Objective To investigate the association between preoperative serum TSH concentration and thyroid carcinoma in patients with nodular goiter.Methods Data of 632 patients with nodular goiter from January 2004 to December 2010 were analyzed retrospectively.Results Preoperative serum TSH in nodular goiter with thyroid carcinoma was higher than that without thyroid carcinoma，which was （2.10±1.38）mU/L and （1.51±0.98）mU/L，respectively （P＜0.000 1）.The risk of malignancy increased as serum level of TSH rose in nodular goiter patients （P=0.023 5），the ratios were 9.91% （0.3-0.9mU/L），12.37% （0.9-1.7mU/L）， 20.09% （1.7-4.8mU/L），and 27.27%（＞4.8mU/L）.The TSH level of stageⅢ-Ⅳ patients higher than that stageⅠ-Ⅱ patients （P=0.030 6）.The diameter of tumor ＞4 cm had highest mean TSH level， and which ≤ 2cm had lowest mean TSH level（P=0.018 6）. Conclusion Preoperative serum TSH level perhaps is a risk predictor for nodular goiter with thyroid carcinoma.
ObjectiveTo investigate the expressions of chemokine receptor CXCR4 and CCR7 in thyroid cancer and its clinicopathologic significance. MethodsFifty-five patients with thyroid cancer were selected in the Affiliated Hospital of North Sichuan Medical College from 2006 to 2009, and 30 patients with thyroid adenoma were selected in the same hospital during 2009. The expressions of CXCR4 and CCR7 were detected in all the selected cases samples (including thyroid cancer and thyroid adenoma) by immunohistochemical SP technique. ResultsThe positive expression rates of CXCR4 and CCR7 in the thyroid cancer were higher than those in the thyroid adenoma (Plt;0.01), which in the thyroid cancer with clinical stage Ⅲ+Ⅳ were higher than those of the clinical stage Ⅰ+Ⅱ (Plt;0.05). The positive expression rate of CCR7 in the thyroid cancer with lymph node metastasis was higher than that of the thyroid cancer without lymph node metastasis (Plt;0.05), which of CXCR4 in the patients with thyroid cancer was independent of lymph node metastasis (Pgt;0.05), and which of CXCR4 and CCR7 were also independent of the age and gender of the patients with thyroid cancer (Pgt;0.05). The positive expressions of CCR7 and CXCR4 in all the patients with thyroid cancer was positively correlated (rs=0.491, P=0.000). ConclusionsCXCR4 and CCR7 are involved in the coordination of thyroid cancer progression. They can be used as prognostic indicators of thyroid cancer. High expression of CCR7 is prone to lymph node metastasis of thyroid cancer.
Objective To explore the diagnosis and relapse factors of thyroid cancer. Methods Two hundreds fifty-six cases of thyroid cancer approved by surgery and pathology from 1999 to 2006 were analyzed retrospectively. Results Two hundred and thirty-five cases were approved papillary thyroid carcinoma (91.8%)，11 cases were follicular thyroid carcinoma (4.3%)， 7 cases were medullary thyroid carcinoma (2.7%)， 3 cases were anaplastic thyroid cancer (1.2%). All patients underwent surgery. The operation procedures included thyroidectomy and lymph nodes dissection in central zone of affecting side and subtotal thyroidectomy of contralateral side. Total or subtotal thyroidectomy of both sides and the dissection in unilateral or bilateral Ⅵ region lymph nodes or functional cervical lymph nodes dessection plus contralateral side Ⅵ region lymph nodes dissection in multi-focal cancer and double leaf gland cancer. Functional cervical lymph nodes dessection if existing lymph nodes metastasis or thyroid cancer invading anterior cervical muscle. Two hundreds twentyeight cases were followed up with complete clinical information about (6.5±1.3) years (3-9 years). Six cases died during follow-up because of relapse or metastasis.Conclusions Imaging evaluation is the main method for diagnosis of thyroid cancer. Needle biopsy is reliable and accurate for diagnosis of thyroid tumor. Diameter of tumor is related with cervical lymph node metastasis. Patho-type and stage of tumor, local invasion extent, lymph node metastasis and operation procedure are related with the relapse closely.
【摘要】目的 探讨甲状腺癌的诊断及治疗方法。方法 回顾性分析我院1999~2003年期间收治的178例行手术治疗的甲状腺癌患者的临床资料。结果 本组患者术前B超检查均发现甲状腺内实性或囊实性结节,其中结节内伴微钙化灶者50例（28.1%），B超检查对于颈部淋巴结转移的阳性预告值为78.1%。行术中冰冻切片检查162例，诊断甲状腺癌144例，阳性率为88.9%。术后病理检查证实有淋巴结转移者为34.3%（61/178），甲状腺癌局部或患侧叶切除术后行二次以上手术者30例，残癌率为43.3%（13/30）。结论 声音嘶哑及B超检查提示甲状腺结节内微钙化灶对甲状腺癌的术前诊断有重要提示意义，亦可作为是否行颈淋巴结清扫的指征之一。术中冰冻切片检查是确诊甲状腺癌的最佳方法。患叶+峡部+对侧大部切除是甲状腺癌的主要手术方式。
Objective To review recent studies on the research advance of the relationship between RET proto-oncogene and differentiated thyroid carcinoma. Methods The literatures in recent years on the structure of RET gene and coding product,cell signal transduction,relationship between RET proto-oncogene and differentiated thyroid carcinoma were reviewed. Results RET gene encoding tyrosine kinase receptor,involving in cell signal transduction,rearrangement of RET gene was frequently seen in papillary thyroid carcinoma. Conclusion Rearrangement of RET gene was closely correlated with the occurrence and progress of differentiated thyroid carcinoma,RET gene may be considered as a new therapeutic target for differentiated thyroid carcinoma.
目的 探讨结节性甲状腺肿与甲状腺癌并存时的诊治方法。 方法 回顾性分析我院1961～2000年手术治疗的4 622例结节性甲状腺肿病例中169例并存甲状腺癌患者的临床资料。 结果 患者平均年龄（42.71±12.96）岁，病程平均19.15年； 43例出现短期内颈部肿块快速长大，32例有气管受压症状，27例出现声音嘶哑； 行超声检查105例，提示甲状腺癌者52例； 行放射性核素扫描检查38例，24例显示甲状腺内凉结节或冷结节； 行术前细针穿刺细胞学检查18例，找到癌细胞11例。术前确诊率为12.43%。术中行快速病理检查57例，55例诊断为甲状腺癌。 结论 在结节性甲状腺肿临床表现的基础上出现颈部肿块增长迅速、气管受压、声音嘶哑等症状时应高度怀疑结节性甲状腺肿与甲状腺癌并存； 甲状腺彩色超声多普勒、甲状腺核素扫描、细针穿刺细胞学等检查对诊断本病有重要意义； 术前检查怀疑甲状腺癌者术中应行快速冰冻切片病理检查，可有效避免再次手术。