Pradhan Roma, Agarwal Amit, Lal Punita, Kumari Niraj, Jain Manoj, Chand Gyan, Mishra Anjali, Agarwal Gaurav, Verma Ashok K, Mishra Saroj K
Department of Endocrine Surgery, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Endocrine Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India.
Indian J Endocrinol Metab. 2018 Nov-Dec;22(6):793-797. doi: 10.4103/ijem.IJEM_264_18.
Anaplastic thyroid cancers (ATCs) usually present in the sixth to seventh decades of life and little is known about the disease in young patients. The aim was to analyze the clinicopathological characteristics diagnosed with ATC in an iodine-deficient area.
The medical records of 100 patients diagnosed with ATC at a tertiary care hospital between 1991 and 2013 were reviewed.
The mean age of patient was 58 years. About 34 patients were ≤50 years. The common presentation was that of a rapidly growing fixed and hard mass (64%). Due to rapid expansion, 27% patients experienced severe pain. About one-third presented as sudden enlargement of pre-existing goiter over few weeks. The median duration of symptoms before diagnosis was 3 months. About 41% presented with lymph node enlargement and 31% with distant metastasis. The diagnosis was established with fine-needle aspiration or core biopsy. Histopathology was available in 32 patients and showed four major patterns: spindle cell (9), giant cell (7), epithelioid (5), squamoid (1), mixed type in 10 patients. Eight patients presenting with stridor required emergency tracheostomy for airway control. Total thyroidectomy with or without lymph node dissection was possible in 21 patients. Patients received radiotherapy with or without chemotherapy. Median overall survival was 3 months. Overall survival was significantly better in patients receiving some form of treatment.
ATC in endemic goiter areas presents at an earlier age. One-third of ATC is due to anaplastic transformation of pre-existing goiter and majority of the patients refuse treatment due to dismal outcome.
间变性甲状腺癌（ATC）通常发生于60至70岁人群，对于年轻患者的该疾病了解甚少。本研究旨在分析碘缺乏地区诊断为ATC的临床病理特征。
回顾了1991年至2013年期间在一家三级医院诊断为ATC的100例患者的病历。
患者的平均年龄为58岁。约34例患者年龄≤50岁。常见表现为快速生长的固定硬块（64%）。由于肿瘤快速生长，27%的患者经历严重疼痛。约三分之一的患者表现为原有甲状腺肿在数周内突然增大。诊断前症状的中位持续时间为3个月。约41%的患者出现淋巴结肿大，31%出现远处转移。通过细针穿刺或粗针活检确诊。32例患者有组织病理学结果，显示四种主要类型：梭形细胞型（9例）、巨细胞型（7例）、上皮样型（5例）、鳞状型（1例），10例为混合型。8例出现喘鸣的患者需要紧急气管切开以控制气道。21例患者可行甲状腺全切术，可伴或不伴淋巴结清扫。患者接受了放疗，可伴或不伴化疗。中位总生存期为3个月。接受某种形式治疗的患者总生存期明显更好。
地方性甲状腺肿地区的ATC发病年龄较早。三分之一的ATC是由原有甲状腺肿的间变转化引起，且大多数患者因预后不佳而拒绝治疗。
