甲狀腺混合性髓樣-乳頭狀癌伴混合性淋巴結轉移1例報道并文獻復習_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

張競軼 ¹ ,  王建華 ¹ , 黃馳 ¹ , 曾錚 ² , 徐書杭 ³

1. ;
2. ;
3. ;

Corresponding?author：

王建華, Email: 311w@163.com

Keywords：

甲狀腺癌; 混合性髓樣-乳頭狀癌; 甲狀腺髓樣癌

DOI：

10.7507/1007-9424.202303047

Video：

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目的回顧1例甲狀腺混合性髓樣-乳頭狀癌伴混合性淋巴結轉移患者的診治經過，結合國內外文獻對本病的診療進行總結，以期為臨床診治提供一定的參考。方法回顧分析該患者的臨床資料、病理切片特征以及免疫組織化學染色結果。在中英文數據庫對該類病例進行檢索，結合既往文獻病例進行分析討論，總結本病的特征。結果該例患者術前血清降鈣素和癌胚抗原均升高，行甲狀腺全切除加雙側中央區及頸側區淋巴結清掃術，術后降鈣素和癌胚抗原較術前明顯下降。隨訪半年，一般情況良好。總結文獻報道病例資料，提示甲狀腺混合性髓樣-乳頭狀癌發病以中老年患者為主，多以頸部無痛性結節為主要臨床表現，多數病例有血清降鈣素與癌胚抗原升高，病理學上以髓樣癌與乳頭狀癌混合存在為主要特征，以髓樣癌成分占比較高較為多見。治療上以甲狀腺全切除術為主要手段，后續治療需監測血清降鈣素、癌胚抗原、甲狀腺球蛋白以及綜合影像學改變，放射性碘治療可根據自身病情特點酌情選擇。本病總體預后較好。結論甲狀腺混合性髓樣-乳頭狀癌發病罕見，在前期診斷時應盡量完善降鈣素和癌胚抗原的檢查，減少漏診的可能；穿刺輔以免疫組織化學檢測有一定的診斷價值；規范的外科手術是治療的最佳手段，準確的病理學分類以及不同類型腫瘤細胞占比有助于指導術后治療。

Citation： 張競軼, 王建華, 黃馳, 曾錚, 徐書杭. 甲狀腺混合性髓樣-乳頭狀癌伴混合性淋巴結轉移1例報道并文獻復習. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(7): 849-854. doi: 10.7507/1007-9424.202303047 Copy

