甲状腺混合性髓样-乳头状癌伴混合性淋巴结转移1例报道并文献复习_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

张竞轶 ¹ ,  王建华 ¹ , 黄驰 ¹ , 曾铮 ² , 徐书杭 ³

1. ;
2. ;
3. ;

Corresponding author：

王建华, Email: 311w@163.com

Keywords：

甲状腺癌; 混合性髓样-乳头状癌; 甲状腺髓样癌

DOI：

10.7507/1007-9424.202303047

Video：

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目的回顾1例甲状腺混合性髓样-乳头状癌伴混合性淋巴结转移患者的诊治经过，结合国内外文献对本病的诊疗进行总结，以期为临床诊治提供一定的参考。方法回顾分析该患者的临床资料、病理切片特征以及免疫组织化学染色结果。在中英文数据库对该类病例进行检索，结合既往文献病例进行分析讨论，总结本病的特征。结果该例患者术前血清降钙素和癌胚抗原均升高，行甲状腺全切除加双侧中央区及颈侧区淋巴结清扫术，术后降钙素和癌胚抗原较术前明显下降。随访半年，一般情况良好。总结文献报道病例资料，提示甲状腺混合性髓样-乳头状癌发病以中老年患者为主，多以颈部无痛性结节为主要临床表现，多数病例有血清降钙素与癌胚抗原升高，病理学上以髓样癌与乳头状癌混合存在为主要特征，以髓样癌成分占比较高较为多见。治疗上以甲状腺全切除术为主要手段，后续治疗需监测血清降钙素、癌胚抗原、甲状腺球蛋白以及综合影像学改变，放射性碘治疗可根据自身病情特点酌情选择。本病总体预后较好。结论甲状腺混合性髓样-乳头状癌发病罕见，在前期诊断时应尽量完善降钙素和癌胚抗原的检查，减少漏诊的可能；穿刺辅以免疫组织化学检测有一定的诊断价值；规范的外科手术是治疗的最佳手段，准确的病理学分类以及不同类型肿瘤细胞占比有助于指导术后治疗。

Citation： 张竞轶, 王建华, 黄驰, 曾铮, 徐书杭. 甲状腺混合性髓样-乳头状癌伴混合性淋巴结转移1例报道并文献复习. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(7): 849-854. doi: 10.7507/1007-9424.202303047 Copy

