Arganini M, Behar R, Wu T C, Straus F, McCormick M, DeGroot L J, Kaplan E L
Surgery. 1986 Dec;100(6):1108-15.
During a 25-year period (1959 through 1983), 54 patients with Hürthle cell tumors were treated and monitored at the University of Chicago Medical Center. Thirty percent were men and 70% were women; mean age at diagnosis was 46.7 +/- 13.2 years (range: 19 to 69 years). Tumors were grouped into three categories at the time of initial diagnosis: group 1, grossly malignant (four patients, or 7.5%); group 2, intermediate (partial capsular and/or subcapsular vascular invasion) (10 patients, or 18.5%); and group 3, benign appearing (40 patients, or 74%). Twenty-one (39%) of the patients had a history of low-dose, external radiation to the head and neck in childhood (including three of four grossly malignant lesions). A separate non-Hürthle cell thyroid carcinoma was found within the thyroid gland in 22 (50%) of the patients--79% were papillary and 21% were follicular carcinomas. In half of these, there was a history of childhood irradiation. During a mean follow-up period of 8.4 years (range, 22 days to 35 years), three additional Hürthle cell tumors were recognized as malignant after metastases were discovered--two were originally classified as intermediate lesions and one was in the benign-appearing group. Thus, seven of 54 of our patients (13%) had Hürthle cell carcinomas. One of the seven patients died of widespread metastases after 35 years, and the other six are currently free of disease. We believe that therapy of these lesions should be individualized. Total thyroid ablation (surgical procedure followed by radioiodine therapy) is appropriate for frankly malignant Hürthle cell cancers, for all Hürthle cell tumors occurring in patients who received low-dose childhood irradiation, for associated papillary or follicular carcinomas, and in those patients who exhibit partial capsular or subcapsular vascular invasion. On the other hand, single, well-encapsulated, benign-appearing Hürthle cell tumors may be treated by lobectomy and careful follow-up, since the chance that they will later exhibit malignant behavior is low (2.5% in our series and 1.5% among patients described in the recent literature).
在1959年至1983年的25年期间，芝加哥大学医学中心对54例许特莱细胞肿瘤患者进行了治疗和监测。其中男性占30%，女性占70%；确诊时的平均年龄为46.7±13.2岁（范围：19至69岁）。在初次诊断时，肿瘤被分为三类：第1组，肉眼可见为恶性（4例患者，占7.5%）；第2组，中度恶性（部分包膜和/或包膜下血管侵犯）（10例患者，占18.5%）；第3组，外观为良性（40例患者，占74%）。21例（39%）患者有儿童时期头部和颈部低剂量外照射史（包括4例肉眼可见为恶性病变中的3例）。在22例（50%）患者的甲状腺内发现了单独的非许特莱细胞甲状腺癌，其中79%为乳头状癌，21%为滤泡状癌。在这些患者中，一半有儿童时期照射史。在平均8.4年的随访期（范围：22天至35年）内，在发现转移后，又有3例许特莱细胞肿瘤被确认为恶性，其中2例最初被归类为中度恶性病变，1例在外观为良性的组中。因此，我们的54例患者中有7例（13%）患有许特莱细胞癌。7例患者中的1例在35年后死于广泛转移，其他6例目前无疾病。我们认为这些病变的治疗应个体化。全甲状腺切除（手术操作后进行放射性碘治疗）适用于明显恶性的许特莱细胞癌、所有发生在接受儿童时期低剂量照射患者中的许特莱细胞肿瘤、相关的乳头状或滤泡状癌，以及那些表现出部分包膜或包膜下血管侵犯的患者。另一方面，单个、包膜完整、外观为良性的许特莱细胞肿瘤可通过叶切除术和仔细随访进行治疗，因为它们随后表现出恶性行为的可能性较低（在我们的系列中为2.5%，在最近文献中描述的患者中为1.5%）。
