Department of Internal Medicine, Norwalk Hospital, Norwalk, Connecticut 06856, USA.
Endocr Pract. 2011 Jan-Feb;17(1):115-21. doi: 10.4158/EP09368.RA.
To present a case of an insular variant of poorly differentiated thyroid carcinoma (PDTC) and to review the literature related to diagnosis, natural history, and treatment of this unusual form of thyroid cancer.
We present the clinical, laboratory, and pathologic findings of the study patient and review English-language literature related to PDTC published between 1970 and the present.
PDTC is a controversial and rare epithelial thyroid cancer, intermediate between differentiated thyroid carcinoma and anaplastic thyroid carcinoma that exhibits increased aggressiveness, propensity to local recurrence, distant metastases, and increased mortality. PDTC warrants aggressive management with total thyroidectomy followed by radioactive iodine ablation and potentially additional therapy for residual or recurrent disease. Some carcinomas do not take up radioactive iodine, and dedifferentiated clones of distant metastases may evolve. It is unclear whether chemotherapy is beneficial. Use of additional imaging modalities, including positron emission tomography, 18-fludeoxyglucose positron emission tomography/computed tomography, 18-fludeoxyglucose positron emission tomography/computed tomography/magnetic resonance imaging, (124)I positron emission tomography/computed tomography, positron emission tomography/magnetic resonance imaging fusion studies, and recombinant human thyrotropin-stimulated radioactive iodine uptake for cancer surveillance are discussed.
PDTC is an unusual and aggressive form of thyroid cancer. Fine-needle aspiration cytology may not yield sufficient information to specifically diagnose PDTC. Aggressive management with total thyroidectomy and neck dissection followed by high-dose radioactive iodine remnant ablation is standard. Iodine I 131 whole body scanning is often the initial test for tumor surveillance, with other imaging modalities applied as needed.
介绍一例岛状型低分化甲状腺癌（PDTC）病例，并复习与这种不常见的甲状腺癌的诊断、自然病史和治疗相关的文献。
我们展示了研究患者的临床、实验室和病理发现，并复习了 1970 年至今发表的与 PDTC 相关的英文文献。
PDTC 是一种有争议且罕见的上皮性甲状腺癌，位于分化型甲状腺癌和间变性甲状腺癌之间，具有侵袭性增加、局部复发、远处转移和死亡率增加的倾向。PDTC 需要积极的治疗，包括全甲状腺切除术，然后进行放射性碘消融，对于残留或复发性疾病可能需要额外的治疗。一些癌无法摄取放射性碘，远处转移的去分化克隆可能会演变。目前尚不清楚化疗是否有益。是否使用额外的成像方式，包括正电子发射断层扫描、18-氟-脱氧葡萄糖正电子发射断层扫描/计算机断层扫描、18-氟-脱氧葡萄糖正电子发射断层扫描/计算机断层扫描/磁共振成像、（124）I 正电子发射断层扫描/计算机断层扫描、正电子发射断层扫描/磁共振成像融合研究以及重组人促甲状腺激素刺激放射性碘摄取，用于癌症监测，正在讨论中。
PDTC 是一种不常见且侵袭性的甲状腺癌。细针穿刺细胞学检查可能无法提供足够的信息来专门诊断 PDTC。全甲状腺切除术和颈部清扫术联合大剂量放射性碘残余消融是标准的积极治疗方法。放射性碘 131 全身扫描通常是肿瘤监测的初始检查，其他成像方式则根据需要应用。
