Submandibular solid-cystic mass as the first and sole manifestation of occult thyroid papillary carcinoma: A case report

BACKGROUND Occult thyroid papillary carcinoma(OTPC)is typically characterized by initial presentation with cervical lymph node metastasis and can be detected through ultrasound.However,the initial and sole manifestation was a submandibular solid-cystic mass.High-frequency ultrasound,enhanced multislice computed tomography(CT)scan,and thyroid function tests revealed no abnormalities,which is relatively uncommon.CASE SUMMARY A 24-year-old Chinese female,who studied at a university in Shandong Province,presented to the clinic in June 2019 with a right submandibular mass that she had noticed 2 mo earlier.Clinical examination revealed a 2-cm,nontender,movable solid-cystic mass in the submandibular region,with no palpable thyroid mass observed.Ultrasonography revealed a 2.0 cm×1.1 cm solid-cystic mass in the right submandibular region,and the thyroid gland showed no abnormalities.CT scan and 131I whole body follow-up scan showed that there were no abnormalities in the thyroid.However,cytology and pathology showed papillary tumor cell clusters,consistent with papillary thyroid carcinoma.Thus,we performed total thyroidectomy and right neck lymph node dissection.The pathology revealed the thyroid was detected as classical thyroid micropapillary carcinoma,and lymph nodes of levels VI central and levels II,III,IV,V on the right side showed no tumor metastasis.The patient was followed up for 2 years without significant recurrence.CONCLUSION The presentation of a submandibular solid-cystic mass as the primary and solitary indication of OTPC is relatively uncommon.Fine needle aspiration is advised for evaluating neck masses.

Occult hepatitis B virus and hepatocellular carcinoma

Occult hepatitis B virus(HBV)infection(OBI)is a challenging pathobiological and clinical issue that has been widely debated for several decades.By definition,OBI is characterized by the persistence of HBV DNA in the liver tissue(and in some cases also in the serum)in the absence of circulating HBV surface antigen(HBsAg).Many epidemiological and molecular studies have indicated that OBI is an important risk factor for hepatocellular carcinoma(HCC)development.OBI may exert direct pro-oncogenic effects through the activation of the same oncogenic mechanisms that are activated in the course of an HBsAg-positive infection.Indeed,in OBI as in HBV-positive infection,HBV DNA can persist in the hepatocytes both integrated into the host genome as well as free episome,and may maintain the capacity to produce proteins-mainly X protein and truncated preS-S protein-provided with potential transforming properties.Furthermore,OBI may indirectly favor HCC development.It has been shown that the persistence of very low viral replicative activity during OBI may induce mild liver necro-inflammation continuing for life,and substantial clinical evidence indicates that OBI canaccelerate the progression of liver disease towards cirrhosis that is considered the most important risk factor for HCC development.

OCCULT CERVICAL METASTASIS OF SQUAMOUS CELL CARCINOMA OF TONGUE AMONG CN0 PATIENTS AND ITS TREATMENT

Objective： To explore the treatment of clinically negative neck （CN0） patients with squamous cell carcinoma of the tongue. Methods： 165 CN0 patients with squamous cell carcinoma of the tongue from 1985 to 2002 were investigated retrospectively. Parts of the patients staged at T1, T2 and T3 underwent resection of primary lesion followed by neck observation, and other patients staged above T2 or at T1 but without follow-up were treated with elective neck dissection （END）. All patients were followed up for more than 3 y or until their death. Results： Lymphatic metastasis was identified histologically after operation in 33 of 120 patients treated with END, and 9 of 45 patients treated with resection of primary lesion alone. The overall rate of occult lymphatic metastasis was 25.45%, which increased with the elevating of clinical T stage. The overall rate of neck uncontrolled death was 20.00% for observation group and 5.00% for END group, and significant difference was found between them （P〈0.05）. For T~ patients in the two groups, the rate of neck uncontrolled death was 7.71% and 4.00% respectively, and no significance was found between them （P〉0.05）. When stage T2 and T3 were considered as middle stage together, significant difference （P〈0.05） could be obtained between observation （70.00%） and END group （0%）. Conclusion： The occult metastasis rate of squamous cell carcinoma of tongue increases with the elevating of clinical stage, and elective neck dissection could be considered for NO patients staged over T2 to improve neck control and survival rate; and regional resection alone of primary lesion could be considered for T1N0 patients to improve quality of life if closely followed up is conducted.

