Departamento de Cirurgia e Urologia Pediátrica, Hospital Estadual dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
Int Braz J Urol. 2019 Jul-Aug;45(4):834-842. doi: 10.1590/S1677-5538.IBJU.2018.0471.
The very rare thyroid-like carcinoma of the kidney (TLCK) is microscopically similar to thyroid follicular cell carcinoma (TFCC). Differential diagnosis with secondary thyroid tumors depends on non-reactivity to immunohistochemical (IHC) markers for TFCC (thyroglobulin - TG and TTF1). We herein describe the fourth Pediatric case in literature and extensively review the subject. Only 29 cases were published to the moment. Most cases were asymptomatic and incidentally detected. Most tumors are hyperechoic and hyperdense with low grade heterogenous enhancement on CT and MRI. Most patients were treated with radical nephrectomy, but partial nephrectomy was used in some cases, apparently with the same results. Metastases are uncommon and apparently do not change prognosis, but follow-ups are limited. Up to the moment, TLCK presents as a low grade malignancy that may be treated exclusively with surgery and frequently with partial kidney renal preservation. A preoperative percutaneous biopsy is a common procedure to investigate atypical tumors in childhood and adult tumors. To recognize the possibility of TLCK is fundamental to avoid unnecessary thyroidectomies in those patients, supposing a primary thyroid tumor.
肾脏甲状腺样癌(TLCK)非常罕见,其显微镜下表现类似于甲状腺滤泡细胞癌(TFCC)。与继发性甲状腺肿瘤的鉴别诊断取决于对 TFCC(甲状腺球蛋白-TG 和 TTF1)免疫组织化学(IHC)标志物无反应性。本文描述了文献中的第四例儿科病例,并对该主题进行了广泛回顾。到目前为止,仅发表了 29 例病例。大多数病例无症状,为偶然发现。大多数肿瘤在 CT 和 MRI 上呈高回声和高密度,呈低级别异质性增强。大多数患者接受根治性肾切除术,但有些病例采用了部分肾切除术,显然结果相同。转移并不常见,似乎不会改变预后,但随访时间有限。到目前为止,TLCK 表现为低度恶性肿瘤,仅通过手术即可治疗,且常采用部分保留肾脏的方法。术前经皮活检是一种常见的方法,用于研究儿童和成人肿瘤中的非典型肿瘤。认识到存在 TLCK 的可能性对于避免对那些假定为原发性甲状腺肿瘤的患者进行不必要的甲状腺切除术至关重要。