Objective To evaluate the markers which contribute to diagnosis and prognosis of thyroid neoplasm. Methods The references about thyroid markers in recent years were reviewed. Results CD26 and galectin-3 could be regarded as a simple, potent markers to differentiate thyroid carcinoma in preoperative diagnosis, CD97 was a specific marker for undifferentiated thyroid carcinoma and its metastasis, CD15 and telomerase could be used in fine-needle aspirate biopsy (FNAB) of thyroid mass, and to improve its diagnostic evaluation, RET/PTC was mainly expressed in thyroid medullary carcinoma, oncofetal fibronectin (oncFN) was specific to papillary and anaplastic carcinoma, thyroid peroxidase was used to identify benign and malignant thyroid tumor. Conclusion Although there are a lot of markers for thyroid neoplasm, but there is no marker which are completely specific to certain histotype of thyroid neoplasm at present.
Objective To investigate the possible interaction between the ras and p53 genes overexpression in thyroid carcinoma, and whether there is correlation between the ras and p53 overexpression and clinico-pathological criteria. Methods Thyroid lesions from eighty patients were examined for expression of ras and p53 genes by the LSAB immunohistochemistic method. Of these patients, 54 were diagnosed as malignant lesions and 26 benign nodular thyroid disorders. Results The positive immunostain rate for ras and p53 genes was 90.7%, 23.0% and 55.5%, 30.7% in carcinoma and benign lesions respectively with statistically significance between thyroid carcinomas and benign disorders (Ｐ＜0.05). Both ras and p53 overexpressions coexisted in 30 thyroid carcinomas and follow-up showed that 3 of them died and 5 of them had recurrence within 4 years.Conclusion Activation of ras gene and inactivation of p53 gene are cooperatively associated in thyroid tumorigenesis. The concurrent overexpression of ras and p53 could result in a poor prognosis.
【Abstract】Objective To investigate the correlation of adhesive molecule expressions with potential of invasion and metastasis in papillary thyroid carcinoma (PTC). Methods S-P immunohistochemical method was used to detect CD44v6 and E-cadherin expression in 58 cases of PTC. Results The positive rates of CD44v6 and E-cadherin in PTC were 72.40%and 41.4% respectively. There was a positive correlation between CD44v6 expression and tumor invasive and metastatic potential in PTC (P＜0.05), and a reverse correlation between E-cadherin expression and the potential (P＜0.01).Moreover,there was a reverse correlation between the CD44v6 and E-cadherin expression in PTC(P＜0.05). Conclusion These data show a correlation between the adhesive molecule expression and the potential of invasion and metastasis in PTC. CD44v6 and E-cadherin may be prognostic indicators in PTC.
Objective To further strengthen the understanding of the genesis of thyroid tumors through the analysis of thyroid nodules in the clonal origin. Method The related literatures which discussed the clonality of thyroid nodules were reviewed and analyzed. Results About the clonal origin of thyroid nodules， the X chromosome inactivation detection and single gene mutation detection were the most widely chosen one at present. Most of the materials available at present related to X chromosome inactivation proposed that major part of the thyroid nodules were monoclonal and the malignant cells spreaded by means of the inner lymphatic vessel net，whereas polyclonal and monoclonal thyroid nodules coexisted occasionally. Only BRAF mutation was found of certain importance in clonal origin identification in the thyroid nodules. Conclusions Thyroid nodule is prevalent in clinical practice，while the clonality of thyroid nodules especially the thyroid tumor is not clear. And for the time being the commonly used methods to identify the clonal origin of thyroid nodule are X chromosome inactivation and single gene mutation detection. Published results confirm the finding of X chromosome inactivation methods that the majority of thyroid nodules are monoclonally originated.
