甲状腺骨肉瘤的诊断及治疗(附1例报告)
摘要
目的探讨甲状腺骨肉瘤的有效诊断及治疗方法。方法对1例甲状腺骨肉瘤患者的临床资料作回顾性分析。结果本例因发现颈部包块就诊,首次查体发现左侧甲状腺可触及活动性无压痛肿块,甲状腺B超检查示甲状腺左叶实性占位性病变,颈部CT图像示甲状腺左叶肿大并多发钙化灶。首次手术病理免疫组织化学染色检查考虑为骨母细胞瘤样分化的骨肉瘤。二次手术病理免疫组织化学染色检查考虑侵袭性骨母细胞瘤或骨肉瘤。之后因CT检查发现双肺多发转移瘤、骨扫描见全身多发肿瘤骨转移征像,行肺穿刺结合病理免疫组织化学染色检查诊断肺恶性肿瘤。根据患者多部位转移瘤及多次病理诊断结果,结合患病情发展特点,最终临床诊断为甲状腺骨肉瘤伴双肺、多发骨转移。行姑息性全身化疗,患者病情稳定。结论甲状腺骨肉瘤临床及影像学表现缺乏特异性,多数诊断依靠术后病理检查,但有时术后病理检查仍无法确诊,需综合考虑临床表现、影像特点、术后病理检查结果及免疫组织化学染色结果后作出诊断。对甲状腺骨肉瘤应依据软组织肉瘤诊疗规范进行个体化治疗。
引文
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[20]Cook PA,Murphy MS,Innis PC,et al.Extraskeletal osteosarcoma of the hand.A case report[J].J Bone Joint Surg Am,1998,80(5):725-729.
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[24]Mccarter MD,Lewis JJ,Antonescu CR,et al.Extraskeletal osteosarcoma:analysis of outcome of a rare neoplasm[J].Sarcoma,2000,4(3):119.
[2]Trowell JE,Arkell DG.Osteosarcoma of the thyroid gland[J].J Pathol,1976,119(2):123-127.
[3]Zembala-Nozyńska E,Lange D.Primary osteosarcoma of the thyroid gland:a case report[J].Contemp Oncol(Pozn),2013,17(1):97-97.
[4]Saito Y,Miyajima C,Nakao K,et al.Highly malignant submandibular extraskeletal osteosarcoma in a young patient[J].Auris Nasus Larynx,2008,35(4):576-578.
[5]Mosalleum E,Afrogheh A,Stofberg S,et al.A review of primary osteosarcoma of the larynx and case report[J].Head Neck Pathol,2015,9(1):158-164.
[6]Saifuddin A.The accuracy of imaging in the local staging of appendicular osteosarcoma[J].Skeletal Radiol,2002,31(4):191-201.
[7]Olgyai G,Horvath V,Kocsis J,et al.Extraskeletal osteosarcoma in the gallbladder[J].Magy Seb,2003,56(2):57-60.
[8]Song HK,Leibold TM,Gal AA,et al.Extraskeletal osteosarcoma of the diaphragm presenting as a chest mass[J].Ann Thorac Surg,2002,74(2):565-567.
[9]Chapman AD,Pritchard SC,Yap WW,et al.Primary pulmonary osteosarcoma:case report and molecular analysis[J].Cancer,2002,91(4):779-784.
[10]Crevecoeur J,Jossa V,Gennigens C,et al.Primary osteosarcoma of the breast:a case report[J].Clin Case Rep,2016,4(1):62-66.
[11]Rapicetta C,Lococo F,Carlinfante G,et al.Extraskeletal osteosarcomaarising from the pleura[J].Lung,2017,195(4):523-525.
[12]Saesue P,Chankaew E,Chawalparit O,et al.Primary extraskeletal osteosarcoma in the pineal region:case report[J].J Neurosurg,2004,101(6):1061-1064.
[13]Casey DL,van de Rijn M,Riley G,et al.Extraskeletal osteosarcoma of the hand:the role of marginal excision and adjuvant radiation therapy[J].Hand,2015,10(4):602-606.
[14]Bane BL,Evans HL,Ro JY,et al.Extraskeletal osteosarcoma:a clinicopathologic review of 26 cases[J].Cancer,1990,65(12):2762-2770.
[15]吕新全,陈奎生,赵庆夏,等.甲状腺原发性骨肉瘤1例及文献复习[J].临床与实验病理学杂志,2006,22(2):250-251.
[16]武忠弼,杨光华.中华外科病理学[M].北京:人民卫生出版杜,2002:1808.
[17]Noel W,Richard JC,Saul S.Modern Surgical Pathology[M].New York:W B Saunders Co,2003:1963.
[18]王维娜,王晔兴,郝智.甲状腺原发性骨肉瘤1例[J].中国肿瘤临床,2015,42(6):372-372.
[19]易生辉,秦刚,黄肖华,等.骨肉瘤的治疗进展[J].医学综述,2017,23(8):1529-1532.
[20]Cook PA,Murphy MS,Innis PC,et al.Extraskeletal osteosarcoma of the hand.A case report[J].J Bone Joint Surg Am,1998,80(5):725-729.
[21]陆轶民,马志敏.骨外骨肉瘤诊治进展[J].国外医学:肿瘤学分册,2004,31(8):632-635.
[22]Ahmad SA,Patel SR,Ballo MT,et al.Extraosseous osteosarcoma:response to treatment and long-term outcome[J].J Clin Oncol,2002,20(2):521-527.
[23]Kajihara M,Sugawara Y,Hirata M,et al.Extraskeletal osteosarcoma in the thigh:a case report[J].Radiat Med,2005,23(2):142-146.
[24]Mccarter MD,Lewis JJ,Antonescu CR,et al.Extraskeletal osteosarcoma:analysis of outcome of a rare neoplasm[J].Sarcoma,2000,4(3):119.