Suganuma Nobuyasu, Wada Nobuyuki, Arai Hiromasa, Nakayama Hirotaka, Fujii Keita, Masudo Katsuhiko, Yukawa Norio, Rino Yasushi, Masuda Munetaka, Imada Toshio
Department of Surgery, Yokohama City University Hospital and Medical Center Fukuura, Kanazawa, Yokohama, Kanagawa Japan.
J Med Case Rep. 2009 Jun 8;3:7259. doi: 10.4076/1752-1947-3-7259.
The distant metastases from differentiated thyroid carcinomas are often untreatable. In particular, bone metastasis is significantly related to poor prognosis since radioactive iodine therapy is generally less effective. Therefore, surgical resection is considered one of the treatments for patients with bone metastases. We report chest wall resection and reconstruction using titanium micromesh covered with polypropylene mesh (Marlex mesh) for metastatic rib bones as a result of follicular thyroid carcinoma.
A 51-year-old man was referred to our institution with a painful chest wall tumor. He presented with a 15 x 10 cm bony swelling on the left chest wall and multiple small lung nodules from follicular thyroid carcinoma. Completion total thyroidectomy, chest wall resection and reconstruction using titanium micromesh covered with Marlex mesh were performed. There were no critical complications associated with surgical treatments and tumor pain disappeared during the postoperative period. Then, he received radioactive iodine therapy and the uptake of radioactive iodine was well observed in bilateral lung fields.
Reconstruction using titanium micromesh covered with Marlex mesh is possible for repairing the wide chest wall resection required for thyroid carcinoma metastasis. This technique would help to enhance treatment efficacy in the combination therapy of radioactive iodine and surgery in patients with large thyroid carcinoma metastasis in the chest wall.
分化型甲状腺癌的远处转移通常难以治疗。特别是骨转移与预后不良显著相关,因为放射性碘治疗一般效果较差。因此,手术切除被认为是骨转移患者的治疗方法之一。我们报告了使用覆盖有聚丙烯网(Marlex网)的钛微网对滤泡状甲状腺癌导致的转移性肋骨进行胸壁切除和重建的病例。
一名51岁男性因胸壁疼痛性肿瘤被转诊至我院。他左侧胸壁有一个15×10厘米的骨性肿胀,以及来自滤泡状甲状腺癌的多个小肺结节。进行了甲状腺全切术、使用覆盖有Marlex网的钛微网进行胸壁切除和重建。手术治疗未出现严重并发症,术后肿瘤疼痛消失。然后,他接受了放射性碘治疗,双侧肺野放射性碘摄取情况良好。
使用覆盖有Marlex网的钛微网进行重建对于修复甲状腺癌转移所需的广泛胸壁切除是可行的。该技术将有助于提高胸壁甲状腺癌大转移患者放射性碘与手术联合治疗的疗效。