Okumura M, Yasumitsu T, Kotake Y, Ohta M, Ohshima S, Miyauchi A
Department of Surgery, Osaka Prefectural Habikino Hospital, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1990 Nov;38(11):2307-13.
We experienced three cases (one 38-year-old male, 58-year-old and 67-year-old females) whose resected mediastinal cysts proved to be metastatic lymph nodes from occult thyroid cancer. Primary lesions in thyroid gland were detected by echography in all three cases though they were detected in one case out of two by CT, in one out of three by 201T1 scintigraphy, in two out of three by 123I scintigraphy. After these examinations on thyroid gland, operations (one lobectomy, one hemithyroidectomy, one total thyroidectomy) were performed. Primary lesions in thyroid gland were all papillary carcinomas, and ranged 4 x 3 mm to 12 x 10 mm in size. Multiple foci were found in two cases, many intrathyroidal metastases in one case, cervical lymph node metastases in two cases. In cases of mediastinal cyst, thyroid gland should be examined by echography paying attention to the mediastinal lymph node metastasis from occult thyroid cancer. When occult thyroid cancer with mediastinal lymph node metastasis is diagnosed, total thyroidectomy followed by 131I radiation therapy is recommended as the treatment for a primary lesion, because of multiple foci in thyroid gland and intrathyroidal metastases.
我们遇到了3例患者（1例38岁男性，2例分别为58岁和67岁女性），其切除的纵隔囊肿经证实为隐匿性甲状腺癌转移的淋巴结。尽管3例患者中2例通过CT、3例中1例通过201Tl闪烁扫描、3例中2例通过123I闪烁扫描检测到甲状腺的原发灶，但所有3例均通过超声检查发现了甲状腺的原发灶。在对甲状腺进行这些检查后，实施了手术（1例叶切除术、1例甲状腺次全切除术、1例甲状腺全切除术）。甲状腺的原发灶均为乳头状癌，大小在4×3mm至12×10mm之间。2例发现多个病灶，1例发现许多甲状腺内转移灶，2例发现颈部淋巴结转移。对于纵隔囊肿患者，应通过超声检查甲状腺，注意隐匿性甲状腺癌的纵隔淋巴结转移。当诊断为隐匿性甲状腺癌伴纵隔淋巴结转移时，由于甲状腺内存在多个病灶和甲状腺内转移，建议对原发灶采用甲状腺全切除术并辅以131I放射治疗。
