甲状腺内胸腺癌1例报告及文献复习

Intrathyroid thymic carcinoma: A case report and literature review

目的:探讨甲状腺内胸腺癌(ITTC)的临床病理学特征、治疗方法和预后,加强临床医生对该病的认识。方法:观察1例ITTC患者的临床表现。肉眼观察肿瘤大体形态表现,行实验室检查和影像学检查,观察甲状腺肿物细针穿刺细胞学表现,光镜下观察肿瘤组织形态表现,对肿瘤组织行免疫组织化学染色和原位杂交检测,术后3和11个月对患者进行随访,并结合文献进行复习。结果:ITTC患者临床主要表现为甲状腺内质稍硬肿物。细胞学检查显示肿瘤细胞呈三维立体结构,部分细胞可见核仁。组织学检查显示癌细胞呈巢状或岛状分布,并向鳞状细胞分化;其周围纤维组织增生,伴淋巴细胞浸润;伴右颈部淋巴结转移。免疫表型检测,癌细胞表达CD117、CD5和P63等,不表达TdT和TTF-1,EBER-ISH (-)。病理诊断为ITTC伴颈部淋巴结转移。患者在术后3和11个月复查CT均未见复发及转移。结论:ITTC恶性程度低,可复发及转移,联合手术及放疗,患者预后良好。

Objective:To study the clinicopathological features,treatment method and prognosis of intrathyroid thymic carcinoma(ITTC),and to strengthen the clinicans’ understandings of the disease.Methods:The clinical manifestations of one patient with ITTC were observed. The general morphology of the tumor was observed with naked eyes,laboratory examination and imaging examination were performed,the fine needle aspiration cytology of the thyroid tumor was observed,the morphology of the tumor tissue was observed under light microscope, immunohistochemistry staining and in situ hybridization were performed in the tumor tissue,and the patient was followed up 3 and 11 months after operation;the relevant literatures were reviewed. Results:The main clinical manifestation of the ITTC patient was a slightly hard mass in the thyroid. The fine needle aspiration cytology results showed that the tumor cells showed a threedimensional structure,and the prominent nucleoli could be seen in some cells. The histology results showed that the cancer cells were nest like or island like and differentiated into the squamous cells;the fibrous tissue proliferated accompanying with lymphocyte infiltration around the cancer cells and the right cervical lymph node metastasis. The immunophenotype detection results showed that the cancer cells expressed CD117,CD5 and P63,but didn’t express TdT and TTF-1,EBER-ISH(-). The pathological diagnosis was ITTC accompanying with cervical lymph node metastasis. No recurrence or metastasis was found on CT3 and 11 months after operation. Conclusion:ITTC has low malignancy degree,which can relapse and metastasize,and combined with surgery and radiotherapy,the prognosis of the patients is good.