Hama Y, Sugenoya A, Kobayashi S, Itoh N, Amano J
Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Surg Today. 1997;27(11):1077-81. doi: 10.1007/BF02385793.
We report on the case of a 57-year-old male found to have squamous cell carcinoma (SCC) arising from thyroglossal duct remnants. The patient presented with an asymptomatic tumor in his anterior neck which was immovable on palpation. Aspiration biopsy cytology revealed class V malignancy with many atypical clusters and marked keratinization. After preoperative radiation, a radical operation employing Sistrunk's procedure with bilateral neck dissection was performed. Histopathological examination confirmed a diagnosis of moderately differentiated SCC, but revealed ciliated columnar epithelium in the walls of the cyst without a normal layer of squamous cells. Furthermore, immunohistochemical studies demonstrated the tumor to be negative for thyroglobulin staining, but positive for cytokeratin and carcinoembryonic antigen. These histopathological findings proved attributable to squamous metaplasia occurring in the ciliated columnar epithelium of the thyroglossal duct. Thus, SCC might originate in the metaplastic portion of the thyroglossal duct remnants. Although the prognosis associated with SCC in the thyroglossal duct is not as optimistic as that associated with papillary carcinoma, no evidence of recurrence has been observed in this patient in the 7 years since his operation. This suggests the effectiveness of our therapeutic approach for this unusual disease.
我们报告一例57岁男性患者，其甲状腺舌管残余组织发生了鳞状细胞癌（SCC）。患者颈部前方出现无症状肿瘤，触诊时不可移动。细针穿刺活检细胞学检查显示为V级恶性肿瘤，有许多非典型细胞团且有明显角化。术前放疗后，采用Sistrunk手术并双侧颈部清扫进行了根治性手术。组织病理学检查确诊为中度分化的SCC，但在囊肿壁中发现有纤毛柱状上皮，而无正常的鳞状细胞层。此外，免疫组化研究表明肿瘤甲状腺球蛋白染色阴性，但细胞角蛋白和癌胚抗原阳性。这些组织病理学发现证明是甲状腺舌管纤毛柱状上皮发生鳞状化生所致。因此，SCC可能起源于甲状腺舌管残余组织的化生部分。尽管甲状腺舌管SCC的预后不像乳头状癌那样乐观，但该患者术后7年未观察到复发迹象。这表明我们对这种罕见疾病的治疗方法是有效的。