Occult hepatitis B virus infection and surgical outcomes in non-B, non-C patients with curative resection for hepatocellular carcinoma

AIM To investigate the prevalence, clinicopathological characteristics and surgical outcomes of occult hepatitis B virus(HBV) infection(OBI) in patients with non-B, non-C(NBNC) hepatocellular carcinoma(HCC).METHODS This study retrospectively examined the cases of 78 NBNC patients with curative resection for HCC for whom DNA could be extracted from formalin-fixed paraffin-embedded tissue. OBI was determined by the HBV-DNA amplification of at least two different sets of primers by TaqM an realtime polymerase chain reaction. Possibly carcinogenetic factors such as alcohol abuse, diabetes mellitus, obesity and non-alcoholic steatohepatitis(NASH) were examined. Surgical outcomes were evaluated according to diseasefree survival(DFS), overall survival(OS) and diseasespecific survival(DSS).RESULTS OBI was found in 27/78 patients(34.6%) with NBNC HCC. The OBI patients were significantly younger than the non-OBI cases at the time of surgery(average age 63.0 vs 68.1, P = 0.0334) and the OBI cases overlapped with other etiologies significantly more frequently compared to the non-OBI cases(P = 0.0057). OBI had no impact on the DFS, OS or DSS. Only tumorrelated factors affected these surgical outcomes.CONCLUSION Our findings indicate that OBI had no impact on surgical outcomes. The surgical outcomes of NBNC HCC depend on early tumor detection; this reconfirms the importance of a periodic medical examination for individuals who have NBNC HCC risk factors.

单侧甲状腺乳头状癌伴对侧腺叶结节合并隐匿性癌的危险因素分析

目的分析单侧甲状腺乳头状癌(PTC)伴对侧腺叶结节合并隐匿性癌的危险因素。方法回顾性分析2021年1月至2022年9月广东医科大学附属医院收治的114例术前诊断为单侧PTC伴对侧腺叶结节患者的临床资料,所有患者均行甲状腺全切除术或近全切除术+中央区淋巴结清扫术(部分同时进行颈侧区淋巴结清扫术)。分析单侧PTC伴对侧腺叶结节合并隐匿性癌的危险因素。结果术后病理检查结果显示,单侧PTC伴对侧腺叶结节合并隐匿性癌30例,无隐匿性癌84例。单因素分析结果显示,两组的PTC肿瘤直径、合并淋巴结转移占比、合并腺体外侵犯占比比较,差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,合并淋巴结转移、合并腺体外侵犯是影响单侧PTC伴对侧腺叶结节合并隐匿性癌的独立危险因素(P<0.05)。结论淋巴结转移及腺体外侵犯是单侧PTC伴对侧腺叶结节合并隐匿性癌的独立危险因素;针对术前诊断为单侧PTC合并对侧腺叶结节,若存在淋巴结转移及腺体外侵犯等恶性特征,应该行甲状腺全切术治疗。

An overview of occult hepatitis B virus infection

Occult hepatitis B virus (HBV) infection (OBI), alternatively defined as occult hepatitis B (OHB), is a challenging clinical entity. It is recognized by two main characteristics: absence of HBsAg, and low viral replication. The previous two decades have witnessed a remarkable progress in our understanding of OBI and its clinical implications. Appropriate diagnostic techniques must be adopted. Sensitive HBV DNA amplification assay is the gold standard assay for detection of OBI. Viral as well as host factors are implicated in the pathogenesis of OBI. However, published data reporting the infectivity of OBI by transfusion are limited. Several aspects including OBI transmission, infectivity and its relation to the development of chronic liver diseases and hepatocellular carcinoma have to be resolved. The aim of the present review is to highlight recent data on OBI with a focus on its virological diagnosis and clinical outcome.

