Objective To sum up experiences in diagnosis and treatment for thyroid malignancy. Methods Clinical records of 8 patients diagnosed as Hashimoto’s disease associated with thyroid malignancy by histologic examination at our hospital from Jan. 1998 to Dec. 1998 were analyzed. Results There were 1 male and 7 females with average age of 37.6 years. The incidence of Hashimoto’s disease associated with thyroid cancer and malignant lymphoma were 7.7% and 2.6%, respectively. No operative mortality and complication was found. Conclusion Hashimoto’s disease is not uncommon. The combined thyroid cancer is small with papillary carcinoma predominance and the prognosis is good. If it is complicated with malignant lymphoma, the thyroid is rapidly enlarged with pain and dyspnea.
ObjectiveTo investigate the value of carbon nanoparticle adopted in reoperation for thyroid cancer recurrence.
MethodsFrom July to November of 2015, patients diagnosed with thyroid cancer recurrence in department of Thyroid & Parathyroid surgery, West China Hospital, Sichuan University were enrolled in the research. All enrollment patients underwent carbon nanoparticles location guided by ultrasonography before reoperation. Relative data about surgery and location were analyzed retrospectively.
ResultsTwenty-two patients were enrolled in the research. Mean operation time was (60.45±12.91) minutes. During surgery, a total of 405 (average 18.4) lymph nodes were harvested, and the staining rate was 71.9% (291/405). The pathological examination showed that there was a significant difference in the positive rate between carbon nanoparticles stained lymph nodes (45.0%, 131/291) and non-stained lymph nodes (5.3%, 6/114), P < 0.001. In addition, the positive rate in non-targeted stained lymph nodes was 30.2% (62/205). By contrast, it was 5.3% (6/114) in non-targeted non-stained lymph nodes. The difference showed significant significance (P < 0.001).
ConclusionsAdoption of carbon nanoparticles in reoperation for thyroid cancer, which improves efficiency of dissection for the non-palpable lymph nodes metastasis, is worth generalizing in clinical practice.
ObjectiveTo investigate the condition of neck lymph node metastasis and related factors in thyroiditis coexisting thyroid cancer, and make clear the indication of neck lymph node dissection. MethodsA retrospective cohort study was conducted with the clinical data of 147 patients with thyroiditis coexisting thyroid cancer who underwent radical resection of thyroid cancer (total thyroidectomy or subtotal thyroidectomy) and neck lymph node dissection, including age, gender, tumor size, number of focuses, and lymph node metastasis. Results Among 147 patients, 65 patients with neck lymph node metastasis (44.22%), central cervical lymph node metastasis rate was 36.05% （53/147）， which was higher than that of lateral lymph node metastasis rate (20.41%, 30/147), Plt;0.05. Neck lymph node metastasis rate was correlated with patient’s gender and tumor size （Plt;0.05）, while it was not correlated with patient’s age and number of focuses (Pgt;0.05). ConclusionCentral neck lymph node metastasis rate is higher in patients with thyroiditis coexisting thyroid cancer, then routine prophylactic central neck lymph node dissection is significant. Patient’s gender and tumor size are correlated with neck lymph node metastasis. When tumor is larger or in male, ipsilateral lymph node dissection should be considered to done.
ObjectiveTo evaluate whether thyroglobin (Tg) value by radioimmunoassay (Tg-RIA) can be used as a complementary marker in differentiated thyroid cancer (DTC) patients, as serum Tg value is the key marker for the follow-up of patients with DTC, and endogenous antithyroglobulin (TgAb) interferes with serum Tg value by immunometric assay (Tg-IMA).
MethodsFifty-five in-hospital patients with DTC after total thyroidectomy and 131I ablation during September and December 2012 were enrolled. Tg-IMA tests and Tg-RIA tests were performed separately. Diagnostic criteria about relapse, metastasis or disease-free status of thyroid carcinoma were established by serum Tg, diagnostic whole body scan (D-WBS), neck ultrasonography, chest CT and patients' history.
ResultsTwo DTC patients showed false negative Tg-IMA and true positive Tg-RIA. Five patients had false negative Tg-RIA because of low sensitivity of RIA. Four patients with weak positive Tg-IMA (1.07-4.09 μg/L) required follow-up. Among the 11 DTC patients with strong TgAb positivity (>115 kU/L), two patients with positive Tg-IMA and positive Tg-RIA received second operation or radioiodine therapy, seven patients had positive Tg-RIA and negative Tg-IMA. Five of the seven patients with strong positive TgAb needed further follow-up, and two of them received radioiodine therapy.
ConclusionTg value with radioimmunoassay is a complementary marker to find false negative Tg-IMA in follow-up patients with DTC.
To search for the relationship between immune state and tumor metastases, CD3,CD4,CD8 and CD44 contents in 13 speciments of fine needle aspiration (FNA) from thyroid cancer patients were detected by the flowcytometry (FCM) and comparison between thyroid cancer and benign tumor was made. The result showed :in thyroid cancer group, CD＋3，CD＋4 cells and the ratio of CD＋4/CD＋8 reduced significantly (Ｐ＜0.01),and CD＋8 cell increased significantly (Ｐ＜0.01), in metastases group,this change was much significantly. CD44 expressed significantly higher in cancer group than that of the benign thyroid neoplasms, and the change was related to the tumor metastases. The results indicate that CD44 can be as a marker of tumor and indicator of metastases. The disturbance of immune system results in active expression of CD44 by tumor cells, so, lead to metastases. It is helpful to the diagnosis of thyroid cancer, assessment of metastases and management in surgery.
