Thyroid follicular renal cell carcinoma excluding thyroid metastases:A case report

BACKGROUND Thyroid follicular renal cell carcinoma is a special type of renal cell carcinoma newly recognized in recent years.It has attracted attention because of its unique histology,immunophenotype,and clinical characteristics.It has a very low incidence,and the number of case reports available for review is limited.Moreover,a thyroid mass with type of tumour is rare.CASE SUMMARY We report a case of a renal mass with a bilateral thyroid mass that was accidentally discovered in a 60-year-old man during physical examination.B-mode ultrasound showed a hypoechoic mass in the middle and lower parenchyma of the right kidney,and computed tomography showed an iso-density shadow tumour in the right kidney.Contrast agents had a significant continuous enhancement effect on the tumour,and the enhancement was not uniform.After partial nephrectomy,pathological analysis was performed to rule out the possibility that the renal tumour was caused by thyroid tumour metastasis.Needle biopsy of the thyroid tumour confirmed that the renal cell carcinoma was not related to the thyroid tumour.The patient was alive at the last postoperative follow-up.CONCLUSION This is the third published case in which thyroid tumour biopsy was performed to confirm that thyroid follicular renal cell carcinoma is not thyroid related.

口腔软组织转移性甲状腺肉瘤样癌1例和文献复习

目的探讨甲状腺肉瘤样癌(STC)的临床病理学特征、诊断和鉴别诊断。方法观察1例甲状腺癌术后原发部位无明显病灶仅有口腔软组织转移的STC的临床特征、细胞和组织学形态以及免疫表型,并复习文献。结果患者女性,63岁,右上腭处带蒂息肉状肿物。光镜下肿瘤组织呈广泛侵袭性,由梭形细胞、多形性巨细胞和上皮样细胞混合构成,核怪异,单个或多个,核仁明显,病理性核分裂象多见,伴有凝固性坏死及多形核白细胞浸润。免疫表型:TTF-1(+)、Vimentin(+++)、CKpan(+)、CK7个别细胞(+)、Ki-67大约35%(+)、SMA(+)、Tg(-)、CD68(-)、LCA(-)、Myogenin(-)、MG(-)、HMB45(-)、S-100(-)。结论口腔软组织转移性STC非常少见,其恶性程度高,预后差,必须结合临床病史、组织学形态及免疫表型进行诊断,且需与其他肿瘤鉴别诊断。

甲状腺乳头状癌的诊治进展

甲状腺乳头状癌是甲状腺最常见的恶性肿瘤,约占甲状腺癌的80%。研究其诊断手段和治疗方法,对攻克该肿瘤很有必要。综合文献认为,对于甲状腺乳头状癌,除了临床物理和影像学检查外,细针穿刺或通过穿刺与术中冷冻切片相结合是最准确的诊断方法。甲状腺乳头状癌以手术为主要治疗手段,术后辅以放疗或化疗。对于较小癌灶进行电视内镜手术或术中寻找前哨淋巴结,有转移者再做清扫术,是指导手术很好的方法。

甲状腺癌冷冻与石蜡切片诊断指标及形态变化对比分析

目的 探讨甲状腺癌冷冻切片的诊断指标及形态变化，加强对其形态学的认识，提高诊断水平。方法 收集甲状腺癌冷冻切片病例29例，对其浸润行为，生长方式、细胞核形态变化等辅助特点进行冷冻切片与石蜡切片HE染色多指标形态学和半定量分析。结果 29例中，乳头状癌26例（89．7％），其他类型癌3例（10．3％）。主要指标为浸润局部组织、瘢痕样胶原、周围软组织、包膜或血管：冷冻切片与石蜡切片分别占86．2％／96．6％，100％／100％，37．9％／41．4％，13．8％／41．4％或0．0％／10.3％；辅助指标为沙砾体、坏死或细胞异型性：冷冻切片与石蜡切片分别占62．1％／58．6％，13．8％／10．3％或37．9％／24．1％。对26例乳头状癌，冷冻与石蜡切片在毛玻璃样核、核沟、假包含体、核内空泡、核密度及乳头分枝密度等多指标观察，并进行半定量分析。除浸润包膜冷冻切片与石蜡切片有统计学意义外，其余指标与石蜡切片基本一致，无统计学差异。结论 甲状腺癌冷冻切片的诊断主要指标靠见到局部组织、胶原和周围软组织等的浸润；参考指标和进一步分型靠肿瘤生长方式、毛玻璃样细胞核等特点。

TTF-1 positive small cell cancers:Don't think they're always primary pulmonary!