Ｂｙ ｕｓｉｎｇ ｍｅｄｉｃａｌ ｉｍａｇｅ ｐｒｏｃｅｓｓ ｓｙｓｔｅｍ ｆｏｒ ＤＮＡ ｃｏｎｔｅｎｔｓ，２６ ｃａｓｅｓ ｏｆ ｔｈｙｒｏｉｄ ｔｕｍｏｒｓ ｔｈａｔ ｃｏｍｐｒｉｓｅｄ ａｄｅｎｏｍａ ５，ｐａｎｉｌｌａｒｙ ａｄｅｎｏｃａｒｃｉｎｏｍａ １４，ｆｏｌｌｉｃｕｌａｒ ｃａｒｃｉｎｏｍａ ５，ｕｎｄｉｆｆｅｒｅｎｔｉａｔｅｄ ｃａｒｃｉｎｏｍａ ２ ａｎｄ ｎｏｒｍａｌ ｔｈｙｒｏｉｄ ｔｉｓｓｕｅ ３ ｗｅｒｅ ｄｅｔｅｃｔｅｄ．Ｔｈｅ ＤＮＡ ｃｏｎｔｅｎｔｓ ｉｎ ｔｈｅ ｎｕｍｂｅｒ ｏｆ ｐｏｌｙｐｌｏｉｄｙ ｗｅｒｅ：ｃａｒｃｉｎｏｍａ ｔｈｅ ｈｉｇｈｅｓｔ ｉｎ ａｍｏｕｎｔ，ａｄｅｎｏｍａ ｔｈｅ ｍｅｄｉｕｍ ａｎｄ ｎｏｒｍａｌ ｔｈｙｒｏｉｄ ｔｉｓｓｕｅ ｔｈｅ ｌｅａｓｔ，ｈｅｎｃｅ ｗｅ ｐｒｏｐｏｓｅ ｔｈａｔ ｔｈｅ ｄｅｔｅｒｍｉｎａｔｉｏｎ ｏｆ ＤＮＡ ｐｌｏｉｄｙ ｉｎ ｔｈｙｒｏｉｄ ｔｕｍｏｒｓ ｍａｙ ｂｅ ｕｓｅｄ ａｓ ａｎ ａｄｊｕｖａｎｔ ｔｏ ｅｖａｌｕａｔｅ ｔｈｅ ｐｒｏｌｉｆｅｒａｔｉｖｅ ａｃｔｉｖｉｔｙ ｏｆ ｔｈｙｒｏｉｄ ｔｕｍｏｒ．
目的总结原发性甲状腺鳞癌的诊治经验。方法回顾分析我院1996～2001年收治的12例原发性甲状腺鳞癌患者的临床资料。结果单纯性鳞癌4例，合并甲状腺其它疾病8例。主要临床表现为颈部包块和声嘶。单纯性鳞癌免疫组化甲状腺球蛋白染色阳性3例，阴性1例。12例患者中10例行姑息性切除者于术后1年内死亡，2例行根治性切除者存活时间超过3年。结论原发性甲状腺鳞癌呈高度恶性，可与甲状腺其它良、恶性疾病并存； 要重视对该病的诊断和鉴别诊断，免疫组化甲状腺球蛋白染色可提高确诊率； 根治性手术切除加综合治疗是提高其生存率的关键。
ObjectiveTo compare the effect of robotic thyroidectomy and endoscopic thyroidectomy on the voice function. MethodsThe clinical data of 181 patients with differentiated thyroid cancer admitted to Panzhihua Central Hospital of Sichuan Province from March 2022 to June 2023 were analyzed retrospectively. According to the operative mode, this patients were divided into two groups: the endoscope group (n=91) and the robot group (n=90). The subjective and objective acoustic indicators were compared between the two groups at 1 day before operation and 1 week, 1 month and 3 months after operation. ResultsThere were no significant difference in voice handicap index (VHI)-10 scores between the two groups at different time points before and after operation (P>0.05). There were no significant difference of VHI-10 scores between preoperative and different postoperative phases in the robot group (P>0.05). The score of VHI-10 at different postoperative phases in the endoscopic group was higher than that at 1 d before operation (P<0.05). The incidence of voice dysfunction (VHI-10 score ≥8) was 1.1% (1/90), 1.1% (1/90) and 0.0% (0/90) in the robot group, 1.1% (1/91) , 2.2% (2/91) and 0.0% (0/91) in the endoscope group at 1 week, 1 month and 3 months after operation respectively, there were no significant difference between the two groups (P>0.05). The fundamental frequency of patients in the endoscopic group was lower than that at 1 d before operation (P<0.05), and there was no significant difference between each phase after operation and at 1 d before operation of fundamental frequency in the robot group (P>0.05). The fundamental frequency of patients in the endoscopic group was lower than that in the robot group at 1 week after operation (P<0.05). The maximum phonation time of each phase after operation in the robot group was not significantly different from that at 1 d before operation (P>0.05). The maximum phonation time of 1 week after operation in the endoscopic group was shorter than that at 1 d before operation (P<0.05) and also shorter than that in the robot group (P<0.05). There were no significant difference in fundamental frequency perturbation, amplitude perturbation, harmonic noise ratio and voice disorder severity index between the two groups at different phases before and after operation (P>0.05). ConclusionCompared with endoscopic thyroidectomy, the voice function of robotic thyroidectomy via bilateral axillary breast approach is better.
