Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan.
Department of Diagnostic Pathology, Kuma Hospital, Kobe 650-0011, Japan.
Endocr J. 2020 Oct 28;67(10):1047-1053. doi: 10.1507/endocrj.EJ20-0248. Epub 2020 Jun 18.
The newest WHO classification adopts hobnail variant as an aggressive variant of papillary thyroid carcinoma (PTC). We here report four cases (ages 70-76 years, all females) with hobnail variant PTC treated at Kuma Hospital. Their lesions were cytologically diagnosed as PTC before surgery, but not as hobnail variant. All patients underwent a total thyroidectomy with central node dissection, and two patients also underwent therapeutic lateral node dissection. The clinical courses of three of the patients were very eventful. One patient showed recurrence to lymph nodes in the lateral compartment only 5 months after the initial surgery. In the initial surgery, one patient had a 36-mm lymph node metastasis in the lateral compartment, which was diagnosed as hobnail variant on pathology; 9 months post-surgery, metastases to the ipsilateral lateral lymph node, lung, and bone were newly detected. Her lung metastasis grew rapidly; its tumor volume-doubling time was 0.15 years and its tumor-doubling rate was 6.67/year. One patient underwent annual ultrasound examinations as postoperative follow-up after hemithyroidectomy for a benign nodule, but a 35-mm nodule diagnosed as PTC on cytology and lateral node metastases appeared within a short period, and she underwent a second surgery. Both the primary lesion and lymph nodes were diagnosed as hobnail variant by postoperative pathology. Three of the four patients showed exceptionally rapid growth of primary and/or metastatic/recurred lesions, indicating that patients with the hobnail variant should undergo very close and careful post-operative observation.
世界卫生组织（WHO）最新分类将鞋钉样变体视为甲状腺乳头状癌（PTC）的侵袭性变体。我们在此报告 4 例在久留米医院治疗的鞋钉样变体 PTC 患者（年龄 70-76 岁，均为女性）。这些患者的病变在手术前细胞学诊断为 PTC，但不是鞋钉样变体。所有患者均接受了全甲状腺切除术和中央淋巴结清扫术，2 例患者还接受了治疗性侧方淋巴结清扫术。其中 3 例患者的临床病程非常复杂。1 例患者在初次手术后仅 5 个月就出现了侧方淋巴结复发。初次手术时，1 例患者侧方淋巴结有 36mm 的转移灶，病理诊断为鞋钉样变体；术后 9 个月，新检测到同侧侧方淋巴结、肺部和骨骼转移。她的肺转移灶生长迅速；其肿瘤倍增时间为 0.15 年，倍增率为 6.67/年。1 例患者因良性结节行半甲状腺切除术，术后每年进行超声检查作为随访，但在短时间内出现了 35mm 的细胞学诊断为 PTC 的结节和侧方淋巴结转移，她再次接受了手术。术后病理均诊断为鞋钉样变体的原发性病变和淋巴结。这 4 例患者中有 3 例原发性和/或转移性/复发性病变的生长速度异常快，这表明鞋钉样变体患者应进行非常密切和仔细的术后观察。
