Mai Kein T, Khanna Priya, Yazdi Hossein M, Perkins D Garth, Veinot John P, Thomas Jane, Lamba Manisha, Nair Bhavani D
Department of Laboratory Medicine, The Ottawa Hospital, Ontario, Canada.
Pathology. 2002 Jun;34(3):239-44. doi: 10.1080/00313020220131291.
Non-medullary thyroid carcinomas arise from follicular cells. The purpose of this study is to correlate clinical and pathological properties of these tumours with the rate of distant metastasis from a series of thyroid tumours excised at one institution.
A total of 311 non-medullary thyroid tumours were identified and divided into: 29 follicular carcinoma (FC), 12 Hürthle cell carcinoma (HC), 13 Hürthle cell papillary thyroid carcinoma (HPTC) with vascular invasion (VI), 32 papillary thyroid carcinoma (PTC) with VI and 225 PTC without VI. The mean follow-up was 6.5 years with a range of 1-17 years. The tumours were histologically subdivided into minimal or wide invasion for FC and HC and focal or extensive invasion for PTC and HPTC, and stratified according to status of VI.
The rate of distant metastasis was similar for FC, malignant Hürthle cell tumours and PTC with VI, and increased with extent of invasion. VI was seen in 12% of all PTC and 0% of HPTC in this study. PTC without VI were associated with a much lower potential of distant metastasis, were smaller in size and occurred in patients of younger age than PTC with VI. In addition, there was a tendency for increased potential for distant metastases with increased tumour size and patient age for all groups of tumours in the study. Patient age and tumour size appeared to play a smaller role than that of VI in predicting distant metastasis.
Our study suggests that the rate of distant metastasis relates to VI, patient age and tumour size, regardless of Hürthle cell, FC or PTC differentiation. PTC of large size, and in patients older than 45 years, have a high propensity for vascular invasion.
非髓样甲状腺癌起源于滤泡细胞。本研究的目的是将这些肿瘤的临床和病理特征与在一家机构切除的一系列甲状腺肿瘤的远处转移率相关联。
共识别出311例非髓样甲状腺肿瘤，并分为：29例滤泡癌（FC）、12例许特莱细胞癌（HC）、13例伴有血管侵犯（VI）的许特莱细胞乳头状甲状腺癌（HPTC）、32例伴有VI的乳头状甲状腺癌（PTC）和225例不伴有VI的PTC。平均随访时间为6.5年，范围为1至17年。肿瘤在组织学上分为FC和HC的微小或广泛侵犯以及PTC和HPTC的局灶性或广泛性侵犯，并根据VI状态进行分层。
FC、恶性许特莱细胞肿瘤和伴有VI的PTC的远处转移率相似，且随侵犯程度增加而升高。在本研究中，所有PTC中有12%出现VI，而HPTC中为0%。不伴有VI的PTC发生远处转移的可能性低得多，体积较小，且发生在比伴有VI的PTC患者年龄更小的患者中。此外，研究中所有肿瘤组的远处转移潜能都有随肿瘤大小和患者年龄增加而升高的趋势。在预测远处转移方面，患者年龄和肿瘤大小似乎比VI起的作用更小。
我们的研究表明，无论许特莱细胞、FC或PTC分化如何，远处转移率均与VI、患者年龄和肿瘤大小有关。大尺寸的PTC以及45岁以上患者的PTC发生血管侵犯的倾向较高。