Elective regional lymphadenectomy for advanced auricular squamous cell carcinoma

AIM: To investigate the rate of occult lymph node disease in elective parotidectomy and neck dissection specimens in patients with advanced auricular cutaneous squamous cell carcinoma(cS CC). METHODS: At a single institution, from 2000 to 2010, 17 patients with advanced auricular cS CC were considered high risk for occult regional parotid and/or neck nodal metastases and, thus, underwent an auriculectomy and elective regional lymphadenectomy(parotidectomy and/or neck dissection). Indications for elective regional lymphadenectomy were large tumor size, locally invasive tumors, post-surgical and post-radiation recurrence, and being an immunosuppressed patient. We determined the presence of microscopic disease in the regional(parotid and neck dissection) pathology specimens.RESULTS: There were 17 advanced auricular c SCC patients analyzed for this study. Fifteen(88%) patients were men. The average age was 69(range: 33 to 86). Ten(59%) patients presented with post-surgical recurrence. Five(29%) patients presented with postradiation recurrence. Four(24%) patients presentedwith both post-surgical and post-radiation recurrence. Four(24%) patients were immunosuppressed(2(12%) were liver transplant patients, 2(12%) were chronic lymphocytic leukemia patients, and 1(6%) was both). The subsite distribution of c SCC included helix(3, 18%), antihelix(2, 12%), conchal bowl(7, 41%), tragus(2, 12%), and postauricular sulcus(3, 18%). Four(24%) patients presented with multifocal auricular cS CC. No patients had bilateral disease. All patients were confirmed to have c SCC on final pathology. The tumors were well(5, 29%), moderately(10, 59%), and poorly(2, 12%) differentiated SCC. The average size of the cS CC tumor was 2.9 cm(range: 1.7 to 7 cm). Twelve(70%) tumors were greater than 2 cm. Six(35%) patients underwent partial auriculectomy. Eleven(65%) patients underwent total auriculectomy. Eight(47%) patients underwent elective parotidectomy and elective neck dissections; 3(18%) underwent only elective parotidectomy; 3(18%) underwent only an elective neck dissection; 2(12%) underwent an elective parotidectomy and therapeutic neck dissection; and 1(6%) underwent a therapeutic parotidectomy and an elective neck dissection. None of the elective parotidectomy or neck dissection specimens were found to contain any malignant disease. All therapeutic parotidectomy and neck dissection specimens contained metastatic SCC. Fourteen(82%) underwent parotidectomy. Of these, 10(71%) underwent superficial parotidectomy whereas 4(29%) underwent total parotidectomy. Fourteen(82%) underwent neck dissections [levels Ⅱ/Ⅴa(1, 7%), levels Ⅱ/Ⅲ/Ⅴa(2, 14%), levels Ⅰ/Ⅱ/Ⅲ/Ⅴa(2, 14%), and complete levels Ⅰ-Ⅴ(9, 64%)]. Three(18%) underwent concurrent temporal bone resections for tumor extension from the auricle. The average follow-up for our patients was 44 mo(range: 4 to 123 mo). At the time of the review, 6(35%) patients were alive and 11(65%) had passed away. CONCLUSION: This study suggests that, in patients with advanced auricular cutaneous SCC, elective regional lymphadenectomy is not necessary. However,furtherprospective studies are necessary to assess the necessity.

