Lin J D, Weng H F, Ho Y S
Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung College of Medicine and Technology, Taoyuan Hsien, Taiwan, Republic of China.
Thyroid. 1998 Feb;8(2):149-53. doi: 10.1089/thy.1998.8.149.
Although up to 24% of metastatic cancers have been reported to spread to the thyroid gland, metastases to the thyroid are not detected in clinical practice in most cases. The prognosis is poor when metastatic cancer to the thyroid occurs. The aim of this study was to examine the clinical presentation, cytopathological findings, and clinical course of secondary cancers of the thyroid. The medical records of a total of 1013 histopathologically verified thyroid cancer patients treated during the period from January 1977 to December 1995 in Chang Gung Medical Center in Linkou were analyzed retrospectively. There were 14 patients (1.4% of all thyroid cancers) with secondary cancers of the thyroid with a mean age of 55.3 +/- 16.7 years. All these patients underwent thyroid ultrasonography and a fine-needle aspiration cytology of the thyroid (FNAC) before biopsy or surgical treatment. Tissue diagnosis was obtained by biopsy or necropsy in 12 or by thyroidectomy specimens in 2 patients. Most of the patients died within 9 months of diagnosis except for 2 patients who were lost to follow-up after transferring to another hospital and 1 patient with lymphoma. Before the surgical diagnosis, there were only 7 patients who metastatic neoplasms to the thyroid gland were diagnosed by FNAC. Anaplastic thyroid carcinoma was diagnosed in 5 patients. Benign nodule was diagnosed in 1 patient and lymphoma in another patient. Most of these patients had widespread metastases to many organs, as well as the thyroid gland. As a result these patients had very short survival times. Delayed diagnosis of the thyroid metastasis was the main reason for the short survival period. In conclusion, most of the metastatic lesions presented as an advanced stage of primary cancers. FNAC was a useful tool in the diagnosis. Histopathological diagnosis by surgical open biopsy is needed for the final diagnosis.
尽管据报道高达24%的转移性癌症会扩散至甲状腺，但在大多数临床实践中并未检测到甲状腺转移。甲状腺发生转移性癌症时预后较差。本研究的目的是探讨甲状腺继发性癌症的临床表现、细胞病理学特征及临床病程。回顾性分析了1977年1月至1995年12月期间在林口长庚医学中心接受治疗的1013例经组织病理学证实的甲状腺癌患者的病历。有14例（占所有甲状腺癌的1.4%）甲状腺继发性癌症患者，平均年龄为55.3±16.7岁。所有这些患者在活检或手术治疗前均接受了甲状腺超声检查及甲状腺细针穿刺细胞学检查（FNAC）。12例通过活检或尸检获得组织诊断，2例通过甲状腺切除标本获得组织诊断。除2例转至其他医院后失访的患者及1例淋巴瘤患者外，大多数患者在诊断后9个月内死亡。在手术诊断前，只有7例患者通过FNAC诊断出甲状腺转移性肿瘤。5例诊断为未分化甲状腺癌。1例诊断为良性结节，另1例诊断为淋巴瘤。这些患者大多数除甲状腺外，还广泛转移至许多器官。因此，这些患者的生存时间非常短。甲状腺转移的延迟诊断是生存时间短的主要原因。总之，大多数转移病灶表现为原发性癌症的晚期阶段。FNAC是诊断的有用工具。最终诊断需要通过手术开放活检进行组织病理学诊断。
