Conzo G, Caracò C, D'Arco E, Giordano A, Amore A, D'Ardis A, De Rosa G, Santini L
Istituto di Anatomia Patologica, Facoltà di Medicina e Chirurgia, II Università degli Studi, Napoli.
Minerva Chir. 1998 Sep;53(9):751-6.
Follicular carcinoma, in association with other prognostic factors, identifies a class of "high-risk" patients in which a more aggressive treatment is indicated. In fact, in patients operated on for follicular carcinoma bone metastases, also many years after primary surgery, are reported. A case of skull metastases in a young women occurred 3 years after a near total lobectomy for follicular thyroid carcinoma is described. After six years the patient underwent total thyroidectomy, resection of skull metastases, radiometabolic therapy with I131 180 m Ci; now she is disease free at three years of follow-up. The biology of metastases in thyroid follicular carcinoma, risk factors and diagnostic and therapeutic controversies are analyzed. Good prognostic factors are considered age < 45 years, good degree of differentiation of primary tumor, small size of bone metastases and early appearance after primary diagnosis. The conclusions is drawn that bone metastases are the worst prognostic factors. In case of single lesion, surgical treatment allows good results.
滤泡状癌，与其他预后因素相关，可识别出一类“高危”患者，对此类患者需采取更积极的治疗。事实上，有报道称，即使在初次手术后多年，仍有滤泡状癌骨转移患者接受手术治疗。本文描述了一例年轻女性在接受甲状腺滤泡状癌近全叶切除术后3年发生颅骨转移的病例。6年后，患者接受了全甲状腺切除术、颅骨转移灶切除术、180毫居里的I131放射性代谢治疗；目前在三年的随访中她无疾病复发。本文分析了甲状腺滤泡状癌转移的生物学特性、危险因素以及诊断和治疗方面的争议。良好的预后因素包括年龄<45岁、原发肿瘤分化程度良好、骨转移灶体积小以及在初次诊断后早期出现。得出的结论是骨转移是最糟糕的预后因素。对于单个病灶，手术治疗可取得良好效果。