原发性甲状腺功能亢进合并隐匿性甲状腺癌的外科诊治

目的探讨原发性甲状腺功能亢进合并隐匿性甲状腺癌的外科诊断和治疗方法。方法对北京协和医院2004年1月至2014年11月收治的51例患者的临床资料进行回顾性分析。结果原发性甲状腺功能亢进合并隐匿性甲状腺癌占同期甲状腺功能亢进手术患者的5.03%,占甲状腺癌手术患者的0.67%。女性患者占92.16%。51例患者术前均诊断为原发性甲状腺功能亢进,其中11例术前同时诊断甲状腺癌可能。所有患者中,25例术中冰冻病理提示恶性,26例术后石蜡病理诊断甲状腺癌。26例行甲状腺大部或次全切除术,4例行甲状腺全切除术,21例行甲状腺全切除＋区域性淋巴结清扫术。肿瘤大小0.1~1.0 cm,平均（0.63±0.35）cm;其中直径≤0.5 cm的有28例（54.9%）。获得随访43例,随访时间1~121个月,平均（28.6±22.7）个月,随访患者均生存至本文发稿时。结论原发性甲状腺功能亢进合并隐匿性甲状腺癌女性患者多见,术前诊断困难,超声是主要检查方法,重视冰冻检查可以提高术中诊断率,手术治疗效果满意,预后良好。

口腔鳞癌患者颈淋巴结cN_0的处理

目的 探讨口腔鳞癌颈淋巴结转移的发生规律及对cN0 患者的治疗原则。方法 通过对四川大学华西口腔医院颌面外科 1980～ 2 0 0 1年住院的 10 2 4例口腔鳞癌患者的临床资料进行回顾性分析。结果 口腔鳞癌患者颈淋巴结的总体转移率为 36 6 2 %,其中舌癌转移率最高为 42 82 %,颊癌和下牙龈癌相近分别为 31 93%和32 76 %,口底癌转移率最低为 2 5 .0 0 %;cN0 患者的颈淋巴结隐匿性转移率为 2 0 94%。口腔鳞癌的隐匿性转移与原发灶的部位、T分期等密切相关。结论 临床上应根据患者肿瘤原发灶的部位、大小和临床分期等综合考虑分析 ,判断颈淋巴结情况 ,从而选择合理的治疗方案。

糖链抗原19－9放免测定对诊断胃肠道潜隐癌的价值

对胃肠道潜隐癌、癌前病变和炎性病变各３０例患者术前的糖链抗原（ＣＡ）１９－９水平进行回顾性分析，发现３组之间或两两比较均有明显差异。发现＜３７ｕ／ｍｌ者９７．４４％为良性病变，＞９０ｕ／ｍｌ者９４．４４％为恶性病变。３７～９０ｕ／ｍｌ之间者复查前后对比，癌变组血清ＣＡ１９－９水平平均升高１４．４２ｕ／ｍｌ，良性病变组平均下降９．６２ｕ／ｍｌ。提示对经内镜活组织检查未被证实的可疑胃肠道肿瘤患者，常规ＣＡ１９－９放免测定有助于发现胃肠道潜隐癌。

甲状腺微小乳头状癌的临床病理分析

目的:探讨甲状腺微小乳头状癌的临床病理特点。方法:对10例原发性甲状腺微小乳头状癌临床和病理资料进行复习,重新阅片确诊。结果:男性1例,女性9例,年龄18～56岁,平均42.2岁。形态特征:癌灶呈结节状或纤维瘢痕状,边界不清,灰白色,质较硬,直径约为0.3～1.0cm,癌组织有纤维血管轴心的复杂分支乳头状结构及毛玻璃核、核内假包涵体、核沟,纤维间质反应及砂粒体。结论:对甲状腺组织标本应仔细观察,书页状切开并多取材,可以提高检出率,减少漏诊。

