Department and Hospital of General Surgery, Bytom, Silesian Medical University, Katowice, Poland.
Endokrynol Pol. 2010 Sep-Oct;61(5):427-9.
Malignant metastases are rarely found in the thyroid gland, the incidence reaching approximately 2% of all thyroid malignant neoplasms. They are most often caused by tumours of the kidneys, lungs, mammary glands, ovary, and colon or by melanomas. The aim of the study was to evaluate the usefulness of fine needle aspiration biopsy (FNA) for diagnosing tumour metastases to thyroid glands.
A total of 15122 patients were operated between 1990 and 2009 for goitres. Malignant neoplasm was diagnosed in 733 (4.8%) patients. Malignant metastases to the thyroid gland were detected in 10 patients, namely 2 men and 8 women aged 48-89 years. The group made up 1.4% of all patients operated for malignant thyroid tumour. Preoperative diagnostic procedure consisted of thyroid scintigraphy, thyroid ultrasonography, and cytology of the material obtained through FNA. In addition, the hormonal activity of the thyroid gland was examined. The range of operation was established through clinical assessment of the tumour, preoperative cytology, and intra-operative histopathology.
Among 7 patients with thyroid metastases from renal clear cell carcinoma, as diagnosed postoperatively, cytology of the thyroid material obtained through FNA revealed follicular tumour in 3 (43%) patients, tumour cells in 2 (28.5%) and atypical cells in the other 2 (28.5%). Intraoperative histopathology confirmed the presence of metastasis from renal clear cell carcinoma (1) and indicated thyroid medullary cancer (1), follicular tumour (4), or trabecular adenoma with necrosis (1). Among two patients with thyroid metastases from breast cancer, cytology confirmed a metastasis from breast cancer in one (the woman was disqualified for surgical treatment) and indicated follicular tumour in one. Intraoperative histopathology suggested thyroid anaplastic cancer. Examination of biopsy specimen revealed epithelial cells accompanied by cell atypia in one patient with thyroid metastasis from lung cancer. Intra-operative examination also indicated cellular atypia in the same patient.
Follicular tumour diagnosed by fine needle aspiration biopsy in patients after treatment for other cancers, especially renal clear cell carcinoma, should alert the surgeon to the possibility that it could be a metastasis of this cancer to the thyroid gland.
恶性转移在甲状腺中很少见，其发生率约占所有甲状腺恶性肿瘤的 2%。它们最常由肾脏、肺部、乳腺、卵巢和结肠的肿瘤或黑色素瘤引起。本研究旨在评估细针抽吸活检（FNA）对诊断甲状腺肿瘤转移的价值。
1990 年至 2009 年间，共有 15122 名患者因甲状腺肿接受了手术。733 名（4.8%）患者被诊断为恶性肿瘤。10 名患者的甲状腺中发现了恶性转移，其中 2 名为男性，8 名为女性，年龄 48-89 岁。该组占所有因恶性甲状腺肿瘤接受手术的患者的 1.4%。术前诊断程序包括甲状腺闪烁显像、甲状腺超声检查和通过 FNA 获得的材料的细胞学检查。此外，还检查了甲状腺的激素活性。手术范围通过对肿瘤的临床评估、术前细胞学检查和术中组织病理学检查来确定。
在 7 名被诊断为肾透明细胞癌甲状腺转移的患者中，通过 FNA 获得的甲状腺材料的细胞学检查显示，3 名（43%）患者为滤泡性肿瘤，2 名（28.5%）患者为肿瘤细胞，另外 2 名（28.5%）患者为不典型细胞。术中组织病理学证实存在肾透明细胞癌转移（1 例），并提示甲状腺髓样癌（1 例）、滤泡性肿瘤（4 例）或伴有坏死的小梁状腺瘤（1 例）。在 2 名乳腺癌甲状腺转移的患者中，细胞学检查在 1 名患者中证实为乳腺癌转移（1 名患者因手术治疗而被排除），在 1 名患者中提示滤泡性肿瘤。术中组织病理学提示甲状腺间变性癌。在 1 名肺癌甲状腺转移患者的活检标本检查中发现上皮细胞伴细胞异型性，术中检查也提示该患者存在细胞异型性。
在接受过其他癌症（尤其是肾透明细胞癌）治疗的患者中，通过 FNA 诊断为滤泡性肿瘤时，外科医生应警惕其可能是甲状腺的这种癌症转移。
