Iñiguez-Ariza Nicole M, Lee Robert A, Brewer Jerry D, Hay Ian D
Division of Endocrinology, Department of Internal Medicine, Mayo Clinic and College of Medicine, Rochester, Minnesota.
Department of Radiology, Mayo Clinic and College of Medicine, Rochester, Minnesota.
J Endocr Soc. 2020 Jul 6;4(8):bvaa095. doi: 10.1210/jendso/bvaa095. eCollection 2020 Aug 1.
Ultrasound-guided percutaneous ethanol ablation procedures for locoregional recurrences in papillary thyroid carcinoma (PTC) can be repeatedly performed over years. Skin metastases (SM) from PTC generally portend a lethal prognosis. Our patient case report demonstrates the innovative use in low-risk PTC (LRPTC) of treatment modalities designed to prevent neck re-explorations and capable of eliminating both locoregional recurrences and SM. In 2004, a 48-year-old man presented with neck nodal metastases due to PTC. He underwent a near-total thyroidectomy and nodal dissection, confirming an 8-mm PTC involving 2 ipsilateral node metastases. Postoperatively, he received 2 doses of radioactive iodine (RAI) for remnant uptake (cumulative dose 338 mCi); posttherapy scanning was unrevealing. In 2007, he underwent right neck dissection for further node metastases. In 2008, a guided biopsy confirmed a level IV node metastasis. He was referred to our institution for ethanol ablation. Two node metastases were ablated and subsequently disappeared. During 2010-2016, he developed an additional 6 node metastases, which were treated with ethanol ablation; all disappeared on high-resolution sonography. FDG-PET-CT scans in 2009 and 2016 were negative for distant spread. In 2016, a SM in his right neck was removed by dermatologic surgery. In 2017-2018, 2 further SM were excised with negative margins, one after Mohs surgery. He has now been disease-free for 20 months. In conclusion, despite 3 neck surgeries and 2 RAI therapies, our patient repeatedly developed both locoregional recurrences and SM. All 11 disease foci were eliminated with minimally invasive procedures which should more often be considered as effective treatment options in LRPTC.
超声引导下经皮乙醇消融术治疗甲状腺乳头状癌（PTC）局部区域复发可在数年内反复进行。PTC的皮肤转移（SM）通常预示着致命的预后。我们的病例报告展示了在低风险PTC（LRPTC）中创新性地使用治疗方式，旨在避免颈部再次手术，并能够消除局部区域复发和SM。2004年，一名48岁男性因PTC出现颈部淋巴结转移。他接受了近全甲状腺切除术和淋巴结清扫术，证实为一个8毫米的PTC，伴有2个同侧淋巴结转移。术后，他接受了2剂放射性碘（RAI）治疗残余甲状腺摄取（累积剂量338毫居里）；治疗后扫描未发现异常。2007年，他因进一步的淋巴结转移接受了右颈部清扫术。2008年，一次引导活检证实为IV级淋巴结转移。他被转诊至我们机构接受乙醇消融治疗。两个淋巴结转移灶被消融，随后消失。在2010 - 2016年期间，他又出现了6个淋巴结转移灶，均接受了乙醇消融治疗；在高分辨率超声检查下所有转移灶均消失。2009年和2016年的FDG - PET - CT扫描均未发现远处转移。2016年，他右颈部的一个SM通过皮肤科手术切除。2017 - 2018年，又切除了2个SM，切缘阴性，其中一个是在莫氏手术后切除。他目前已无病生存20个月。总之，尽管进行了3次颈部手术和2次RAI治疗，我们的患者仍反复出现局部区域复发和SM。所有11个病灶均通过微创手术消除，在LRPTC中应更频繁地将这些微创手术视为有效的治疗选择。