隐匿型甲状腺癌

目的：研究国人隐匿型甲状腺癌（ＯＴＣ）的诊治及生物学行为。方法：采用本院１９７６～１９９５年收治的２１９例分化型甲状腺癌（ＤＴＣ），其中ＯＴＣ４１例进行随访。结果：非隐匿型甲状腺癌中有更多甲状腺外浸润，但ＯＴＣ多灶性更多见，淋巴结转移两者差异无显著性。３７例ＯＴＣ病人有随访结果，平均随访１０年，只有１例（２．４％）死于ＯＴＣ肺转移。有４例分别于术后２～６年复发，总复发率１０．８％。经统计初次手术类型为复发相关因素，甲状腺部分切除术后复发明显高于患侧一叶及更大范围切除术后。４１例ＯＴＣ中术前诊断（包括怀疑恶性）仅１６例。结论：ＯＴＣ病人的１０年生存率达９１．９％；ＯＴＣ占同期ＤＴＣ的１９％，应综合应用Ｂ超、ＦＮＡＢ、冰冻病理等提高诊断率；首次手术应行一叶切除术，临床诊断淋巴结转移再行改良颈淋巴结清扫术。

肛门隐血与肝胆胰腺癌普查的关系

目的:用棉棒涂抹肛门方法代替大便隐血试验,不仅可以初筛大肠癌,还可以作为初筛肝胆胰腺癌的辅助手段。方法:223例肝胆胰腺癌病人做肛门隐血试验,其中有121例呈阳性反应,阳性率为54.2％。在40～60岁健康人群中筛查14645人,511人肛门隐血呈阳性反应,阳性率为3.4％。结果:检出消化道癌6例(食管癌1例,贲门癌1例,胃癌2例,肝癌2例)。结论:提示肛门隐血阳性时,应进一步用超声波检查肝胆胰有无肿瘤。

隐匿性乙肝与肝细胞肝癌关系的研究进展

慢性乙肝是肝细胞肝癌(hepatocellular carcinoma,HCC)发生的主要危险因素已是公认的定论,那么隐匿性乙肝(occult hepatitis B virus infection,OBI)与HCC的相关性如何,却尚有争议。此文综合国内外临床和动物研究结果,总结出:OBI是HCC发生的重要危险因素。OBI保留有显性乙型肝炎病毒(hepatitis B virus,HBV)感染相同的致癌机制,如整合进宿主基因组,顺式激活相关基因或合成蛋白后反式作用于基因组或相关蛋白质,如合成乙肝病毒X蛋白(hepatitis B virus X antigen,HBX)、前S蛋白和乙肝表面抗原(hepatitis B surface antigen,HBs Ag),这些蛋白可使肝细胞发生转化,影响信号通路,使细胞增殖、凋亡失衡。其次,持续存在的低载量病毒可导致轻微但持续的炎症坏死,肝细胞循环坏死、再生,加速肝硬化进程,最终导致HCC。最后,病毒突变及甲基化修饰在HCC发生中也有重要作用。

隐匿性乳腺癌的诊治分析(附14例报告)

目的探讨隐匿性乳腺癌的诊断、治疗方法。方法回顾性分析1995年1月￣2004年6月该科收治的14例隐匿性乳腺癌的诊断和治疗经过及随访结果。结果所有病例均为女性,占同期乳癌的0.86%,14例患者均行乳腺钼靶摄片,异常者6例,双乳B超,3例考虑乳癌。13例行改良根治术,1例保乳根治术。随访至今,2例死亡,12例生存,其中1例带瘤生存,最长1例存活5a。结论临床对女性腋窝肿块应高度警惕隐性乳癌可能,提高认识,影像学检查及连续切片、免疫组化有助于乳腺原发灶检出。治疗予改良根治术或结合病情及自身愿望保留乳房手术综合化放疗。

舌鳞状细胞癌颈部淋巴结转移的临床分析

目的 探讨舌鳞癌颈转移的发生规律以及对cN0 (临床不怀疑转移 )患者的治疗原则。方法 通过对4 39例舌癌患者的临床资料进行回顾性分析。结果 舌鳞癌的总体转移率为 4 2 14 % ,cN0 患者的颈淋巴结隐匿性转移率为 2 6 6 6 % ,舌鳞癌的隐匿性转移与肿瘤T分期等密切相关。结论 临床上应根据原发灶的大小等综合考虑分析 。