1.	万政, 刘梅, 郗洪庆, 等. 混合性甲状腺癌预后因素及病理特征分析. 中华内分泌外科杂志, 2021, 15(2): 147-153.
2.	Papotti M, Negro F, Carney JA, et al. Mixed medullary-follicular carcinoma of the thyroid. A morphological, immunohistochemical and in situ hybridization analysis of 11 cases. Virchows Arch, 1997, 430(5): 397-405.
3.	宋光耀, 席峥, 高志安, 等. 甲状腺髓样癌合并乳头状癌1例. 中国误诊学杂志, 2004, 4(6): 958.
4.	吴义春, 吴强, 吴继锋, 等. 甲状腺乳头状癌合并髓样癌1例. 临床与实验病理学杂志, 2007, 23(1): 115-116.
5.	高志斌, 王兆平, 赵莺, 等. 甲状腺混合性髓样乳头状癌一例. 中华病理学杂志, 2008, 37(10): 716-717.
6.	周兵, 王洁, 刘浩茹, 等. 甲状腺髓样癌伴乳头状癌1例. 临床与实验病理学杂志, 2017, 33(9): 1059-1060.
7.	蔡玲玲, 刘宇飞, 胡余昌, 等. 甲状腺混合性髓样-滤泡细胞癌1例并文献复习. 巴楚医学, 2018, 1(1): 98-101.
8.	魏松锋, 王萍萍, 程润芬, 等. 甲状腺混合性髓样-乳头状癌与甲状腺髓样癌合并乳头状癌的临床病理特征比较. 中华普通外科杂志, 2021, 36(6): 405-409.
9.	胥芹, 张超, 田妍. 甲状腺混合性髓样-乳头状癌超声表现1例. 中国超声医学杂志, 2022, 38(1): 119.
10.	Shimizu M, Hirokawa M, LiVolsi VA, et al. Combined “mixed medullary-follicular” and “papillary” carcinoma of the thyroid with lymph node metastasis. Endocr Pathol, 2000, 11(4): 353-358.
11.	Shiroko T, Yokoo N, Okamoto K, et al. Mixed medullary-papillary carcinoma of the thyroid with lymph node metastases: report of a case. Surg Today, 2001, 31(4): 317-321.
12.	Hewavisenthi SJ, Ariyarathne J, Gunawardena PA. Mixed medullary follicular carcinoma—an unusual thyroid neoplasm. Ceylon Med J, 2000, 45(1): 34-35.
13.	Goyal R, Nada R, Rao KL, et al. Mixed medullary and follicular cell carcinoma of the thyroid with lymph node metastasis in a 7-year-old child. Pathol Int, 2006, 56(2): 84-88.
14.	Gupta V. Simultaneous presentation of giant pheochromocytoma, primary hyperparathyroidism, and mixed-medullary-papillary thyroid cancer in MEN 2A. Indian J Endocrinol Metab, 2013, 17(4): 751-755.
15.	Jain M, Verma D, Thomas S, et al. Mixed medullary-papillary carcinoma thyroid: an uncommon variant of thyroid carcinoma. J Lab Physicians, 2014, 6(2): 133-135.
16.	Subramanian N, Agarwal SK, Agarwal A, et al. Rare mixed thyroid carcinomas: a report of two cases. Iran J Otorhinolaryngol, 2022, 34(120): 55-57.
17.	Dionigi G, Castano P, Bertolini V, et al. Simultaneous medullary and papillary thyroid cancer: two cases reports. J Med Case Rep, 2007, 1: 133. doi:10.1186/1752-1947-1-133.
18.	Nangue C, Bron L, Portmann L, et al. Mixed medullary-papillary carcinoma of the thyroid: report of a case and review of the literature. Head Neck, 2009, 31(7): 968-974.
19.	Hasney CP, Amedee RG. Mixed medullary-papillary carcinoma of the thyroid: a case report. Laryngoscope, 2010, 120 Suppl 4: S153. doi:10.1002/lary.21617.
20.	Hanna AN, Michael CW, Jing X. Mixed medullary-follicular carcinoma of the thyroid: diagnostic dilemmas in fine-needle aspiration cytology. Diagn Cytopathol, 2011, 39(11): 862-865.
21.	Chambers M, Tafe LJ, Gutmann EJ, et al. Cytologic features of a case of mixed medullary and follicular cell-derived thyroid carcinoma with review of the literature. Diagn Cytopathol, 2021, 49(3): E125-E129. doi: 10.1002/dc.24615.
22.	Zoroquiain P, Torres J, Goñi I, et al. True mixed medullary papillary carcinoma of the thyroid: a case report with low blood calcitonin levels. Endocr Pathol, 2012, 23(3): 168-171.
23.	Tohidi M, Pourbehi G, Bahmanyar M, et al. Mixed medullary-follicular carcinoma of the thyroid. Case Rep Endocrinol, 2013, 2013: 571692. doi:10.1155/2013/571692.
24.	Gurkan E, Gurbuz Y, Tarkun I, et al. Mixed medullary-papillary carcinoma of the thyroid: report of two cases and review of the literature. Indian J Pathol Microbiol, 2014, 57(4): 598-602.
25.	Guerreiro V, Costa C, Oliveira J, et al. Mixed medullary-papillary thyroid carcinoma with mixed lymph node metastases: A case report. Clin Case Rep, 2021, 9(5): e04165. doi:10.1002/ccr3.4165.
26.	Kim WG, Gong G, Kim EY, et al. Concurrent occurrence of medullary thyroid carcinoma and papillary thyroid carcinoma in the same thyroid should be considered as coincidental. Clin Endocrinol (Oxf), 2010, 72(2): 256-263.
27.	Sandilos G, Lou J, Butchy MV, et al. Features of mixed medullary thyroid tumors: An NCDB analysis of clinicopathologic characteristics and survival. Am J Surg, 2023, S0002-9610(23)00058-2. doi:10.1016/j.amjsurg.2023.02.006.
28.	Wang M, Chen H, Wang Y, et al. Diagnostic value and cost-effectiveness of FNA-CT versus FNAC for medullary thyroid carcinoma. Clin Endocrinol (Oxf), 2023, 98(5): 709-718.
29.	中国医师协会外科医师分会甲状腺外科医师委员会, 中国抗癌协会甲状腺癌专业委员会, 中国研究型医院学会甲状腺疾病专业委员会. 甲状腺髓样癌诊断与治疗中国专家共识(2020版). 中国实用外科杂志, 2020, 40(9): 1012-1020.
30.	Biscolla RP, Ugolini C, Sculli M, et al. Medullary and papillary tumors are frequently associated in the same thyroid gland without evidence of reciprocal influence in their biologic behavior. Thyroid, 2004, 14(11): 946-952.
31.	Zhang D, Yang M, Zhang X, et al. Thirty synchronous medullary and papillary thyroid carcinomas. Front Endocrinol (Lausanne), 2023, 14: 1153248. doi:10.3389/fendo.2023.1153248.
32.	Sadow PM, Hunt JL. Mixed medullary-follicular-derived carcinomas of the thyroid gland. Adv Anat Pathol, 2010, 17(4): 282-285.
33.	Ciampi R, Romei C, Pieruzzi L, et al. Classical point mutations of RET, BRAF and RAS oncogenes are not shared in papillary and medullary thyroid cancer occurring simultaneously in the same gland. J Endocrinol Invest, 2017, 40(1): 55-62.
34.	Negura I, Ianole V, Danciu M, et al. Thyroid collision tumors: the presence of the medullary thyroid carcinoma component negatively influences the prognosis. Diagnostics (Basel), 2023, 13(2): 285. doi:10.3390/diagnostics13020285.
35.	Myoteri D, Dellaportas D, Carvounis E, et al. Mixed medullary and papillary thyroid carcinoma: a stepwise diagnosis. J BUON, 2016, 21(6): 1561-1562.

