儿童及青少年弥漫硬化型甲状腺乳头状癌的超声特征:与经典亚型的对照研究
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摘要
目的回顾性分析儿童及青少年甲状腺乳头状癌弥漫硬化型(DSVPC)和经典亚型(CPTC)的临床病理和超声特征,给儿童及青少年DSVPC的手术前临床管理提供建议指南。方法收集两家医院儿童及青少年甲状腺癌病例,选取纳入12例DSVPC和82例CPTC,总结比较分析两组的临床病理和超声征象。结果 DSVPC组织学和细胞学表现为淋巴细胞浸润和弥漫散在沙砾体形成,超声上多表现为双侧甲状腺不均质低回声改变、弥漫微小点状钙化、伴或不伴边缘不光整的低回声肿块和颈部多发淋巴结肿大。桥本甲状腺炎(P=0.038)、甲状腺包膜侵犯(P=0.007)和多发结节(P=0.003)的发生率,DSVPC组明显高于CPTC组,差异具有明显统计学意义。结论在儿童及青少年甲状腺检查时,若超声发现甲状腺弥漫散在点状钙化伴或不伴低回声肿块和颈部多发淋巴结肿大,应考虑DSVPC的诊断,提示外科进行甲状腺全切和广泛颈部淋巴结切除的准备。
Objective The aim of this study was to retrospectively analyze the clinical histopathological features as well as sonographic features of diffuse sclerosing variant of papillary thyroid carcinoma(DSVPC)and conventional papillary thyroid carcinoma(CPTC)in pediatric patients.We hope that these findings will provide a guideline for preoperative management of DSVPC in children and adolescents.Methods From 12 DSVPC patients and 82 CPTC patients were enrolled in this study.The clinical histopathological findings and the sonographic features were compared between the two groups.Results Histopathologically and Cytologically,DSVPCs show heavy lymphocytic infiltration and multiple psammoma bodies.The sonographic features of DSPC are characterized by heterogeneous echotexture,scattered microcalcifications having snowstorm appearance with or without a poorly defined associated heterogeneous hypoechogenicity solid mass,and it is almost always combined with multiple metastatic lymph nodes at the neck.Hashimoto thyroiditis(P=0.038),extrathyroidal invasion(P=0.007)and multifocality(P=0.003)were significantly more frequent in DSVPCs than CPTCs(P<0.05).Conclusions At the time of US thyroid examination in children and adolescents,if we found diffuse scattered microcalcifications with or without a ill defined associated suspicious mass on ultrasound and multiple lymph nodes enlargement in the neck,the diagnosis of DSVPC should be considered and suggest surgery for the preparation of total thyroidectomy and extensive neck lymph node excision.
Objective The aim of this study was to retrospectively analyze the clinical histopathological features as well as sonographic features of diffuse sclerosing variant of papillary thyroid carcinoma(DSVPC)and conventional papillary thyroid carcinoma(CPTC)in pediatric patients.We hope that these findings will provide a guideline for preoperative management of DSVPC in children and adolescents.Methods From 12 DSVPC patients and 82 CPTC patients were enrolled in this study.The clinical histopathological findings and the sonographic features were compared between the two groups.Results Histopathologically and Cytologically,DSVPCs show heavy lymphocytic infiltration and multiple psammoma bodies.The sonographic features of DSPC are characterized by heterogeneous echotexture,scattered microcalcifications having snowstorm appearance with or without a poorly defined associated heterogeneous hypoechogenicity solid mass,and it is almost always combined with multiple metastatic lymph nodes at the neck.Hashimoto thyroiditis(P=0.038),extrathyroidal invasion(P=0.007)and multifocality(P=0.003)were significantly more frequent in DSVPCs than CPTCs(P<0.05).Conclusions At the time of US thyroid examination in children and adolescents,if we found diffuse scattered microcalcifications with or without a ill defined associated suspicious mass on ultrasound and multiple lymph nodes enlargement in the neck,the diagnosis of DSVPC should be considered and suggest surgery for the preparation of total thyroidectomy and extensive neck lymph node excision.
引文
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[2]LAM A F.Pathology of endocine tumors update:world health organization new elassifiation 2017-other thyroid tumors[J].AISP:Reviews&Reports,2017,22(4):209-216.
[3]CIBAS E S,ALI S Z.The Bethesda System For Reporting Thyroid Cytopathology[J].Am J Clin Pathol,2009,132(5):658-665.
[4]MOON W J,JUNG S L,LEE J H,et al.Benign and malignant thyroid nodules:US differentiation-multicenter retrospective study[J].Radiology,2008,247(3):762-770.
[5]SHEU S Y,SCHWERTHEIM S,WORM K,et al.Diffuse sclerosing variant of papillary thyroid carcinoma:lack of BRAFmutation but occurrence of RET/PTC rearrangements[J].Mod Pathol,2007,20(7):779-787.
[6]朱蓓琳,邬宏恂,臧亚萍,等.甲状腺弥漫硬化型乳头状癌的超声特征及价值[J].中国超声医学杂志,2014,30(10):867-870.
[7]JEONG S H,HONG H S,LEE E H,et a1.Papillary thyroid carcinoma arising in children and adolescent hashimoto′s thyroiditis:ultrasonographic and pathologic findings[J].Int JEndocrinol,2016,12:1-6.