超声弹性成像在甲状腺癌诊断中的应用价值

目的探讨超声弹性成像在甲状腺癌诊断中的应用价值。方法采用2011年3月-6月进行甲状腺超声健康体检中发现的453例512个结节进超声弹性成像检查,按5分法对甲状腺结节弹性图像进行评分,以0-2分作为判断甲状腺良性结节的诊断标准,3-4分作为判断甲状腺恶性结节的诊断标准,并与病理结果对照。结果 512个结节,评分0-2分的456个,3-4分56个。≥3分的56个结节病理结果:乳头状癌47个,其中隐匿癌31个;滤泡癌3个,其中隐匿癌1个;髓样癌2个;腺瘤4个。结论超声弹性成像对甲状腺癌的诊断有较高的应用价值。

隐匿性肾细胞癌的诊治再讨论

目的:进一步提高对隐匿性肾细胞癌(ORCC)的认识水平。方法:回顾性分析1998～2007年先后收治的7例ORCC患者的临床资料,并结合国内外文献资料对此型肾癌及其诊治进行讨论。结果:6例病理检查诊断为肾透明细胞癌,1例诊断为结节型肉瘤样肾细胞癌,其中G_1-G_22例,G_22例,G_33例。5例分别于肾癌根治术加综合治疗后3个月、5个月、1 5个月、19个月和4.5年因肺、肝、骨骼癌细胞转移、癌性恶液质而死亡;1例皮肤转移患者生存14个月;另1例口服索拉非尼者生存12个月死亡。结论:ORCC是以转移癌(骨骼、肝等)表现首诊而缺乏肾癌症状的晚期肾癌,如能提高警惕,对泌尿系器官进行全面检查,确诊并不难。肾癌根治术加综合治疗能延长患者的生存期。

乳腺癌局部淋巴结内隐匿性微小癌转移的免疫组化研究

１１２例女性乳腺癌病人手术切除１８４０枚淋巴结，常规病理检查无癌转移。现用连续切片，单克隆抗细胞角蛋白（ＡＥ１／ＡＥ３）、抗上皮细胞膜（ＥＭＡ）抗体及多克隆抗角蛋白抗体对肿瘤组织及所有淋巴结按ＬＳＡＢ法进行免疫染色。几种抗体均对肿瘤组织、淋巴结内微小癌灶及单个癌细胞呈现免疫染色阳性反应，尤以抗ＥＭＡ抗体反应最强。结果查出２７．７％（３１／１１２）病例及２．２７％（５０／１８４０）淋巴结内存在隐匿性微小癌转移。其中６１例病人经７年随访，显示有隐匿性微小癌转移病人肿瘤复发、远处扩散转移均较无癌转移病人高，而且术后时间短。作者对隐匿性微小癌的淋巴结内转移及其病理生物学与临床意义进行了讨论。

cN0口腔鳞状细胞癌颈部淋巴结转移的临床分析

目的：探讨颈部淋巴结阴性（c N0）的口腔鳞癌（OSCC）患者发生颈淋巴结隐匿性转移的规律和相关影响因素。方法：收集2008-07-2013-07接受颈淋巴结清扫的85例c N0 OSCC患者的临床和病理资料进行回顾性分析。结果：85例c N0 OSCC患者中,总隐匿性转移率为28.24%（24/85）。c N0 OSCC患者淋巴结转移率与性别、发病部位无相关性（P〉0.05）,与年龄、原发灶大小、病理分期及生长方式存在显著相关性（P〈0.05）。结论：肿瘤体积越大、分化程度越低、患者年龄越小其淋巴结隐匿性转移率越高,对此类患者需积极行相应颈部淋巴结清扫处理。