1.	萬政, 劉梅, 郗洪慶, 等. 混合性甲狀腺癌預后因素及病理特征分析. 中華內分泌外科雜志, 2021, 15(2): 147-153.
2.	Papotti M, Negro F, Carney JA, et al. Mixed medullary-follicular carcinoma of the thyroid. A morphological, immunohistochemical and in situ hybridization analysis of 11 cases. Virchows Arch, 1997, 430(5): 397-405.
3.	宋光耀, 席崢, 高志安, 等. 甲狀腺髓樣癌合并乳頭狀癌1例. 中國誤診學雜志, 2004, 4(6): 958.
4.	吳義春, 吳強, 吳繼鋒, 等. 甲狀腺乳頭狀癌合并髓樣癌1例. 臨床與實驗病理學雜志, 2007, 23(1): 115-116.
5.	高志斌, 王兆平, 趙鶯, 等. 甲狀腺混合性髓樣乳頭狀癌一例. 中華病理學雜志, 2008, 37(10): 716-717.
6.	周兵, 王潔, 劉浩茹, 等. 甲狀腺髓樣癌伴乳頭狀癌1例. 臨床與實驗病理學雜志, 2017, 33(9): 1059-1060.
7.	蔡玲玲, 劉宇飛, 胡余昌, 等. 甲狀腺混合性髓樣-濾泡細胞癌1例并文獻復習. 巴楚醫學, 2018, 1(1): 98-101.
8.	魏松鋒, 王萍萍, 程潤芬, 等. 甲狀腺混合性髓樣-乳頭狀癌與甲狀腺髓樣癌合并乳頭狀癌的臨床病理特征比較. 中華普通外科雜志, 2021, 36(6): 405-409.
9.	胥芹, 張超, 田妍. 甲狀腺混合性髓樣-乳頭狀癌超聲表現1例. 中國超聲醫學雜志, 2022, 38(1): 119.
10.	Shimizu M, Hirokawa M, LiVolsi VA, et al. Combined “mixed medullary-follicular” and “papillary” carcinoma of the thyroid with lymph node metastasis. Endocr Pathol, 2000, 11(4): 353-358.
11.	Shiroko T, Yokoo N, Okamoto K, et al. Mixed medullary-papillary carcinoma of the thyroid with lymph node metastases: report of a case. Surg Today, 2001, 31(4): 317-321.
12.	Hewavisenthi SJ, Ariyarathne J, Gunawardena PA. Mixed medullary follicular carcinoma—an unusual thyroid neoplasm. Ceylon Med J, 2000, 45(1): 34-35.
13.	Goyal R, Nada R, Rao KL, et al. Mixed medullary and follicular cell carcinoma of the thyroid with lymph node metastasis in a 7-year-old child. Pathol Int, 2006, 56(2): 84-88.
14.	Gupta V. Simultaneous presentation of giant pheochromocytoma, primary hyperparathyroidism, and mixed-medullary-papillary thyroid cancer in MEN 2A. Indian J Endocrinol Metab, 2013, 17(4): 751-755.
15.	Jain M, Verma D, Thomas S, et al. Mixed medullary-papillary carcinoma thyroid: an uncommon variant of thyroid carcinoma. J Lab Physicians, 2014, 6(2): 133-135.
16.	Subramanian N, Agarwal SK, Agarwal A, et al. Rare mixed thyroid carcinomas: a report of two cases. Iran J Otorhinolaryngol, 2022, 34(120): 55-57.
17.	Dionigi G, Castano P, Bertolini V, et al. Simultaneous medullary and papillary thyroid cancer: two cases reports. J Med Case Rep, 2007, 1: 133. doi:10.1186/1752-1947-1-133.
18.	Nangue C, Bron L, Portmann L, et al. Mixed medullary-papillary carcinoma of the thyroid: report of a case and review of the literature. Head Neck, 2009, 31(7): 968-974.
19.	Hasney CP, Amedee RG. Mixed medullary-papillary carcinoma of the thyroid: a case report. Laryngoscope, 2010, 120 Suppl 4: S153. doi:10.1002/lary.21617.
20.	Hanna AN, Michael CW, Jing X. Mixed medullary-follicular carcinoma of the thyroid: diagnostic dilemmas in fine-needle aspiration cytology. Diagn Cytopathol, 2011, 39(11): 862-865.
21.	Chambers M, Tafe LJ, Gutmann EJ, et al. Cytologic features of a case of mixed medullary and follicular cell-derived thyroid carcinoma with review of the literature. Diagn Cytopathol, 2021, 49(3): E125-E129. doi: 10.1002/dc.24615.
22.	Zoroquiain P, Torres J, Go?i I, et al. True mixed medullary papillary carcinoma of the thyroid: a case report with low blood calcitonin levels. Endocr Pathol, 2012, 23(3): 168-171.
23.	Tohidi M, Pourbehi G, Bahmanyar M, et al. Mixed medullary-follicular carcinoma of the thyroid. Case Rep Endocrinol, 2013, 2013: 571692. doi:10.1155/2013/571692.
24.	Gurkan E, Gurbuz Y, Tarkun I, et al. Mixed medullary-papillary carcinoma of the thyroid: report of two cases and review of the literature. Indian J Pathol Microbiol, 2014, 57(4): 598-602.
25.	Guerreiro V, Costa C, Oliveira J, et al. Mixed medullary-papillary thyroid carcinoma with mixed lymph node metastases: A case report. Clin Case Rep, 2021, 9(5): e04165. doi:10.1002/ccr3.4165.
26.	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. Clin Endocrinol (Oxf), 2010, 72(2): 256-263.
27.	Sandilos G, Lou J, Butchy MV, et al. Features of mixed medullary thyroid tumors: An NCDB analysis of clinicopathologic characteristics and survival. Am J Surg, 2023, S0002-9610(23)00058-2. doi:10.1016/j.amjsurg.2023.02.006.
28.	Wang M, Chen H, Wang Y, et al. Diagnostic value and cost-effectiveness of FNA-CT versus FNAC for medullary thyroid carcinoma. Clin Endocrinol (Oxf), 2023, 98(5): 709-718.
29.	中國醫師協會外科醫師分會甲狀腺外科醫師委員會, 中國抗癌協會甲狀腺癌專業委員會, 中國研究型醫院學會甲狀腺疾病專業委員會. 甲狀腺髓樣癌診斷與治療中國專家共識(2020版). 中國實用外科雜志, 2020, 40(9): 1012-1020.
30.	Biscolla RP, Ugolini C, Sculli M, et al. Medullary and papillary tumors are frequently associated in the same thyroid gland without evidence of reciprocal influence in their biologic behavior. Thyroid, 2004, 14(11): 946-952.
31.	Zhang D, Yang M, Zhang X, et al. Thirty synchronous medullary and papillary thyroid carcinomas. Front Endocrinol (Lausanne), 2023, 14: 1153248. doi:10.3389/fendo.2023.1153248.
32.	Sadow PM, Hunt JL. Mixed medullary-follicular-derived carcinomas of the thyroid gland. Adv Anat Pathol, 2010, 17(4): 282-285.
33.	Ciampi R, Romei C, Pieruzzi L, et al. Classical point mutations of RET, BRAF and RAS oncogenes are not shared in papillary and medullary thyroid cancer occurring simultaneously in the same gland. J Endocrinol Invest, 2017, 40(1): 55-62.
34.	Negura I, Ianole V, Danciu M, et al. Thyroid collision tumors: the presence of the medullary thyroid carcinoma component negatively influences the prognosis. Diagnostics (Basel), 2023, 13(2): 285. doi:10.3390/diagnostics13020285.
35.	Myoteri D, Dellaportas D, Carvounis E, et al. Mixed medullary and papillary thyroid carcinoma: a stepwise diagnosis. J BUON, 2016, 21(6): 1561-1562.