1. 万政, 刘梅, 郗洪庆, 等. 混合性甲状腺癌预后因素及病理特征分析. 中华内分泌外科杂志, 2021, 15(2): 147-153.
2. Papotti M, Negro F, Carney JA, et al. Mixed medullary-follicular carcinoma of the thyroid. A morphological, immunohistochemical and in situ hybridization analysis of 11 cases. Virchows Arch, 1997, 430(5): 397-405.
3. 宋光耀, 席峥, 高志安, 等. 甲状腺髓样癌合并乳头状癌1例. 中国误诊学杂志, 2004, 4(6): 958.
4. 吴义春, 吴强, 吴继锋, 等. 甲状腺乳头状癌合并髓样癌1例. 临床与实验病理学杂志, 2007, 23(1): 115-116.
5. 高志斌, 王兆平, 赵莺, 等. 甲状腺混合性髓样乳头状癌一例. 中华病理学杂志, 2008, 37(10): 716-717.
6. 周兵, 王洁, 刘浩茹, 等. 甲状腺髓样癌伴乳头状癌1例. 临床与实验病理学杂志, 2017, 33(9): 1059-1060.
7. 蔡玲玲, 刘宇飞, 胡余昌, 等. 甲状腺混合性髓样-滤泡细胞癌1例并文献复习. 巴楚医学, 2018, 1(1): 98-101.
8. 魏松锋, 王萍萍, 程润芬, 等. 甲状腺混合性髓样-乳头状癌与甲状腺髓样癌合并乳头状癌的临床病理特征比较. 中华普通外科杂志, 2021, 36(6): 405-409.
9. 胥芹, 张超, 田妍. 甲状腺混合性髓样-乳头状癌超声表现1例. 中国超声医学杂志, 2022, 38(1): 119.
10. Shimizu M, Hirokawa M, LiVolsi VA, et al. Combined “mixed medullary-follicular” and “papillary” carcinoma of the thyroid with lymph node metastasis. Endocr Pathol, 2000, 11(4): 353-358.
11. Shiroko T, Yokoo N, Okamoto K, et al. Mixed medullary-papillary carcinoma of the thyroid with lymph node metastases: report of a case. Surg Today, 2001, 31(4): 317-321.
12. Hewavisenthi SJ, Ariyarathne J, Gunawardena PA. Mixed medullary follicular carcinoma—an unusual thyroid neoplasm. Ceylon Med J, 2000, 45(1): 34-35.
13. Goyal R, Nada R, Rao KL, et al. Mixed medullary and follicular cell carcinoma of the thyroid with lymph node metastasis in a 7-year-old child. Pathol Int, 2006, 56(2): 84-88.
14. Gupta V. Simultaneous presentation of giant pheochromocytoma, primary hyperparathyroidism, and mixed-medullary-papillary thyroid cancer in MEN 2A. Indian J Endocrinol Metab, 2013, 17(4): 751-755.
15. Jain M, Verma D, Thomas S, et al. Mixed medullary-papillary carcinoma thyroid: an uncommon variant of thyroid carcinoma. J Lab Physicians, 2014, 6(2): 133-135.
16. Subramanian N, Agarwal SK, Agarwal A, et al. Rare mixed thyroid carcinomas: a report of two cases. Iran J Otorhinolaryngol, 2022, 34(120): 55-57.
17. Dionigi G, Castano P, Bertolini V, et al. Simultaneous medullary and papillary thyroid cancer: two cases reports. J Med Case Rep, 2007, 1: 133. doi:10.1186/1752-1947-1-133.
18. Nangue C, Bron L, Portmann L, et al. Mixed medullary-papillary carcinoma of the thyroid: report of a case and review of the literature. Head Neck, 2009, 31(7): 968-974.
19. Hasney CP, Amedee RG. Mixed medullary-papillary carcinoma of the thyroid: a case report. Laryngoscope, 2010, 120 Suppl 4: S153. doi:10.1002/lary.21617.
20. Hanna AN, Michael CW, Jing X. Mixed medullary-follicular carcinoma of the thyroid: diagnostic dilemmas in fine-needle aspiration cytology. Diagn Cytopathol, 2011, 39(11): 862-865.
21. Chambers M, Tafe LJ, Gutmann EJ, et al. Cytologic features of a case of mixed medullary and follicular cell-derived thyroid carcinoma with review of the literature. Diagn Cytopathol, 2021, 49(3): E125-E129. doi: 10.1002/dc.24615.
