原发性甲状腺鳞状细胞癌的超声表现和临床特点

Ultrasonic characters and clinical features of primary squamous cell carcinoma of the thyroid

目的 探讨原发性甲状腺鳞状细胞癌（primary squamous cell carcinoma of the thyroid,PSCCT）的临床特点、超声表现及其诊断价值,旨在提高对该病的认识.方法 回顾性分析5例经术后病理证实的PSCCT患者的临床资料和超声声像图特点.结果 5例患者平均年龄62岁（46～79岁）,临床触诊均有无痛性颈部包块,2例伴不同程度的呼吸困难和吞咽困难,2例伴声音嘶哑.本组患者4例（4/5）分别于术后4～15个月死亡,平均生存期9.5个月.高频超声表现为：①5例PSCCT肿块体积较大（最大直径2.9～5.5 cm）,均表现为边界不清、形态不规则的实性混合回声肿块,其中2例呈分叶状,内部均可见片状极低回声区,仅1例肿块内部见少许微小钙化,其余4例均无明显钙化；②3例肿块突破甲状腺被膜,且与甲状腺周围组织分界不清；③3例肿块内部可见少量血流信号,呈点线状分布,2例肿块内见中量血流信号,4例可测得高阻力频谱（RI 0.72～0.88）；④3例患者合并颈部异常淋巴结.结论 PSCCT有一定超声影像特点,结合其临床表现有助于定性诊断.

Objective To analyze the clinical and ultrasonic features of primary squamous cell carcinoma of the thyroid（PSCCT）and diagnostic value of ultrasonography （US） in PSCCT in order to improve the cognition of PSCCT.Methods The clinical data and ultrasonic characters of 5 patients with PSCCT confirmed by pathology post surgery were retrospectively reviewed.Results The average age of the 5 patients was 62 years （range from 46 to 79）.All of 5 patients with PSCCT were presented with a painless neck mass in clinical palpation examination.Of them,2 patients had different degrees of difficulty in breathing and swallowing,2 patients had hoarseness.Four of 5 patients had died after surgery with average survival time of 9.5 months.On US,the size of lesions was large（a maximum diameter of 2.9-5.5 cm）,all of 5 lesions appeared as single solid mixed-echogenicity mass including irregular lamellate marked hypoechoic region,with irregular margin and undefined boundary.Of them,2 lesions presented with lobulated,only 1 lesion exhibited microcalcification and another 4 lesions had no calcification,3 lesions exhibited a？ sign of breakthrough thyroid envelope.Color Doppler flow imaging showed few blood flow （3/5） and moderate blood flow （2/5）,a higher vascular resistance spectrum was detected in 4 lesions （RI 0.72-0.88）.Three patients exhibited suspicious cervical lymph nodes.Conclusions The characteristic ultrasonic appearance combined with the clinical features enables a confident preoperative diagnosis of PSCCT.