Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana 70112, USA.
Thyroid. 2010 Dec;20(12):1413-7. doi: 10.1089/thy.2010.0093. Epub 2010 Nov 7.
The presence of estrogen receptors (ERs) in both normal and neoplastic thyroid tissues has been demonstrated in numerous publications. Growth-stimulatory effects of estrogen on thyroid tissue have been postulated to account for the prevalence of thyroid cancers in premenopausal women. However, the role of ERs in mediating these effects is by no means clear-cut, and the significance of ER expression by thyroid carcinomas is currently unknown. This article reports a patient with papillary thyroid cancer and a rare profile of immunohistochemical markers.
A 67-year-old woman underwent a total thyroidectomy for papillary thyroid carcinoma and received radioiodine therapy postoperatively. The patient presented 3 months postoperatively with an enlarging neck mass at the surgical site associated with compressive symptoms and vocal cord paralysis. The patient underwent modified radical neck dissection for debulking of the recurrent tumor, which was invading into the prevertebral fascia. Immunohistochemical analysis of the resected mass revealed positive staining for ER-alpha (ER-alpha) and for gross cystic disease fluid protein 15, both markers with specificities for mammary carcinomas. However, evaluation for a possible primary breast cancer was negative. This case represents an unusual presentation of a rapidly recurring papillary thyroid carcinoma masquerading immunohistochemically as a primary breast cancer. Although the existence of ER-positive thyroid cancer has been well established, the dramatic increase in ER expression between initial and recurrent tumors in this postmenopausal woman raises the question of the significance of these receptors to the progression of the disease. Further, this case is the first to our knowledge to document gross cystic disease fluid protein 15 expression by a primary thyroid carcinoma.
This case highlights the need to further explore the possible ramifications of ER expression in thyroid malignancy.
大量文献已经证明，雌激素受体（ERs）存在于正常和肿瘤甲状腺组织中。雌激素对甲状腺组织的生长刺激作用被认为是绝经前妇女甲状腺癌高发的原因。然而，ER 在介导这些作用中的作用并非一目了然，甲状腺癌中 ER 表达的意义目前尚不清楚。本文报道了一名患有甲状腺乳头状癌和罕见免疫组织化学标志物的患者。
一名 67 岁女性因甲状腺乳头状癌接受了全甲状腺切除术，并在术后接受了放射性碘治疗。术后 3 个月，患者出现手术部位增大的颈部肿块，伴有压迫症状和声带麻痹。患者因复发性肿瘤进行了改良根治性颈淋巴结清扫术，该肿瘤侵犯了前纵膈筋膜。切除肿块的免疫组织化学分析显示 ER-α（ER-α）和巨大囊性病液蛋白 15 呈阳性染色，这两种标志物均具有乳腺癌的特异性。然而，对可能的原发性乳腺癌的评估为阴性。该病例代表了一种不常见的表现，即快速复发的甲状腺乳头状癌在免疫组化上伪装成原发性乳腺癌。尽管 ER 阳性甲状腺癌的存在已得到充分证实，但在这名绝经后妇女的初始和复发性肿瘤之间 ER 表达的显著增加引发了这些受体对疾病进展的意义的问题。此外，据我们所知，该病例是首例记录原发性甲状腺癌表达巨大囊性病液蛋白 15 的病例。
该病例强调了进一步探讨 ER 表达在甲状腺恶性肿瘤中可能产生的影响的必要性。