22. Zoroquiain P, Torres J, Goñi I, et al. True mixed medullary papillary carcinoma of the thyroid: a case report with low blood calcitonin levels. Endocr Pathol, 2012, 23(3): 168-171.
23. Tohidi M, Pourbehi G, Bahmanyar M, et al. Mixed medullary-follicular carcinoma of the thyroid. Case Rep Endocrinol, 2013, 2013: 571692. doi:10.1155/2013/571692.
24. Gurkan E, Gurbuz Y, Tarkun I, et al. Mixed medullary-papillary carcinoma of the thyroid: report of two cases and review of the literature. Indian J Pathol Microbiol, 2014, 57(4): 598-602.
25. Guerreiro V, Costa C, Oliveira J, et al. Mixed medullary-papillary thyroid carcinoma with mixed lymph node metastases: A case report. Clin Case Rep, 2021, 9(5): e04165. doi:10.1002/ccr3.4165.
26. Kim WG, Gong G, Kim EY, et al. Concurrent occurrence of medullary thyroid carcinoma and papillary thyroid carcinoma in the same thyroid should be considered as coincidental. Clin Endocrinol (Oxf), 2010, 72(2): 256-263.
27. Sandilos G, Lou J, Butchy MV, et al. Features of mixed medullary thyroid tumors: An NCDB analysis of clinicopathologic characteristics and survival. Am J Surg, 2023, S0002-9610(23)00058-2. doi:10.1016/j.amjsurg.2023.02.006.
28. Wang M, Chen H, Wang Y, et al. Diagnostic value and cost-effectiveness of FNA-CT versus FNAC for medullary thyroid carcinoma. Clin Endocrinol (Oxf), 2023, 98(5): 709-718.
29. 中国医师协会外科医师分会甲状腺外科医师委员会, 中国抗癌协会甲状腺癌专业委员会, 中国研究型医院学会甲状腺疾病专业委员会. 甲状腺髓样癌诊断与治疗中国专家共识(2020版). 中国实用外科杂志, 2020, 40(9): 1012-1020.
30. Biscolla RP, Ugolini C, Sculli M, et al. Medullary and papillary tumors are frequently associated in the same thyroid gland without evidence of reciprocal influence in their biologic behavior. Thyroid, 2004, 14(11): 946-952.
31. Zhang D, Yang M, Zhang X, et al. Thirty synchronous medullary and papillary thyroid carcinomas. Front Endocrinol (Lausanne), 2023, 14: 1153248. doi:10.3389/fendo.2023.1153248.
32. Sadow PM, Hunt JL. Mixed medullary-follicular-derived carcinomas of the thyroid gland. Adv Anat Pathol, 2010, 17(4): 282-285.
33. Ciampi R, Romei C, Pieruzzi L, et al. Classical point mutations of RET, BRAF and RAS oncogenes are not shared in papillary and medullary thyroid cancer occurring simultaneously in the same gland. J Endocrinol Invest, 2017, 40(1): 55-62.
34. Negura I, Ianole V, Danciu M, et al. Thyroid collision tumors: the presence of the medullary thyroid carcinoma component negatively influences the prognosis. Diagnostics (Basel), 2023, 13(2): 285. doi:10.3390/diagnostics13020285.
35. Myoteri D, Dellaportas D, Carvounis E, et al. Mixed medullary and papillary thyroid carcinoma: a stepwise diagnosis. J BUON, 2016, 21(6): 1561-1562.

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甲状腺混合性髓样-乳头状癌伴混合性淋巴结转移1例报道并文献复习

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