Abrams J
Belegabteilung für HNO-Heilkunde, Kopf-und Halschirurgie, Plastische Operationen, Schilddrüsenchirurgie, St.-Barbara-Klinik, Am Heessener Wald 1, 59073, Hamm, Deutschland.
HNO. 2009 Sep;57(9):910-3. doi: 10.1007/s00106-008-1788-9.
Medullary carcinomas represent 4% of all thyroid carcinomas. Most important for diagnosis are ultrasound criteria and determination of serum calcitonin, using the pentagastrin test if necessary. We report on a 51-year-old woman who was suffering from persistent globus sensation. Ultrasound examination detected a small thyroid nodule with microcalcification in the right thyroid gland. Serum calcitonin representing the most important tumor marker was massively increased. We performed a total thyroidectomy with dissection of the paratracheal compartments and a conservative neck dissection on the side of the tumor. Postoperatively, serum calcitonin decreased but still remained increased overall. Because there is no other therapeutic option besides surgical treatment, the initial intervention is of tremendous importance. In addition, examination for a possible hereditary medullary thyroid carcinoma is required, which influences the patient's prognosis considerably and necessitates screening examinations of other relatives.
髓样癌占所有甲状腺癌的4%。诊断的最重要依据是超声标准以及血清降钙素的测定,必要时采用五肽胃泌素试验。我们报告一名51岁女性,她患有持续的咽部异物感。超声检查发现右侧甲状腺有一个伴有微钙化的小甲状腺结节。作为最重要的肿瘤标志物,血清降钙素大幅升高。我们进行了全甲状腺切除术,同时清扫气管旁间隙,并对肿瘤侧进行了保守性颈部清扫。术后,血清降钙素有所下降,但总体仍保持升高。由于除手术治疗外没有其他治疗选择,初始干预极为重要。此外,需要检查是否存在可能的遗传性甲状腺髓样癌,这对患者的预后有很大影响,并且需要对其他亲属进行筛查。