Résumé
Thyroid follicular carcinoma (FTC) is one of the highly differentiated malignant tumors second only to papillary thyroid carcinoma (PTC). Its occurrence is mainly caused by the abnormal differentiation of thyroid follicular epithelial cells. Lymph node metastasis around FTC is rare, but distant tissue metastasis is more common. At present, there are few studies on the pathogenesis of FTC. The clinical diagnosis and treatment of FTC are mainly focused on imaging examination, fine needle aspiration and so on. Surgical resection is the main clinical treatment, with unfavourable prognosis. In this paper, the epidemiology, pathogenesis, diagnosis and treatment of FTC were summarized, and the research progress of FTC was reviewed.
Résumé
Objective To analyze whether preoperative serum thyroglobulin (Tg) can be the indicator for predicting malignancy in follicular thyroid tumors (FTC).Methods A retrospective analysis was done for 125 patients with FTC who had been diagnosed by pathology in our hospital.The patients were grouped into benign group and malignant group.Sex,age,tumor size and preoperative serum Tg concentration were analyzed.Results There were 62 patients in benign group (23 male and 39 female).The mean age was 49 years old,ranging from 19 to 78 years,and the mean diameter of tumors was (3.4±1.374) cm,ranging from 0.1 to 5.5 cm.There were 63 patients in malignant group (13 male and 50 female).The mean age was 46 years old,ranging from 15 to 79 years,and the mean diameter of tumors was (3.14±1.143) cm,ranging from 0.3 to 7 cm.The mean preoperative serum Tg concentration was (299.73± 495.02) ng/ml in malignant group and(48.20 ±43.68)ng/ml in the benign group.Through comparing the two groups,we found age and tumors diameter had no statistical difference between the two groups (P＞0.05),while sex and Tg had statistical difference (P＜0.05).When the cutoff of Tg was 100 ng/ml,the sensitivity and specificity for the diagnosis of malignancy was 48.7％ and 90％ respectively.Conclusions Tg can be used as auxiliary diagnosis index of thyroid FTC.High preoperative Tg levels should be highly suspected the possibility of FTC.
Résumé
Differentiated thyroid cancers are rarely associated with distant metastases and have 10-year survival rates higher than 80%; however, the prognosis deteriorates significantly if metastasis occurs. Bone is the second most common site of metastasis after the lungs in cases of thyroid cancer. Here we describe a case in which a 57-year-old female patient had extremely severe pain on the posterior neck. After magnetic resonance imaging, 18F-FDG PET CT and ultrasonography guided biopsy, right papillary thyroid carcinoma with cervical spine metastasis was suspected; therefore, she underwent surgery for removal of thyroid carcinoma and seventh cervical spine metastasis. Pathologic diagnosis was confirmed as left thyroid follicular carcinoma with seventh cervical spine metastasis and synchronous right thyroid papillary carcinoma. The patient then underwent an additional spinal tumor removal operation, I131 treatment and external radiation therapy. Complete removal of the cervical spine tumor could not be achieved due to intra-operative bleeding and the need to prevent damage to the spinal cord. Following treatment, the patient reported great relief from severe neck pain. This is a rare presentation of follicular thyroid carcinoma with cervical spine metastasis in Korea.
Sujets)
Femelle , Humains , Adulte d'âge moyen , Adénocarcinome folliculaire , Biopsie , Carcinome papillaire , Diagnostic , Fluorodésoxyglucose F18 , Hémorragie , Corée , Poumon , Imagerie par résonance magnétique , Cou , Cervicalgie , Métastase tumorale , Pronostic , Moelle spinale , Rachis , Taux de survie , Glande thyroide , Tumeurs de la thyroïde , ÉchographieRésumé
Among thyroid cancer patients, metastatic skull bone is rare, especially in the skull base region. The authors describe the case of a 42-year-old man with thyroid follicular carcinoma which metastasized to the left petrous bone. During the previous year, the patient had suffered from left tinnitus, hearing loss and peripheral facial nerve palsy; An CT and MRI scans demonstrated severe permeative bone destruction, as well as an enhancing soft tissue mass in the left petrous bone. Left carotid angiography revealed multiple feeding vessels, mainly via the occipital and superior laryngeal artery. The feeders were occluded by intra-arterial embolization with N-butylcyanoacrylate(NBCA). The patient underwent subtotal petrosectomy with near total removal of the tumor, followed by total thyroidectomy. He returned to work one month postoperatively and showed no evidence of recurrence during the follow-up period of seven months.