Babu Agil, Lakhera Kamal Kishor, Patel Pinakin, Singh Suresh, Sahni Manish, Nuttaki Srikanth, Singhal Pranav M
Department of Surgical Oncology, SMS Medical College, Jaipur Rajasthan, India.
Indian J Surg Oncol. 2023 Sep;14(3):553-555. doi: 10.1007/s13193-023-01769-x. Epub 2023 May 10.
Medullary carcinoma of the thyroid is a rare type of thyroid cancer that arises from the parafollicular cells or C-cells, which produce calcitonin. It accounts for approximately 5-10% of all thyroid cancers (Leboulleux et al. in Clin Endocrinol 61(3):299-310, 2004). The main treatment for medullary thyroid carcinoma is surgery, which involves the removal of the thyroid gland and any affected lymph nodes. In advanced cases where the cancer has spread to nearby structures such as the trachea (Gupta et al. in Indian J Surg Oncol 11(1):75-79, 2020), tracheal resection followed by reconstruction may be necessary to remove the cancer (Chernichenko et al. in Curr Opin Oncol 24(1):29-34, 2012) and restore proper breathing, closure of large tracheal defect can be done with pectoralis major myocutaneous flap (Salmerón-González et al. Plast Surg Nurs 38. 162-165, 2018). In this article, we report a case of recurrent medullary carcinoma thyroid with tracheal infiltration and tracheal resection was done, both of which is extremely rare. A 38-year-old male patient with a history of total thyroidectomy presented with recurrence was referred to our department, his previous biopsy and IHC revealed medullary carcinoma thyroid. Ga-68 DOTA PET CT scan was done which showed PET avid residual mass over right side, multiple bilateral cervical nodes, and tracheal infiltration (Fig. 1) then underwent a bronchoscopy showing involvement of the second, third, and fourth tracheal ring. Bilateral neck dissection with sleeve resection of trachea with overlying residual tumor was done and was sent for frozen which revealed positive margins and re-excision of margins was done, which lead to large defect (Fig. 2) which could not be closed primarily with a Montgomery T Tube. A de-epithelized pectoralis major myocutaneous flap used to close the tracheal defect followed by placing the Montgomery T Tube (Fig. 3).Post-operative period was uneventful. The final histopathology report showed R0 resection of tumor. T tube was removed after 4 weeks.
甲状腺髓样癌是一种罕见的甲状腺癌，起源于分泌降钙素的滤泡旁细胞或C细胞。它约占所有甲状腺癌的5%-10%（Leboulleux等人，《临床内分泌学》，2004年，第61卷第3期，第299-310页）。甲状腺髓样癌的主要治疗方法是手术，包括切除甲状腺和任何受影响的淋巴结。在癌症已扩散至附近结构如气管的晚期病例中（Gupta等人，《印度外科肿瘤学杂志》，2020年，第11卷第1期，第75-79页），可能需要进行气管切除并重建以切除癌症（Chernichenko等人，《肿瘤学当前观点》，2012年，第24卷第1期，第29-34页）并恢复正常呼吸，可用胸大肌肌皮瓣闭合大的气管缺损（Salmerón-González等人，《整形外科学护理》，2018年，第38卷，第162-165页）。在本文中，我们报告了一例复发性甲状腺髓样癌伴气管浸润且进行了气管切除的病例，这两种情况都极为罕见。一名有甲状腺全切病史的38岁男性患者因复发被转诊至我科，其先前的活检和免疫组化显示为甲状腺髓样癌。进行了Ga-68 DOTA PET CT扫描，结果显示右侧有PET摄取阳性的残留肿块、双侧多个颈部淋巴结以及气管浸润（图1），随后进行了支气管镜检查，显示第二、第三和第四气管环受累。进行了双侧颈部清扫并袖状切除气管及覆盖其上的残留肿瘤，送检冰冻切片显示切缘阳性，遂再次切除切缘，这导致了一个大的缺损（图2），无法用蒙哥马利T形管一期闭合。使用去上皮的胸大肌肌皮瓣闭合气管缺损，随后放置蒙哥马利T形管（图3）。术后过程顺利。最终的组织病理学报告显示肿瘤R0切除。4周后取出T形管。
