In recent years, with the improvement of the sensitivity of examination equipment and the change of people's living environment and diet, the rate of thyroid cancer has risen rapidly, which has increased nearly five folds in 10 years. The pathogenesis, clinical manifestation, biological behavior, treatment and prognosis of thyroid carcinoma of different pathological types are obviously different. Papillary thyroid carcinoma (PTC) can develop at any age, which accounts for about 90% of thyroid cancer. It progresses slowly and has favourable prognosis, but lymph node metastasis appears easily. Whether PTC is accompanied by lymph node metastasis has an important impact on its prognosis and outcome. The Raf murine sarcoma viral oncogene homolog B(BRAF)gene mutation plays a crucial role in PTC lymph node metastasis. Having an in-depth understanding of the specific role and mechanism of BRAF gene mutation in PTC is expected to provide new ideas for diagnosis and treatment of PTC.
Objective To explore the protein expressions of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1)， and to investigate their relationships between their serum concentration before operation and the infiltration and metastasis of thyroid carcinoma. Methods The protein expressions of MMP-9 and TIMP-1 in 32 cases of thyroid carcinomas, 23 cases of adjacent tissues and 30 cases of benign hyperplastic lesions were measured by using immunohistochemistry. The preoperative serum concentrations of MMP-9 and TIMP-1 in 21 cases of thyroid carcinomas and 19 cases of benign hyperplastic lesions were determined by enzyme-linked immunosorbent assay. Results The positive expression rates of MMP-9 and TIMP-1 in tumor tissues were significantly higher （75.0%,56.3%）than those in adjacent tissues and benign hyperplastic lesions （30.4%, 21.7%; 26.7%, 23.3%) P＜0.05. There were correlations between the expressions of MMP-9 and TIMP-1 and the local infiltrative degrees, lymph node metastasis and TNM stage （P＜0.05）. There was a negative correlation between the expression of MMP-9 and the expression of TIMP-1 （r=-0.509， P=0.003）. The concentration of MMP-9 in serum of thyroid carcinoma patients was (122.60±36.20) ng/ml, whereas TIMP-1 was (59.44±38.65) ng/ml, both of which were significantly higher compared to those of benign group (P＜0.05). In addition, there was a positive correlation between the expressions of MMP-9/TIMP-1 in the carcinoma tissues and their concentrations in serum （P＜0.05）.Conclusion To detection the expressions of MMP-9 and TIMP-1 in the lesion and their concentrations in the serum may not only contribute to the differential diagnosis of thyroid tumors, but may also help to predict the prognosis of the carcinoma.
ObjectiveTo investigate the expression of tumor suppressor gene Tat interacting protein 30 (TIP30) gene in papillary thyroid carcinoma and it’s clinical significance in treatment of thyroid carcinoma. Methods Thirty cases of pathological specimens wax pieces of papillary thyroid carcinoma from 2003 to 2006 in our hospital were selected, in which there were 7 male, 23 female； and the age was from 15 to 70 years old, average 44.7 years. Six cases were nodular goiter with carcinomatous change in local area (papillary), 2 cases were thyroid capsular invasion. Distant lymph node metastasis and lesions surrounding the thyroid tissue were not confirmed by pathology. Every specimen was divided into tumor tissue and adjacent tissue (1-2 cm far away from tumor and non-cancerous tissue was confirmed by pathology). The expression of TIP30 in specimen was detected by immunohistochemical method with staining index and the average absorbance. ResultsTIP30 was expressed in the cell membrane and cytoplasm, which was showed as brown particles. ①Staining index: TIP30 in adjacent tissues was expressed highly with 21 (70.0%) positive cases (gt;2 points) and 9 (30.0%) negative cases (≤2 points), while its expression in cancer tissues was reduced or missed with 11 (36.7%) positive cases (gt;2 points) and 19 (63.3%) negative cases (≤2 points). There was a statistical difference between them (P＜0.05), and it was not related to age and gender of patients (Pgt;0.05). ②The average absorbance of TIP30 in cancer tissues was significantly lower than that in adjacent tissue (P＜0.05). ConclusionThe expression of TIP30 in papillary thyroid carcinoma is reduced or deleted, which can supply some theory support for its gene therapy.
ObjectiveTo explore a method for establishing a priority-scoring model for thyroid carcinoma patient admission. MethodsA questionnaire survey was conducted among specialists and outpatients in the thyroid surgery department of the hospital. The weight coefficient of the index factors was calculated to establish the priority-scoring mode by the analytic hierarchy process. The differences in results between specialists and patients were compared. The logical rationality of the model index was tested. ResultsA priority-scoring model for thyroid carcinoma surgery admission was established, including 10 first-level indicators, such as sex, age, cancer type and TNM stage. The weight coefficients of the indicators from high to low were cancer type (0.137), TNM stage (0.134), tumor size (0.127), tumor invasion degree (0.126), tumor invasion site (0.124), relationship between tumor and capsule (0.111), age (0.093), sex (0.061), place of residence (0.05) and medical insurance type (0.035). After the total ratio test, the model CR value was 0.0073, and the model index was highly rational. ConclusionThis study successfully establish a priority-scoring model for thyroid carcinoma surgery admission, which can provide references and a basis for tiered medical services and relevant researches in the future.
