Fujimoto Y, Obara T, Ito Y, Kodama T, Aiba M, Yamaguchi K
Department of Endocrine Surgery, Tokyo Women's Medical College, Japan.
Cancer. 1990 Dec 1;66(11):2306-12. doi: 10.1002/1097-0142(19901201)66:11<2306::aid-cncr2820661109>3.0.co;2-p.
A diffuse sclerosing variant is not very rare among papillary carcinomas of the thyroid when the patients are female and younger than 30 years of age. The variant is characterized by diffuse involvement of one or both thyroid lobes, with dense sclerosis, patchy lymphocytic infiltration, and abundant psammoma bodies. Controversy still exists concerning its prognosis. We reviewed our experience with 14 patients treated between 1958 and 1988. All patients were young females, their age being from 10 to 28 years with a mean of 19.6. Hashimoto's thyroiditis had been suspected in nine patients before they came to our clinic. Nowadays the diagnosis of this cancer is possible when we have this entity in mind and detect abundant psammoma bodies either by ultrasonography or by soft-tissue roentgenography of the neck. Total thyroidectomy with modified neck dissection was carried out in eight patients, subtotal thyroidectomy with neck dissection in five, and lobectomy with neck dissection in one. All of them are alive and well without distant metastasis at a mean follow-up of 16 years. Because most of the patients with this variant of papillary carcinoma are young women and the prognosis is favorable, a complete resection without causing later recurrence, but also cosmetic and complication-free surgery, should be considered.
弥漫性硬化型甲状腺乳头状癌在30岁以下女性患者中并不罕见。该型的特点是一个或两个甲状腺叶弥漫受累，伴有致密硬化、散在淋巴细胞浸润及大量砂粒体。关于其预后仍存在争议。我们回顾了1958年至1988年间治疗的14例患者的经验。所有患者均为年轻女性，年龄在10至28岁之间，平均年龄19.6岁。9例患者在来我院就诊前曾怀疑患有桥本甲状腺炎。如今，当我们考虑到这种疾病并通过超声检查或颈部软组织X线检查发现大量砂粒体时，就有可能做出这种癌症的诊断。8例行全甲状腺切除加改良颈部淋巴结清扫术，5例行次全甲状腺切除加颈部淋巴结清扫术，1例行甲状腺叶切除加颈部淋巴结清扫术。平均随访16年，所有患者均存活良好，无远处转移。由于大多数这种类型的甲状腺乳头状癌患者为年轻女性且预后良好，应考虑进行完整切除，既能避免后期复发，又能保证手术美观且无并发症。
