Gavrailov M, Petkov R, Mikhaĭlov I, Kŭtev N, Todorov G
Khirurgiia (Sofiia). 1995;48(2):5-7.
The disputable issue of the pathogenetic relation between struma nodosa and thyroid gland carcinoma is discussed. A total of 234 patients with definitive diagnosis thyroid carcinoma, operated in the clinic of endocrine surgery--Higher Medical Institute, Sofia, are retrospectively analyzed. Clinical, past history and pathomorphologic data are considered--123 patients present papillary carcinoma, 67--follicular, and 42--mixed form. All patients undergo operative management over the period 1980 through 1991. Later, to the aforementioned group are added further 50 patients with carcinoma of the thyroid, treated from 1991 to late December 1992, and thus the total number amounts to 284 cases--153 papillary, 79 follicular and 52 mixed forms, respectively. In 67.2 per cent of the cases the thyroid carcinoma presents clinical patterns of a solitary node, in 27.8 per cent--node of multinodular struma, and in 4.9 per cent--formation associated with another thyroid disease. Multifocal location is established in five cases. As shown by the pathomorphological study in 18 per cent of the cases it is a matter of a combination--thyroid carcinoma and struma multinodosa, and in 1.2 per cent of the cases only there is conclusive evidence of solitary adenoma malignization. The obtained results lead to the inference that thyroid carcinoma deriving from the nodose structures of the gland is an exception, rather than rule.
本文讨论了结节性甲状腺肿与甲状腺癌之间发病机制关系这一有争议的问题。对索非亚高等医学院内分泌外科诊所收治的234例确诊为甲状腺癌的患者进行了回顾性分析。考虑了临床、既往史和病理形态学数据——123例为乳头状癌，67例为滤泡状癌，42例为混合性癌。所有患者在1980年至1991年期间接受了手术治疗。后来，又将1991年至1992年12月底治疗的另外50例甲状腺癌患者纳入上述组，因此总数达284例——分别为153例乳头状癌、79例滤泡状癌和52例混合性癌。在67.2%的病例中，甲状腺癌表现为孤立结节的临床模式，27.8%为多结节性甲状腺肿结节，4.9%与另一种甲状腺疾病相关的病变。5例确定为多灶性。病理形态学研究表明，18%的病例为甲状腺癌与多结节性甲状腺肿并存，仅1.2%的病例有孤立性腺瘤恶变的确凿证据。所得结果得出的结论是，起源于甲状腺结节结构的甲状腺癌是例外情况，而非普遍规律。