Thyroid transcription factor 1 (TTF-1) plays a key role in morphogenesis of the lungs and is expressed in up to 90% of pulmonary small cell carcinomas.This explains why this marker is frequently used in the search for the primary origin of metastatic endocrine tumours.Here we report on a TTF-1 expressing mixed endocrine-exocrine carcinoma of the common bile duct in a patient with pulmonary nodules that did not appear to be neoplastic.TTF-1 positivity in pulmonary and extrapulmonary neuroendocrine tumours is reviewed,and we conclude that TTF-1 expression in neuroendocrine tumours of the small-cell type are not uncommon at extrapulmonary locations.Therefore,immunohistochem-istry for TTF-1 in such tumours should be interpreted with caution.

甲状腺肉瘤样癌1例报道

甲状腺肉瘤样癌属未分化癌,恶性度高,预后差,在甲状腺癌中罕见,近年来少有研究报道。笔者报道1例65岁男性,双侧甲状腺质硬、Ⅲ度肿大,彩超阴性,手术探查术中冰冻阴性,最终依靠术后病理诊断左侧甲状腺肉瘤样癌伴淋巴结转移。通过这一案例可见甲状腺肉瘤样癌彩超可表现为阴性,最终诊断依靠病理特征及免疫组织化学。临床医师对可疑甲状腺未分化癌患者需加强对本病认识,避免误诊漏诊。

甲状腺癌合并颈内静脉瘤栓7例分析

目的：探讨甲状腺癌合并颈内静脉瘤栓的诊断与治疗。方法回顾性分析2010年1月—2014年12月中国医学科学院肿瘤医院收治的7例甲状腺癌合并颈内静脉瘤栓患者的临床资料。术前 CT 证实7例甲状腺癌患者均合并颈内静脉瘤栓。5例行根治切除,其中2例切除颈内静脉及内部瘤栓、3例切除瘤栓而保留颈内静脉；2例行姑息切除。术后病理提示4例为未分化癌,3例为分化型甲状腺癌。结果4例未分化癌患者（2例行根治切除,2例行姑息切除）均于术后6个月内死于广泛的局部复发及远处转移；3例分化型甲状腺癌患者术后分别随访了39、40、44个月,均存活且无肿瘤复发。结论对于甲状腺癌合并颈内静脉瘤栓的患者,CT 有助于明确诊断并根据瘤栓的位置制定手术方案；对于分化型甲状腺癌患者,应尽量行根治术,可获得较好的治疗效果。

以肾转移为首发症状的甲状腺碰撞癌1例报告

本文报道1例患者,女,62岁。因体检彩色多普勒超声检查发现左肾占位1d入院泌尿系CT检查示左肾下极占位性病变。术前诊断为左肾癌。行后腹腔镜根治性左肾切除术。术后病理诊断为甲状腺滤泡样左肾细胞癌,甲状腺肿瘤转移不除外。甲状腺彩色多普勒超声和CT检查示甲状腺右叶占位。甲状腺穿刺病理诊断为右侧甲状腺滤泡样癌。行甲状腺癌根治术,术后病理诊断为甲状腺右叶滤泡癌,甲状腺左叶乳头状癌。术后诊断为甲状腺碰撞癌。予I^(131)内照射辅以左甲状腺素钠片治疗。术后7个月复查CT未见肾癌复发和肺转移。术后9个月复查彩色多普勒超声未见甲状腺癌复发;I^(131)显像未见明显异常。碰撞癌成分复杂,组织起源不明,甲状腺碰撞癌伴肾转移极为罕见,诊断依靠病理检查。甲状腺癌肾转移的预后好于原发性肾癌。