甲状腺超声检查中的“结节内结节”：良性甲状腺肿瘤转化为滤泡癌的可能性
"Nodule in Nodule" on Thyroid Ultrasonography: Possibility of Follicular Carcinoma Transformed from Benign Thyroid Tumor.
作者信息
Kobayashi Kaoru, Ota Hisashi, Hirokawa Mitsuyoshi, Yabuta Tomonori, Fukushima Mitsuhiro, Masuoka Hiroo, Higashiyama Takuya, Kihara Minoru, Ito Yasuhiro, Miya Akihiro, Miyauchi Akira
机构信息
Kuma Hospital, Kobe, Japan.
出版信息
Eur Thyroid J. 2017 Apr;6(2):101-107. doi: 10.1159/000452971. Epub 2016 Dec 13.
BACKGROUND
It is generally considered impossible to differentiate follicular carcinomas from follicular adenomas by means of ultrasonography or cytology before surgery. Therefore, follicular carcinoma is histopathologically diagnosed by verifying capsular and/or vascular invasion after surgery. However, ultrasonography may play an important role in diagnosing follicular carcinoma preoperatively in a small number of cases.
CASE DESCRIPTION
Four cases of follicular carcinoma or follicular neoplasm that transformed from a benign thyroid tumor and demonstrated a "nodule in nodule" appearance on ultrasonography are presented in this report. Characteristic ultrasound features of such patients are: (1) a "nodule in nodule" appearance, (2) a well-defined boundary line between the nodules, and (3) separate distribution of blood signals within each nodule.
CONCLUSION
A small number of patients with follicular carcinomas or follicular neoplasms may present with a "nodule in nodule" appearance on ultrasonography. It was suggested a long time ago that follicular carcinomas may develop from benign thyroid tumors. The fact that follicular carcinomas appear within benign tumors may be evidence of thyroid tumorigenesis.
背景
一般认为，术前通过超声检查或细胞学检查无法区分滤泡状癌和滤泡状腺瘤。因此，滤泡状癌是在术后通过证实包膜和/或血管侵犯进行组织病理学诊断的。然而，超声检查在少数情况下可能在术前诊断滤泡状癌中发挥重要作用。
病例描述
本报告介绍了4例由良性甲状腺肿瘤转变而来、超声检查显示“结节内结节”表现的滤泡状癌或滤泡状肿瘤病例。此类患者的特征性超声表现为：（1）“结节内结节”表现；（2）结节之间边界清晰；（3）每个结节内血流信号分布独立。
结论
少数滤泡状癌或滤泡状肿瘤患者超声检查可能呈现“结节内结节”表现。很久以前就有人提出滤泡状癌可能由良性甲状腺肿瘤发展而来。滤泡状癌出现在良性肿瘤内这一事实可能是甲状腺肿瘤发生的证据。
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