Sywak Mark, Pasieka Janice L, Ogilvie Travis
Tom Baker Cancer Center and University of Calgary, Calgary, Alberta, Canada.
J Surg Oncol. 2004 Apr 1;86(1):44-54. doi: 10.1002/jso.20044.
Tall cell (TCV), columnar cell (CCV), insular (IC), diffuse sclerosing (DSPTC) and solid/trabecular are uncommon subtypes of thyroid cancer, which have generally been described in case reports or small series in the world literature. Due to the rarity of these thyroid cancers, their clinical behavior remains incompletely understood. The aim of this review was to pool the currently available clinical information regarding these uncommon thyroid cancers so as to gain a better understanding of their clinical aspects and natural history.
A computer-aided search of MEDLINE (1966-2001, PUBMED website) and CINAHL (1982-2001) databases was performed, as well as a review of the reference section of each primary study was done. All cases of TCV, CCV, DSPTC, solid/trabecular, and IC described in the English medical literature were identified. For the subtypes DSPTC, TCV, and IC, clinical data from the published case series were combined in a weighted analysis. Weighting was based on the number of cases per series. For the CCV and the solid/trabecular variant, due to the small number of cases, raw figures for the clinical features were obtained.
DSPTC (n = 65) appeared to have a tendency for intra-thyroidal extension (40%) and a high propensity for nodal metastates (68%). The mean overall tumor related mortality was similar to well differentiated thyroid cancer (WDTC) at only 2% at 8 years follow-up. The solid/trabecular variant was seen in 37% of the radiation induced thyroid tumors of the Chernobyl accident. It had a high propensity for extrathyroidal extension, and cervical lymph node metastases were found in up to 83% of patients. Unlike WDTC, TCV (n = 209) was a more aggressive tumor, associated with distant metastases in 22% of cases and had a mean tumor related mortality of 16%. The histological diagnosis of TCV was a poor prognostic factor regardless of patient age or tumor size. The CCV (n = 41) had a high overall mortality rate of 32%. When encapsulated, however, CCV had an excellent prognosis similar to that found in WDTC. In contrast, CCV tumors that were not encapsulated had extrathyroidal spread in 67% and had distant metastases in 87% of patients. The variant of IC (n = 213) appeared to be an aggressive subtype of thyroid cancer. The mean loco-regional recurrence and/or distant metastases rate was 64% and tumor related mortality was high at 32%.
DSPTC, TCV, CCV, and IC are thyroid cancer subtypes, which have a biological aggressiveness, which appear to be intermediate between that of WDTC and poorly differentiated anaplastic thyroid cancer. J. Surg. Oncol. 2004;86:44-54.
高细胞型（TCV）、柱状细胞型（CCV）、岛状型（IC）、弥漫硬化型（DSPTC）及实体/小梁状型是甲状腺癌的罕见亚型，世界文献中通常仅在病例报告或小样本系列研究中有所描述。由于这些甲状腺癌较为罕见，其临床行为仍未被完全了解。本综述的目的是汇总目前关于这些罕见甲状腺癌的临床信息，以便更好地了解其临床特征及自然病程。
利用计算机检索MEDLINE（1966 - 2001年，PUBMED网站）和CINAHL（1982 - 2001年）数据库，并查阅每项原始研究的参考文献部分。识别英文医学文献中描述的所有TCV、CCV、DSPTC、实体/小梁状型及IC病例。对于DSPTC、TCV和IC亚型，将已发表病例系列的临床数据进行加权分析合并。加权基于每个系列的病例数。对于CCV和实体/小梁状变体，由于病例数较少，获取了临床特征的原始数据。
DSPTC（n = 65）似乎有甲状腺内浸润倾向（40%），且淋巴结转移倾向较高（68%）。平均总体肿瘤相关死亡率与高分化甲状腺癌（WDTC）相似，8年随访时仅为2%。实体/小梁状变体在切尔诺贝利事故辐射诱发的甲状腺肿瘤中占37%。它有较高的甲状腺外浸润倾向，高达83%的患者出现颈部淋巴结转移。与WDTC不同，TCV（n = 209）是一种侵袭性更强的肿瘤，22%的病例发生远处转移，平均肿瘤相关死亡率为16%。无论患者年龄或肿瘤大小，TCV的组织学诊断都是不良预后因素。CCV（n = 41）总体死亡率较高，为32%。然而，当有包膜时，CCV的预后极佳，与WDTC相似。相比之下，无包膜的CCV肿瘤67%有甲状腺外扩散，87%的患者发生远处转移。IC变体（n = 213）似乎是甲状腺癌的一种侵袭性亚型。局部区域复发和/或远处转移的平均发生率为64%，肿瘤相关死亡率高达32%。
DSPTC、TCV、CCV和IC是甲状腺癌亚型，具有生物学侵袭性，其侵袭性似乎介于WDTC和低分化间变性甲状腺癌之间。《外科肿瘤学杂志》2004年；86：44 - 54。