Objective To detect the expression of KiSS-1 protein in papillary thyroid carcinoma, and to analyze its significance. Methods Paraffin-embedded specimens of 32 patients with thyroid papillary carcinoma and its adjacent cancer tissues were included in this study. Then the expression of KiSS-1 protein was detected by munohistochemistry and its relationship with clinical pathological features was analyzed. Results KiSS-1 protein mainly expressed in the cell membrane and cytoplasm. The expression of KiSS-1 protein was positive in adjacent tissues, but decreased or absent in cancer tissues in 32 patients. In the latter, there were 11 cases with positive expression (34.4%) and 21 cases with negative expression (65.6%), and the difference was statistically significant (χ2=31.256, Plt;0.001). The average value of KiSS-1 protein expression represented by absorbance (A) value (119.595 2) in cancer tissues was higher than that in adjacent tissues (174.805 0), t=34.429, Plt;0.001. The expression of KiSS-1 protein in cancer tissues was not related to patient gender (P=0.618) and age (P=0.061), but except TNM staging (P=0.034). The expression rate of KiSS-1 protein in cancer tissues with lymph node metastasis (4/4, 100%) was significantly higher than that without lymph node metastasis (7/28, 25.0%)， P=0.003. Conclusion The expression of KiSS-1 protein is decreased or absent in papillary thyroid carcinoma, which may be involved in tumorigenesis, invasion, and metastasis.
Objective To explore the change of constitution in thyroid diseases of West China Hospital between 2000 and 2012， in order to provide clinical evidence. Methods Clinical data， including gender， age， and pathological diagnosis of patients with thyroid disease who underwent primary thyroid surgery in our hospital from 2000 to 2012 were collected retrospectively and analyzed statistically. Results A total of 9 642 patients were enrolled， including 1 893 male patients and 7 749 female patients. The ratio of male to female patients was 1 to 4.09. In male patients， the proportion of thyroid carcinoma were significantly higher than those of female group （P=0.02）；in male patients younger than 45 group， the proportion of thyroid carcinoma were significantly higher than those of female group （P＜0.01）. There was no statistical difference on the proportion between male and female patients older than 45 group （P=0.90）. Proportion of thyroid carcinoma， especially proportion of papillary thyroid carcinoma （PTC） increased in general. Proportion of Hashimoto thyroiditis （HT） increased in general too. HT with thyroid carcinoma accounted for an increasing proportion of all patients with HT. Proportion of nodular goiter （NG） increased at first and then declined. Proportion of thyroid adenoma （TA） decreased on the whole. Conclusions Proportion of thyroid carcinoma， especially proportion of PTC increase in recent years on the whole in patients underwent surgery. All these changes need to be given sufficient attention.
ObjectiveTo explore the influencing factors affecting lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) metastasis in papillary thyroid carcinoma (PTC) and construct a clinical nomogram prediction model to provide a reference for LN-prRLN dissection decision-making. MethodsThe clinical data of PTC patients admitted to the General Surgery Department of Baoding No.1 Central Hospital from January 2021 to December 2023 were retrospectively analyzed. Among them, 325 patients underwent LN-prRLN dissection, and they were divided into non-metastatic group (269 cases) and metastasis group (56 cases) according to the presence or absence of LN-prRLN metastasis. By comparing the differences of clinical and pathological characteristics between the two groups, the risk factors of LN-prRLN metastasis were analyzed and discussed, and then the nomogram prediction model of LN-prRLN metastasis was constructed with the risk factors, and the effectiveness of the model was verified and evaluated. ResultsIn 325 patients, 56 cases (17.23%) occurred LN-prRLN metastasis. The results of univariate analysis showed that gender, extrathyroidal extension, lymph nodes anterior to right recurrent laryngeal nerve (LN-arRLN) metastasis, location of cancer focus, and lateral lymph node metastasis (LLNM) were related to LN-prRLN metastasis of PTC (P<0.05). Multivariate binary logistic regression analysis showed that male [OR=3.878, 95%CI (1.192, 12.615)], with extrathyroidal extension [OR=2.836, 95%CI (1.036, 7.759)], with LN-arRLN metastasis [OR=10.406, 95%CI (3.225, 33.926)], right cancer focus [OR= 5.632, 95%CI (1.812, 17.504)] and with LLNM [OR=3.426, 95%CI (1.147, 10.231)] were the risk factors of LN-prRLN metastasis. Receiver operating characteristic curves of nomogram prediction model based on the above risk factors showed that the area under the curve was 0.865, 95%CI was (0.795, 0.934), Jordan index was 0.729, sensitivity was 0.873, and specificity was 0.856, which had higher prediction value. The C-index of Bootstrap test was 0.840 [95%CI (0.755, 0.954) ]. Calibration curves showed that predictive value close to the ideal curve, had good consistency. The clinical decision curve analysis showed that the model had good clinical prediction effect on LN-prRLN metastasis of PTC. ConclusionsMale, extrathyroidal extension, LN-arRLN metastasis, right cancer focus and LLNM are independent risk factors for LN-prRLN metastasis of PTC. The nomogram prediction model based on the above independent risk factors has high discrimination and calibration, which is helpful for surgeons to make clinical decisions.
