Segal K, Ben-Bassat M, Avraham A, Har-El G, Sidi J
Int Surg. 1985 Jul-Sep;70(3):205-9.
Seven cases of Hashimoto's disease (HT) occurring in association with carcinoma of the thyroid gland are presented. The diagnosis of HT was not reached before surgery in any of the cases; it was an incidental histopathological finding. There was no case of pure papillary cancer: two specimens showed mixed papillary and follicular cancers, four revealed follicular carcinomas (one of them with anaplastic areas) and one medullary neoplasm. Other authors, however, have reported that pure papillary carcinoma occurred with significantly greater frequency in thyroids also displaying Hashimoto's disease. Total thyroidectomy was performed in all seven patients and one patient with anaplastic follicular cancer also received external irradiation. TSH suppressive therapy was given postoperatively. All these patients are alive with no evidence of further disease after seven to 17 years of follow-up study, whereas the mortality in our total series of thyroid cancers, even in patients with low-grade malignancy, was about 9%. Thus the prognosis of patients with carcinoma of the thyroid gland with coexisting Hashimoto's disease is better than that of patients with carcinoma of the thyroid gland alone. Hashimoto's thyroiditis does not seem to be a premalignant lesion. There was no evidence suggesting that thyroid carcinoma originated in the proliferating epithelium of Hashimoto's thyroiditis. It would appear that thyroid carcinoma stimulates the development of HT in some patients and that the presence of the autoimmune inflammatory reaction and the circulating antibodies retard growth and dissemination of carcinoma of the thyroid gland.
本文报告了7例桥本氏病（HT）合并甲状腺癌的病例。所有病例在手术前均未诊断出HT，而是偶然的组织病理学发现。没有纯乳头状癌的病例：2个标本显示为乳头状和滤泡状混合癌，4个为滤泡状癌（其中1个有间变区域），1个为髓样肿瘤。然而，其他作者报告称，在同时患有桥本氏病的甲状腺中，纯乳头状癌的发生率明显更高。所有7例患者均接受了甲状腺全切除术，1例患有间变性滤泡癌的患者还接受了外照射。术后给予促甲状腺激素（TSH）抑制治疗。经过7至17年的随访研究，所有这些患者均存活，且无进一步疾病证据，而我们整个甲状腺癌系列患者的死亡率，即使是低级别恶性肿瘤患者，也约为9%。因此，合并桥本氏病的甲状腺癌患者的预后优于单纯甲状腺癌患者。桥本氏甲状腺炎似乎不是癌前病变。没有证据表明甲状腺癌起源于桥本氏甲状腺炎的增殖上皮。似乎甲状腺癌在某些患者中刺激了HT的发展，并且自身免疫性炎症反应和循环抗体的存在会阻碍甲状腺癌的生长和扩散。
