慢性淋巴细胞性甲状腺炎合并隐匿性乳头状癌28例临床病理分析

Clinicopathologic features of chronic lymphocytic thyroiditis with occult papillary thyroid carcinoma

目的探讨慢性淋巴细胞性甲状腺炎（HT）合并隐匿性甲状腺乳头状癌（occultPTC）的临床病理特征，以提高诊疗水平。方法选取1999年7月至2005年7月经手术切除病理证实的HT合并occultPTC患者28例，对其临床表现、促甲状腺激素（TSH）结果、影像学及病理特征进行回顾性分析并随访。复习HE切片，用免疫组织化学EnVision二步法检测CKl9、galectin-3（Gal-3）及bcl-2。结果189例HT合并甲状腺乳头状癌34例（17．9％），occuhPTC28例（14．8％）；女19例，男9例；平均年龄36．7岁；TSH正常11例（39．3％），增高8例（28．6％），降低9例（32．1％）；癌肿直径均〈0．8cm，其中0．2～0．5cm16例，〉O．5cm12例；彩色超声和CT发现斑片状钙化（非沙砾体）6例（21．4％），未发现淋巴结；术前临床均未明确诊断；随访2～7年，28例均健在，均未复发或转移。结论HT合并occultPTC，好发于中年女性，预后良好，无临床特异性征象，TSH检测对诊断无帮助，HT纤维化、钙化者应高度重视，宜选择术中快速病理，HT合并occultPTC确诊依靠病理。

Objective To study the clinicopathology characteristics of chronic lymphocytic thyroiditis （Hashimoto＇s thyroiditis, HT） with occult papillary thyroid carcinoma （occult PTC） in order to improve its diagnostic and therapeutic accuracy. Methods A restrospective analysis was done on the clinical materials of 28 cases of HT with occult PTC from July 1999 to July 2005. All cases were confirmed by operation and pathologic biopsy. Clinical and gross findings were collected. All HE slides were reexamined and immunostains for CK19, galectin-3,and bcl-2 were performed （Envision method）. Results In total 189 cases of chronic lymphocytic thyroiditis,28cases （14.8%,28/189）had coexistent occult papillary thyroid carcinoma. There were 19 females and 9 males with median age of 36.7 years old. Normal TSH presented in llcases （39.3 %）, high in 8 cases（28.6 %）, and low in 9cases （32.1%）. All tumor diameter was counted for 〈0.8 cm, 16 cases （57.1%） tumor diameter 0.2-0.5 cm, 12 cases （42.9 %） 〉0.5 cm. Coarse calcification was seen in 6 cases（21.4 %） in color ultrasonic exam and CT scans. Follow-up data showed that 28 patients were all alive with no evidence of recurrence or metastasis for 2 to 7 years by December 2007. Conclusion There are no special clinical characteristics in coexistent HT with occult PTC.Coarse calcification in HT in the group of middle-aged women increase the likelihood of the diagnosis. But the diagnosis depends on pathology. Because of the high incidence of occult PTC in HT population, it would be necessary to keep an eye on this particular type of thyroid carcinoma, and multiple sampling in suspected area of HT specimen is advised in the hope not to miss any small tumor in clinical practice.