Objective The expression of CD15 antigen and oncoprotein bcl-2 in thyroid cancer were examined in order to study the correlation between them. Methods The expression of CD15 and bcl-2 in 50 thyroid cancers, 20 adjacent noncancerous portion, 45 adenoma and 10 normal thyroid tissue were respectively investigated by microwave-LSAB immunohistochemical technique. Results The positive rate of CD15 and bcl-2 in thyroid cancer was 68.0% and 46.0% respectively, which was significantly higher than that in adenoma or adjacent noncancerous (Ｐ＜0.05). The percentage of CD15 and bcl2 positive expression were found to be significantly correlated with the tumor metastasis (Ｐ＜0.05), but not correlated with histological feature. Expression of CD15 was significantly correlated with bcl-2.Conclusion Expression of CD15 and bcl-2 can be regarded as a parameter to evaluate tumor metastasis and prognosis of thyroid cancer.
ObjectiveTo assess the efficiency, safety and long-term prognosis for interventional bronchoscopy in the treatment of trachea invasion by thyroid cancer.
MethodsThe clinical data of forty-three patients with trachea invasion by thyroid cancer in Changhai Hospital from January 2006 to September 2015 were retrospectively analyzed. The trachea diameter and dyspnea score were compared before and after interventional treatment to explore the efficiency. The complications during and after therapy were observed. All patients were treated with interventional modalities including electrocautery, argon plasma coagulation, laser, cryotherapy, stent insertion or radioactive seeds implantation according to different invasion types, degree of stenosis and base situation.
ResultsThe trachea diameter increased from (3.9±1.5)mm to (10.6±0.6)mm after bronchoscopy therapy (t=-17.314, P < 0.000 1). The dyspnea score decreased from 3.3±0.7 to 2.3±0.7 after bronchoscopy therapy (t=9.274, P < 0.000 1). The complications during therapy included haemorrhage (46.5%), vocal cord paralysis (4.7%) and glottis edema (7.0%). The restenosis rate in the patients with stent insertion was 26.7%. Thirty-seven patients were followed up successfully, and the medium survival time for follow-up patients was 27 months. The univariate and multivariate analysis indicated that the kind of interventional modalities used for therapy was an independent prognostic factor of survival (HR=0.261, P=0.036). The medium survival time for the patients treated with≥3 methods, 2 methods and 1 method was 47 months, 36 months and 13 months, respectively.
ConclusionsFor trachea invasion by thyroid cancer, bronchoscopic therapy can effectively relieve airway obstruction and dyspnea symptom. Combination of multiple interventional modalities could have a favorable prognosis after treatment.
ObjectiveTo review the recent progress of the molecular targeted therapy for thyroid cancer.
MethodsThe literatures of molecular etiology for thyroid cancer, mechanism and evaluation of targeted therapy via Medline and CHKD database were reviewed.
ResultsSo far, four molecular targeted drugs (Sorafenib, Lenvatinib, Vandetanib, and Cabozantinib) have been approved for treatment of advanced thyroid cancer by FDA. They can mainly improve the patient's progression-free survival. Besides, several new molecular targeted drugs have accomplishedⅠphase or Ⅱ phase clinical trials. These drugs may be new options for treatment of advanced thyroid cancer in the future.
ConclusionsMolecular targeted drugs have been the main therapeutic method for advanced thyroid cancer. However, we should invent more effective new drugs and investigate the drug combination to improve the therapeutic effect.
Objective To summarize the progress in the diagnosis and treatment of thyroid cancer related genes. Methods By using the method of literature review, The literatures of thyroid cancer related gene were reviewed on the study of emerging diagnosis and treatment strategy. Results Combined detection of BRAF oncogene, RAS oncogene, RET/PTC rearrangement, PAX8-PPARγ fusion gene and its related genes, can effectively improve the prediction accuracy of the malignant thyroid nodule form benign, and has become a basis of targeted drug therapy. Conclusion In preoperative thyroid cancer, Joint detection of related gene can provide a molecular basis for the patients to guide the operation and drug treatment.
ObjectiveTo summarize the domestic and abroad articles related to the research on the relation between miRNA-221/222 and thyroid cancer, and explore the important effects of miRNA-221/222 in diagnosis and treatment of thyroid cancer.
MethodsDomestic and international publications involving the relationship of miRNA-221/222 to thyroid cancer were screened and reviewed.
ResultsMiRNA-221/222 is a tumor marker with high specificity and sensitivity in thyroid cancer. It has important significance for diagnosis, treatment and prognosis of thyroid cancer.
ConclusionMiRNA-221/222 is not only related to diagnosis of thyroid cancer, but also have provided a new research direction and method for gene therapy of thyroid cancer．
