Nixon Iain J, Coca-Pelaz Andrés, Kaleva Anna I, Triantafyllou Asterios, Angelos Peter, Owen Randall P, Rinaldo Alessandra, Shaha Ashok R, Silver Carl E, Ferlito Alfio
ENT Department, NHS Lothian, Lauriston Building, Lauriston Place, Edinburgh, UK.
Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.
Ann Surg Oncol. 2017 Jun;24(6):1533-1539. doi: 10.1245/s10434-016-5683-4. Epub 2016 Nov 21.
Metastasis to the thyroid gland from nonthyroid sites is an uncommon clinical presentation in surgical practice. The aim of this review was to assess its incidence management and outcomes.
A literature review was performed to identify reports of metastases to the thyroid gland. Both clinical and autopsy series were included.
Metastases to the gland may be discovered at the time of diagnosis of the primary tumor, after preoperative investigation of a neck mass, or on histologic examination of a thyroidectomy specimen. The most common primary tumors in autopsy studies are from the lung. In clinical series, renal cell carcinoma is most common. For patients with widespread metastases in the setting of an aggressive malignancy, surgery is rarely indicated. However, when patients present with an isolated metastasis diagnosed during follow-up of indolent disease, surgery may achieve control of the central neck and even long-term cure. Other prognosticators include features of the primary tumor, time interval between initial diagnosis and metastasis, and extrathyroid extent of disease.
In patients with thyroid metastases, communication among clinicians treating the thyroid and the index primary tumor is essential. The setting is complex, and decisions must be made considering the features of the primary tumor, overall burden of metastases, and comorbidities. Careful balancing of these factors influences individualized approaches.
非甲状腺部位转移至甲状腺在外科临床实践中是一种不常见的表现。本综述的目的是评估其发病率、治疗及预后。
进行文献回顾以确定甲状腺转移的报告。临床和尸检系列均纳入。
甲状腺转移可在原发性肿瘤诊断时、颈部肿块术前检查后或甲状腺切除标本的组织学检查中发现。尸检研究中最常见的原发性肿瘤来自肺部。在临床系列中，肾细胞癌最为常见。对于患有侵袭性恶性肿瘤且有广泛转移的患者，很少需要手术。然而，当患者在惰性疾病随访期间出现孤立转移并被诊断时，手术可能实现对中央颈部的控制甚至长期治愈。其他预后因素包括原发性肿瘤的特征、初始诊断与转移之间的时间间隔以及甲状腺外疾病范围。
对于甲状腺转移患者，治疗甲状腺的临床医生与索引原发性肿瘤的临床医生之间的沟通至关重要。情况复杂，必须根据原发性肿瘤的特征、转移的总体负担和合并症做出决策。仔细权衡这些因素会影响个体化治疗方法。
