甲状腺腺瘤及结节性甲状腺肿484例的再认识

Recognition of 484 Cases of Throid Adenomas and Nodular Goiter

目的 对 484例甲状腺腺瘤与结节性甲状腺肿的再认识 ,纠正 2 52例原甲状腺腺瘤的诊断。方法 选自本院 1 990～ 2 0 0 0年病检档案资料 ,对原 484例甲状腺腺瘤和结节性甲状腺肿的切片进行复查、重新诊断。结果 原诊断甲状腺腺瘤 349例 (72 .1 1 % ) ,结节性甲状腺肿 1 35例 (2 7.89% ) ,复查后确诊腺瘤 97例 (2 0 .0 4 % )。结节性甲状腺肿 387例(79.96% )。复查前腺瘤与结节性甲状腺肿之比为 2 .59∶ 1 ,复查后比为 1∶ 3.99。结论 甲状腺腺瘤与结节性甲状腺肿两种疾病尽管属良性病变 ,但治疗有差异 ,故二者不宜混淆。遇有腺瘤性甲状腺肿 ,且有囊性变时 ,就容易将腺瘤性甲状腺肿误诊为甲状腺腺瘤 ;结节内或囊壁中淋巴组织的增生数量较少时 ,以往多被诊断为腺瘤 ;忽视了对腺瘤性甲状腺肿时 ,间质纤维组织的增生 ,并分隔滤泡 ,有形成结节的趋势的镜下观察 ,导致甲状腺腺瘤的过早诊断。因甲状腺腺瘤与结节性甲状腺肿的临床表现、预后、复发、恶性变均不相同 ,故应严格掌握上述疾病的诊断及鉴别要点 。

Objective To recognize 484 cases of thyroid adenomas and nodular goiters and to correct the diagoses of 252 cases primary diagnosis of thyroid adenomas.Methods We selected the pathological material from 1990 to 2000 and checked and diagnosed these slices again.Results Before review, there wer 349 cases of thyroid adenomas(72.11%) and 135 cases of nodular goiters(27.89%) primarily, and after review, there were 97 cases of thyroid adenomas(20.04%) and 387 cases of nodular goiters(79.96%).The ratio between adenomas and goiters changed from 2.59∶1 to 1∶3.99.Conclusions Thyroid adenomas and nodular goiters were different in treatment,and were not easily confused,although they were both benign diseases.As adenomatoid goiter was accompanied with cystic degeneration,the misdiagnosis often occurred.When there were little quantity of lymph tissue proliferation in the node or cyst wall,the misdiagnosis often occurred.When we neglected that adenomatoid goiters had the trend to take the shape of node, the misdiagnosis often occurred. As the clinical manifestation,prognosis,recurrence and malignisation between thyroid adenoma and nodular goiter were different, the major points of diagnosis and differential diagnosis should be grasped,so as to avoid misdiagnosis.