Objective To investigate the expression of c-met in tall cell variant of papillary thyroid carcinoma, and to compare it with other types of thyroid carcinoma and benign thyroid tissue. Methods The expressions of c-met in 60 cases of thyroid specimens were tested by immunohistochemical staining. Results The levels of expressed c-met in tall cell variant specimens were significantly higher than those in other types of papillary thyroid carcinoma and benign thyroid tissue. c-met expressions were significantly different in the following pairs of types: tall cell variant vs common papillary carcinoma of thyroid (P=0.000 1), tall cell variant vs follicular variant papillary thyroid carcinoma (P=0.000 1), and tall cell variant vs benign thyroid tissue (P=0.000 1). In addition, for all types of papillary carcinomas evaluated, c-met expression was significantly higher in specimens with extracapsular spread (P=0.010 0) and skeletal muscle invasion (P=0.020 0). Conclusion The high expression of c-met is a significant marker for tall cell variant papillary carcinoma of thyroid and its invasive behavior. This finding may explain the unusually aggressive behavior of this tumor and suggest a role for c-met in the early identification of patients with tall cell variant thyroid carcinoma.
ObjectiveTo summarize the prevention and treatment strategies and their effects on lymphatic leakage following transoral endoscopic thyroid cancer lateral neck lymph node dissection. MethodsA retrospective review was conducted, we collected clinical data from 47 patients with papillary thyroid carcinoma who underwent transoral endoscopic thyroidectomy and lateral neck lymph node dissection at our hospital from January 2021 to May 2023. A stepwise sequential treatment plan was adopted for patients with postoperative lymphatic leakage: low-fat, low-protein diet, continuous strong negative pressure suction, subcutaneous injection of Group A streptococcus in the surgical cavity, and ligation of the thoracic duct or lymphatic vessels through a small incision. The effectiveness of the sequential treatment plan was summarized. ResultsOut of the 47 patients, lymphatic leakage occurred in 5 cases postoperatively. Patient No.1 was cured of lymphatic leakage after sequential treatments including pectoralis major muscle flap occlusion of the jugular venous angle, low-fat, low-protein diet, continuous strong negative pressure suction postoperatively, subcutaneous injection of Group A streptococcus in the surgical cavity, and finally ligation of the thoracic duct or lymphatic vessels through a small incision. Patient No.20 was conservatively cured of lymphatic leakage with an initial surgical procedure involving pectoralis major muscle flap occlusion of the jugular venous angle, low-fat, low-protein diet, continuous strong negative pressure suction postoperatively, and subcutaneous injection of Group A streptococcus in the surgical cavity. Patient No.28 recovered after only pectoralis major muscle flap occlusion of the jugular venous angle, low-fat, low-protein diet and continuous strong negative pressure suction postoperatively. Treatment process of patient No.30 was the same as Patient No.1, Patient No.36 was the same as Patient No.20. Through the stepwise sequential treatment measures, all 5 patients successfully recovered from lymphatic leakage; the postoperative hospital stay ranged from 3 to 17 days, with an average of 8.6 days. ConclusionsThe stepwise sequential treatment plan used in this study can effectively prevent and treat lymphatic leakage after transoral endoscopic thyroid cancer lateral neck lymph node dissection. Given the small sample size of this study, we believe that it is necessary to conduct long-term studies to confirm the durability and stability of these measures.
Objective
To summarize the advanced researchs of autoimmune thyroid disease(ATD) complicated with differentiated thyroid cancer (DTC).
Methods
The related literatures about concurrent ATD and DTC were consulted and reviewed.
Results
Hashimoto diseas (HD) complicated with DTC at home and abroad were reported more and more, whether merging with HD or other ATD disease could affect the prognosis of papillary thyroid cancer (PTC) was a controversial topic. HD and DTC (mainly PTC) had some same epidemiological and molecular features.
Conclusion
Better understanding of clinical pathology and characteristic of DTC concurrent with ATD can provide some new insights to immunotherapy for DTC.
