May M, Marusch F, Kaufmann O, Seehafer M, Helke C, Hoschke B, Gastinger I
Urologische Klinik, Carl-Thiem-Klinikum, Cottbus.
Chirurg. 2003 Aug;74(8):768-74. doi: 10.1007/s00104-003-0674-y.
We investigated the usefulness of thyroidectomy for solitary metastases from renal cell carcinomas in ten patients. In the absence of postoperative morbidity and mortality, a mean survival time of 3.4 years was observed. Subsequently, four patients developed intracerebral metastases. Swelling of the neck and the discovery of a nodule in the thyroid of patients who have undergone nephrectomy for renal cell carcinoma should raise suspicion of a metastasis, possibly after a long latency period. With the aid of modern immunohistochemical methods, renal cell carcinoma metastasis can now be identified unequivocally, with differentiation from a primary follicular carcinoma of the thyroid rendered possible by a combination of TTF-1, thyroglobulin, and CD 10. In the event of a solitary lesion with no extrathyroidal tumour manifestation, an R0 resection of the metastasis should always be attempted. If tumour dissemination has occurred, palliative measures and endoscopic intervention (e.g. placement of an endotracheal stent) with the aim of improving quality of life by preventing obstruction of the airways are justified.
我们对10例肾细胞癌孤立性转移灶行甲状腺切除术的有效性进行了研究。在无术后并发症及死亡的情况下，观察到平均生存时间为3.4年。随后，4例患者发生脑转移。对于因肾细胞癌接受肾切除术的患者，颈部肿胀以及甲状腺结节的发现应引起对转移的怀疑，可能在很长的潜伏期之后。借助现代免疫组化方法，现在可以明确识别肾细胞癌转移灶，通过甲状腺转录因子-1（TTF-1）、甲状腺球蛋白和CD10的联合检测可以将其与甲状腺原发性滤泡癌区分开来。对于无甲状腺外肿瘤表现的孤立性病变，应始终尝试对转移灶进行R0切除。如果发生肿瘤播散，采取姑息措施和内镜干预（如放置气管内支架）以通过防止气道阻塞来改善生活质量是合理的。
