以远处转移为首发表现的24例甲状腺滤泡癌临床病理特征分析

Analyses of the clinical and pathological features of follicular thyroid carcinoma with distant metastasis as first manifestation

目的:探讨以远处转移为首发表现的甲状腺滤泡癌(follicular thyroid carcinoma,FTC)临床病理特点、诊断及预后。方法:回顾性分析天津医科大学肿瘤医院2001年1月至2016年1月收治的129例FTC患者,总结以远处转移为首发表现的FTC临床资料、病理诊断及形态特征,并进行生存分析。结果:129例FTC患者中,以远处转移为首发表现占18.6%(24/129),其中以骨转移最为常见为13.2%(17/129),临床主诉通常为转移部位的肿块及疼痛。转移的滤泡癌病理形态主要分为4种:微滤泡型10例、实性型4例、正常滤泡型9例、大滤泡型1例。转移性滤泡癌免疫组织化学甲状腺球蛋白(thyroglobulin,TG)、甲状腺转录因子1(thyroid transcription factor-1,TTF-1)呈阳性。生存分析显示本组病例5年生存率为87.1%;其中,首发为单病灶患者较多病灶患者预后较好(P=0.022);活检组织病理形态为正常滤泡或大滤泡亚型者与实性或微滤泡亚型者相比具有较好的预后(P=0.012)。结论:FTC易发生远处转移,部分以远处转移为首发表现,诊断需要结合病理形态学及免疫组织化学染色;转移癌的首发病灶数及病理形态学亚型具有一定的预后提示意义。

Objective：The clinicopathological features, diagnosis, and prognosis of follicular thyroid carcinoma （FTC） with distant me-tastasis as the first manifestation were evaluated in this study. Methods：A total of 129 FTC cases with clinical data were retrospective-ly analyzed in the Department of Pathology, Tianjin Medical University Cancer Institute and Hospital （January 2001 to January 2016）. Survival analysis and conjoint analysis on FTC with clinical data, diagnosis, and morphological characteristics with distant metastasis as the first manifestation were performed. Results：Among the 129 FTC cases, 24 cases demonstrated distant metastasis as the first mani-festation （18.6%）. Bone metastasis was the most common （13.2%）. The presence of mass and pain at the metastatic sites were the usu-al clinical complaints. The morphological characteristics of FTC with distant metastasis can be classified into four subtypes：microfollicu-lar （10 cases）, solid （4 cases）, normofollicular （9 cases）, and macrofollicular （1 case）. Immunostaining tests on thyroglobulin and thyroid transcription factor-1 showed positive results in FTC with metastasis. Survival analysis showed that the five-year survival rates in the 24 cases were 87.1%. The prognosis of patients with solitary metastasis was better than that of patients with multiple metastasis （P=0.022）. A higher survival rate was found in the normofollicular and macrofollicular subtypes than that detected in the microfollicular and solid subtypes （P=0.012）. Conclusion：FTC is susceptible to distant metastasis. Some patients with FTC demonstrated distant me-tastasis as the first manifestation, and their diagnosis can be confirmed by pathological feature analysis and immunostaining. The prog-nostic significance is possibly related to the number of lesions of FTC with distant metastasis and histopathological subtypes.