甲状腺内转移瘤的外科治疗：一项多中心研究的初步结果
Surgical treatment of intrathyroid metastases: preliminary results of a multicentric study.
作者信息
Calzolari Filippo, Sartori Paola Vincenza, Talarico Carlo, Parmeggiani Domenico, Beretta Edoardo, Pezzullo Luciano, Bovo Giorgio, Sperlongano Pasquale, Monacelli Massimo, Lucchini Roberta, Misso Claudia, Gurrado Angela, D'Ajello Michele, Uggeri Franco, Puxeddu Efisio, Nasi Piergiorgio, Testini Mario, Rosato Lodovico, Barbarisio Alfonso, Avenia Nicola
机构信息
Inter-Hospital Functional Area of Endocrine Surgery, Umbria Region, Perugia, Italy.
出版信息
Anticancer Res. 2008 Sep-Oct;28(5B):2885-8.
BACKGROUND
Intrathyroid metastases (ITM) are rare and usually have a dismal prognosis. The aim of this study was to detect which neoplasms metastasize most often to the thyroid gland, their clinical features and treatment options.
MATERIALS AND METHODS
Retrospective analysis of clinical files of 17,122 patients submitted to surgery for thyroid disease between 1995 and 2005. Twenty-five patients (median age 61 years) were affected by ITM.
RESULTS
The site of the primary tumor was: kidney (15), lung (4), colon (3), breast (1), melanoma (1), and unknown in 1 patient. Ten patients (40%) complained of preoperative symptoms, in the others, thyroid involvement was incidentally discovered during the follow-up for the primary cancer. Twenty patients (80%) underwent total thyroidectomy, 3 received thyroid lobectomy and 2 palliative procedures. Morbidity was 16%, mortality was nil. The median follow-up was 24 months.
CONCLUSION
ITM should always be suspected in any patient with a previous history of malignancy. Fine-needle agobiopsy (FNAB) with immunohistochemical stains may help in preoperative workup. A long delay between the primary tumor and the recurrence warrants surgery and total thyroidectomy seems to be the treatment of choice because of the multifocality of metastasis to the thyroid gland.
背景
甲状腺内转移（ITM）较为罕见，预后通常较差。本研究旨在确定哪些肿瘤最常转移至甲状腺，其临床特征及治疗选择。
材料与方法
回顾性分析1995年至2005年间因甲状腺疾病接受手术的17122例患者的临床资料。25例患者（中位年龄61岁）患有ITM。
结果
原发肿瘤部位为：肾（15例）、肺（4例）、结肠（3例）、乳腺（1例）、黑色素瘤（1例），1例患者原发部位不明。10例患者（40%）术前有症状，其余患者在原发性癌症随访期间偶然发现甲状腺受累。20例患者（80%）接受了全甲状腺切除术，3例接受了甲状腺叶切除术，2例接受了姑息性手术。发病率为16%，无死亡病例。中位随访时间为24个月。
结论
既往有恶性肿瘤病史的任何患者均应怀疑有ITM。细针穿刺活检（FNAB）及免疫组化染色有助于术前评估。原发性肿瘤与复发之间的长时间间隔需要手术治疗，由于甲状腺转移具有多灶性，全甲状腺切除术似乎是首选治疗方法。
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