再興, 李正江, 唐平章, 等. 甲狀腺髓樣癌的外科治療及預后分析. 中華耳鼻咽喉頭頸外科雜志, 2011, 46(3): 209-213.
24.	趙自然, 康維明. 甲狀腺髓樣癌外科診治. 中華臨床醫師雜志(電子版), 2012, 6(5): 1249-1252.
25.	陳曉紅. 甲狀腺髓樣癌的治療策略. 臨床耳鼻咽喉頭頸外科雜志, 2016, 30(21): 1667-1671.
26.	龔進發, 陳曦. 甲狀腺髓樣癌的診治. 外科理論與實踐, 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. 張相民, 藍小林, 李榮, 等. 甲狀腺髓樣癌 17 例臨床分析. 中華實用診斷與治療雜志, 2013, 27(10): 1032-1033.
5. 滕衛平, 劉永鋒, 高明, 等. 甲狀腺結節和分化型甲狀腺癌診治指南. 中國腫瘤臨床, 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-?osyk M, Rucha?a 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, 張華偉, 粱波, 等. 甲狀腺髓樣癌的超聲診斷. 醫學影像學雜志, 2013, 23(12): 1897-1900.
11. 王滿立, 李妙珊, 馮占武, 等. 甲狀腺髓樣癌超聲特征與病理結果對比分析. 實用醫學雜志, 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. 王軍鐵, 張彬, 鄢丹桂, 等. 73 例初治甲狀腺髓樣癌術式探討. 中國腫瘤臨床, 2012, 39(7): 410-413.
23. 張再興, 李正江, 唐平章, 等. 甲狀腺髓樣癌的外科治療及預后分析. 中華耳鼻咽喉頭頸外科雜志, 2011, 46(3): 209-213.
24. 趙自然, 康維明. 甲狀腺髓樣癌外科診治. 中華臨床醫師雜志(電子版), 2012, 6(5): 1249-1252.
25. 陳曉紅. 甲狀腺髓樣癌的治療策略. 臨床耳鼻咽喉頭頸外科雜志, 2016, 30(21): 1667-1671.
26. 龔進發, 陳曦. 甲狀腺髓樣癌的診治. 外科理論與實踐, 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狀腺髓樣癌的診治體會并文獻復習

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