甲状舌管乳头状癌诊断及治疗

Papillary carcinoma in a thyroglossal duct remnant

目的:探讨甲状舌管乳头状癌病例的诊断治疗方法。方法:2例患者术前接受常规体检、B超、细针穿刺检查,手术均包括颈前肿块及舌骨中部的切除(Sistrunk operation),一侧甲状腺肿块切除或腺叶切除。一例患者由于发现明显右颈肿大淋巴结,故同时实施了功能性颈清扫术。术后标本行常规病理检查。结果:2例患者标本符合甲状舌管乳头状癌诊断,并正在密切随访中。结论:甲状舌管癌为罕见病种,已有公认的诊断标准,Sistrunk手术仍为一种适当的外科治疗方法。

Purpose: To report 2 cases of papillary thyroid carcinoma occurring in a thyroglossal duct remnant, and to discuss the diagnostic and therapeutic methods by reviewing the literature. Methods: An asymptomatic midline mass occurring in the upper neck was the sole presenting complaint in 2 cases. The preoperative evaluation included a complete head and neck examination, B-ultra sound examination and FNAB. The Sistrunk procedure was done. A lobectomy( case 1) and a lumpectomy ( case 2) were performed respectively, because of the abnormality found in their thyroid gland. A modified neck dissection was performed in case 2 because of regional lymphadenopathy. The following histologic studies were carried out on tissues with HE stain. Results: Diagnoses of thyroglossal duct carcinoma were made by several pathologists. Tissues from thyroid were first diagnosed as nodular goiter in case 1 and thyroid adenoma in case 2. In case 2, one positive lymph node and invasion to the hyoid bone was found. Conclusions: Malignant lesions are rare in the thyroglossal duct remnant. The diagnostic criteria is acknowledged. Resection of the thyroglossal duct carcinoma by the Sistrunk procedure is an adequate surgical approach. But the controversy about further treatment will continue because of the lack of large series of patients and the 10 to 20 year follow-up.