Huikangling Tablet Intervened Peripheral Blood Micrometastasis of Differentiated Thyroid Carcinoma / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the clinical effect of Huikangling Tablet (HT, extracted from Scabrous Patrinia root) on peripheral blood micrometastasis of differentiated thyroid carcinoma (DTC) patients.</p><p><b>METHODS</b>Totally 87 DTC patients with positive micrometastasis were randomly assigned to the treatment group (45 cases) and the control group (42 cases). DTC endocrine inhibition treatment standards were executed in all patients. They all took levothyroxine sodium (50 microg/tablet, from low dose, 25 microg each time, once per day, 0.5 h before breakfast), and its dosage was gradually added one week later. The dosage was adjusted according to tested results of TSH combined recurrence risk stratification and endocrine suppression induced adverse reactions risk stratification. Patients in the treatment group took HT (0.4 g per tablet, 3 tablets each time, three times per day for a total of 12 weeks) combined TSH suppression therapy, while those in the control group only received TSH suppression therapy. Peripheral micrometastatic cytokeratin 19 (CK19) and polymorphic epithelial mucin1 (MUC1) were detected by FCM at week 4 and 12. Meanwhile, distant metastasis and adverse reactions were observed.</p><p><b>RESULTS</b>After 4-week treatment positive micrometastasis was shown in 18 cases (40%) of the treatment group and 29 cases (69%) in the control group with statistical difference (chi2 = 5.68, P < 0.05). After 12-week treatment positive micrometastasis was shown in 7 cases (15.6%) of the treatment group and 17 cases (44.7%) in the control group with statistical difference (chi2 = 8.49, P < 0.01). Pulmonary metastasis occurred in 2 cases and bone metastasis in 1 case of the control group at follow-ups. Cervical lymph node metastasis without accompanied recurrence of thyroid cancer occurred in one case of the treatment group. No obvious liver or renal abnormalities occurred.</p><p><b>CONCLUSION</b>HT inhibited peripheral blood micrometastasis of DTC patients and its mechanism needed to be further studied.</p>

Clinical value of combined detection of cytokeratin 19 and polymorphic epithelial mucin in peripheral blood of patients with thyroid cancer / 肿瘤

Objective: To examine the expressions of cytokeratin 19 (CK19) and polymorphic epithelial mucin (MUC1) in peripheral blood of patients with thyroid cancer, and evaluate their clinical value as the biomarkers in the detection of circulating tumor cells and blood micrometastasis. Methods: The flow cytometry (FCM) was used to detect CK19-positive and MUC1-positive cells in peripheral blood of 491 patients with thyroid cancer and 376 patients with nodular goiter. Results: The positive expression rates of CK19 in patients with thyroid cancer and nodular goiter were 35.4% (174/491) and 7.7% (29/376), respectively (P = 0.000); the positive expression rates of MUC1 in patients with thyroid cancer and nodular goiter were 32.8% (161/491) and 3.5% (13/376), respectively (P = 0.000). In univariate analysis, the tumor size, tumor capsule invasion, lymph node metastasis and distant metastasis were significantly associated with the positive expression of CK19 or MUC1 and the positive expressions of both CK19 and MUC1 (P < 0.05). In multivariate analysis, tumor capsule invasion, lymph node metastasis and distant metastasis were independent factors related to the positive expression of CK19 or MUC1 and the positive expressions of both CK19 and MUC1 (P < 0.05). There was a positive correlation between the expressions of CK19 and MUC1 (r = 0.628, P = 0.000). Conclusion: The expressions of CK19 and MUC1 were significantly related to tumor capsule invasion, lymph node metastasis and distant metastasis of thyroid cancer, and these two biomarkers may be helpful to predict the blood micrometastasis and evaluate the prognosis.

Clinical analysis on giant lymph node hyperplasia on neck / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To improve the diagnosis and management level of giant lymph node hyperplasia (Castleman's disease).</p><p><b>METHODS</b>To retrospective analyze 10 misdiagnosed cases with Castleman's disease in order to give some suggestions for clinical diagnosis and differential diagnosis.</p><p><b>RESULTS</b>Ten patients with neck giant lymph node hyperplasia underwent surgical treatment after misdiagnosis. There were 8 localized Castleman's disease constituted of 6 cases with hyaline vascular type and 2 cases with mixture type and 2 multicentric Castleman's disease constituted of 1 cases with plasma cell type and 1 cases with mixture type were classified according to the criteria described by Frizzera. Ten cases were diagnosed by secondary operation after misdiagnosis and were clinically characterized by painless neck lymphadenectasis, 2 cases with multicentric Castleman's disease accompanied with aspecific systemic symptom and (or) multi-system damage. Ten cases survived for 4 - 17 years during follow-up periods in which 1 case with plasma cell type, multicentric Castleman's disease was recurrent 2 years later and underwent lymphadenectomy and chemotherapy and have no local recurrence so far.</p><p><b>CONCLUSIONS</b>Castleman's disease on neck is seldom seen and liable to misdiagnose. The diagnosis of Castleman's disease is based on its histopathological characteristics by lymph node resection biopsy. It should be considered in the differential diagnosis with lymph node tuberculosis, lymphadenitis, sarcoidosis and granuloma. Operation is the first choice for patient with localized type and multicentric type without serious involvement of multiple system functions.</p>