1. 萬政, 劉梅, 郗洪慶, 等. 混合性甲狀腺癌預后因素及病理特征分析. 中華內分泌外科雜志, 2021, 15(2): 147-153.
2. Papotti M, Negro F, Carney JA, et al. Mixed medullary-follicular carcinoma of the thyroid. A morphological, immunohistochemical and in situ hybridization analysis of 11 cases. Virchows Arch, 1997, 430(5): 397-405.
3. 宋光耀, 席崢, 高志安, 等. 甲狀腺髓樣癌合并乳頭狀癌1例. 中國誤診學雜志, 2004, 4(6): 958.
4. 吳義春, 吳強, 吳繼鋒, 等. 甲狀腺乳頭狀癌合并髓樣癌1例. 臨床與實驗病理學雜志, 2007, 23(1): 115-116.
5. 高志斌, 王兆平, 趙鶯, 等. 甲狀腺混合性髓樣乳頭狀癌一例. 中華病理學雜志, 2008, 37(10): 716-717.
6. 周兵, 王潔, 劉浩茹, 等. 甲狀腺髓樣癌伴乳頭狀癌1例. 臨床與實驗病理學雜志, 2017, 33(9): 1059-1060.
7. 蔡玲玲, 劉宇飛, 胡余昌, 等. 甲狀腺混合性髓樣-濾泡細胞癌1例并文獻復習. 巴楚醫學, 2018, 1(1): 98-101.
8. 魏松鋒, 王萍萍, 程潤芬, 等. 甲狀腺混合性髓樣-乳頭狀癌與甲狀腺髓樣癌合并乳頭狀癌的臨床病理特征比較. 中華普通外科雜志, 2021, 36(6): 405-409.
9. 胥芹, 張超, 田妍. 甲狀腺混合性髓樣-乳頭狀癌超聲表現1例. 中國超聲醫學雜志, 2022, 38(1): 119.
10. Shimizu M, Hirokawa M, LiVolsi VA, et al. Combined “mixed medullary-follicular” and “papillary” carcinoma of the thyroid with lymph node metastasis. Endocr Pathol, 2000, 11(4): 353-358.
11. Shiroko T, Yokoo N, Okamoto K, et al. Mixed medullary-papillary carcinoma of the thyroid with lymph node metastases: report of a case. Surg Today, 2001, 31(4): 317-321.
12. Hewavisenthi SJ, Ariyarathne J, Gunawardena PA. Mixed medullary follicular carcinoma—an unusual thyroid neoplasm. Ceylon Med J, 2000, 45(1): 34-35.
13. Goyal R, Nada R, Rao KL, et al. Mixed medullary and follicular cell carcinoma of the thyroid with lymph node metastasis in a 7-year-old child. Pathol Int, 2006, 56(2): 84-88.
14. Gupta V. Simultaneous presentation of giant pheochromocytoma, primary hyperparathyroidism, and mixed-medullary-papillary thyroid cancer in MEN 2A. Indian J Endocrinol Metab, 2013, 17(4): 751-755.
15. Jain M, Verma D, Thomas S, et al. Mixed medullary-papillary carcinoma thyroid: an uncommon variant of thyroid carcinoma. J Lab Physicians, 2014, 6(2): 133-135.
16. Subramanian N, Agarwal SK, Agarwal A, et al. Rare mixed thyroid carcinomas: a report of two cases. Iran J Otorhinolaryngol, 2022, 34(120): 55-57.
17. Dionigi G, Castano P, Bertolini V, et al. Simultaneous medullary and papillary thyroid cancer: two cases reports. J Med Case Rep, 2007, 1: 133. doi:10.1186/1752-1947-1-133.
18. Nangue C, Bron L, Portmann L, et al. Mixed medullary-papillary carcinoma of the thyroid: report of a case and review of the literature. Head Neck, 2009, 31(7): 968-974.
19. Hasney CP, Amedee RG. Mixed medullary-papillary carcinoma of the thyroid: a case report. Laryngoscope, 2010, 120 Suppl 4: S153. doi:10.1002/lary.21617.
20. Hanna AN, Michael CW, Jing X. Mixed medullary-follicular carcinoma of the thyroid: diagnostic dilemmas in fine-needle aspiration cytology. Diagn Cytopathol, 2011, 39(11): 862-865.
