Endocrine Surgery, Clinic of General and Abdominal Surgery, University Medical Center, Gutenberg University Mainz, Mainz, Germany.
Thyroid. 2010 Jan;20(1):93-8. doi: 10.1089/thy.2009.0026.
Apart from regional lymph node metastases, systemic metastases occur sporadically in papillary thyroid carcinomas (PTC). The lung and bones are the most frequent localizations. Additionally known but extremely rare locations are metastases of the skeletal muscles, ovaries, submandibular gland, sphenoidal sinus, brain, adrenals, and, as shown in only two previously published cases to date, the pancreas.
In this article we report about two additional patients with pancreatic metastases from PTC. There is almost no prior experience about therapeutic approaches to this type of metastases. In both patients distant metastases within the pancreas were successfully removed. Postoperative histology confirmed the diagnoses. Supplemental genetic analysis did not demonstrate a BRAF V600E mutation or expression of a RET/PTC1 rearrangement in one case, but revealed a BRAF V600E mutation in the second case. Surgery avoided impending complications maintaining quality of life. One patient had a tumor-specific survival of 42 months. The other patient has occult disease.
Our two patients benefited of a calculated aggressive surgical action. Thus, if low perioperative mortality and morbidity can be warranted, surgical measures are justifiable in selected cases.
除了区域淋巴结转移外，甲状腺乳头状癌（PTC）也会偶尔发生全身性转移。肺部和骨骼是最常见的转移部位。此外，已知但极为罕见的转移部位还包括骨骼肌、卵巢、颌下腺、蝶窦、脑、肾上腺，以及迄今为止仅在两例既往发表的病例中出现的胰腺。
本文报告了另外两例来自 PTC 的胰腺转移患者。对于此类转移，几乎没有治疗经验。在这两名患者中，胰腺内的远处转移均成功切除。术后组织学检查证实了诊断。补充遗传分析在一例中未显示 BRAF V600E 突变或 RET/PTC1 重排的表达，但在第二例中显示 BRAF V600E 突变。手术避免了即将发生的并发症，维持了生活质量。一名患者的肿瘤特异性生存率为 42 个月。另一名患者疾病隐匿。
我们的两名患者受益于精心设计的积极手术治疗。因此，如果可以保证低围手术期死亡率和发病率，那么在选择的病例中，手术治疗是合理的。