21. Chambers M, Tafe LJ, Gutmann EJ, et al. Cytologic features of a case of mixed medullary and follicular cell-derived thyroid carcinoma with review of the literature. Diagn Cytopathol, 2021, 49(3): E125-E129. doi: 10.1002/dc.24615.
22. Zoroquiain P, Torres J, Go?i I, et al. True mixed medullary papillary carcinoma of the thyroid: a case report with low blood calcitonin levels. Endocr Pathol, 2012, 23(3): 168-171.
23. Tohidi M, Pourbehi G, Bahmanyar M, et al. Mixed medullary-follicular carcinoma of the thyroid. Case Rep Endocrinol, 2013, 2013: 571692. doi:10.1155/2013/571692.
24. Gurkan E, Gurbuz Y, Tarkun I, et al. Mixed medullary-papillary carcinoma of the thyroid: report of two cases and review of the literature. Indian J Pathol Microbiol, 2014, 57(4): 598-602.
25. Guerreiro V, Costa C, Oliveira J, et al. Mixed medullary-papillary thyroid carcinoma with mixed lymph node metastases: A case report. Clin Case Rep, 2021, 9(5): e04165. doi:10.1002/ccr3.4165.
26. 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. Clin Endocrinol (Oxf), 2010, 72(2): 256-263.
27. Sandilos G, Lou J, Butchy MV, et al. Features of mixed medullary thyroid tumors: An NCDB analysis of clinicopathologic characteristics and survival. Am J Surg, 2023, S0002-9610(23)00058-2. doi:10.1016/j.amjsurg.2023.02.006.
28. Wang M, Chen H, Wang Y, et al. Diagnostic value and cost-effectiveness of FNA-CT versus FNAC for medullary thyroid carcinoma. Clin Endocrinol (Oxf), 2023, 98(5): 709-718.
29. 中國醫師協會外科醫師分會甲狀腺外科醫師委員會, 中國抗癌協會甲狀腺癌專業委員會, 中國研究型醫院學會甲狀腺疾病專業委員會. 甲狀腺髓樣癌診斷與治療中國專家共識(2020版). 中國實用外科雜志, 2020, 40(9): 1012-1020.
30. Biscolla RP, Ugolini C, Sculli M, et al. Medullary and papillary tumors are frequently associated in the same thyroid gland without evidence of reciprocal influence in their biologic behavior. Thyroid, 2004, 14(11): 946-952.
31. Zhang D, Yang M, Zhang X, et al. Thirty synchronous medullary and papillary thyroid carcinomas. Front Endocrinol (Lausanne), 2023, 14: 1153248. doi:10.3389/fendo.2023.1153248.
32. Sadow PM, Hunt JL. Mixed medullary-follicular-derived carcinomas of the thyroid gland. Adv Anat Pathol, 2010, 17(4): 282-285.
33. Ciampi R, Romei C, Pieruzzi L, et al. Classical point mutations of RET, BRAF and RAS oncogenes are not shared in papillary and medullary thyroid cancer occurring simultaneously in the same gland. J Endocrinol Invest, 2017, 40(1): 55-62.
34. Negura I, Ianole V, Danciu M, et al. Thyroid collision tumors: the presence of the medullary thyroid carcinoma component negatively influences the prognosis. Diagnostics (Basel), 2023, 13(2): 285. doi:10.3390/diagnostics13020285.
35. Myoteri D, Dellaportas D, Carvounis E, et al. Mixed medullary and papillary thyroid carcinoma: a stepwise diagnosis. J BUON, 2016, 21(6): 1561-1562.

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甲狀腺混合性髓樣-乳頭狀癌伴混合性淋巴結轉移1例報道并文獻復習

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