With the advancement of thyroid tumor treatment concepts and the progress of standardized treatment processes nationwide, the 5-year survival rate of thyroid tumors in China has risen from 67.5% in 2003 to 84.3% in 2015. As China has been continuously enriching its treatment options for advanced thyroid cancer in recent years, gradually improving the standardized treatment system for early and intermediate thyroid cancer, enhancing multidisciplinary collaboration methods and concepts, and regularizing scientific statistics, the survival rate of thyroid tumors continues to improve. We still need to consider the future development direction and core driving force of China’s thyroid discipline, correctly view the “prosperous” stage of domestic thyroid discipline development, and actively review the future development direction of China’s thyroid discipline.
目的探讨结节性甲状腺肿合并甲状腺微小癌的临床特征、诊断、治疗原则及预后。方法回顾分析2003年1月至2010年2月期间在我科手术治疗的34例结节性甲状腺肿合并甲状腺微小癌患者的临床资料。结果 病理诊断乳头状癌33例，滤泡状癌1例。行患侧叶全切除术+峡部切除术+对侧叶次全切除术+患侧中央区淋巴结清扫术3例，1例加行患侧改良性颈部淋巴结清扫术; 患侧叶全切除术+峡部切除术+对侧叶次全切除术22例; 患侧叶全切除术+峡部切除术1例; 甲状腺全切除术8例。2例患者出现术后低钙血症，1周后恢复正常，无其他手术相关并发症发生。随访3个月至5年(平均20.2个月)，无一例复发或死亡。结论 甲状腺多发结节有恶性的可能，B超有助于诊断。手术方法多为患侧叶全切除术+峡部切除术+对侧叶次全切除术，预后较好。
Objective To analyze clinical features of reoperation patients with differentiated thyroid cancer, and to explore reason, surgical pattern and therapeutic effectiveness of reoperation. Method The clinical data of 80 patients with differentiated thyroid cancer underwent reoperation from January 2012 to June 2016 in Peking Union Medical College Hospital were analyzed retrospectively. Results ① Eighty (5.37%) patients with differentiated thyroid cancer underwent reoperation were identified from a total of 1 491 patients with thyroid cancer in our treatment team. Twenty-seven cases were males, 53 cases were females. The male to female ratio was 1∶1.96. The age was (44±13) years with a range from 14 to 66 years. The median time between reoperation and the first operation was 16.8 months with a range from 8 days to 17 years. ② Thirteen cases underwent reoperation because of uncertain frozen sections, and the reoperation style was residual lobectomy and selective lymph node dissection. Sixty-seven cases underwent reoperation because of local recurrence or metastasis, 15 of them accepted residual lobectomy and selective lymph node dissection while the other 52 accepted selective lymph node dissection. ③ The rate of residual in thyroid cancer confirmed by postoperative pathology was 18.8% (15/80). The rate of cervical lymph node metastasis was 63.8% (51/80). The temporary laryngeal recurrent nerve injury occured in 6 cases, the temporary hypocalcemia occured in 9 cases, and the lymphorrhagia occured in 2 cases. ④ The hospitalization time was (6.50±0.97) d with a range from 3 to10 d, the time of drainage tube remove was (2.41 ±0.95) d with a range from 2 to 7 d. Seventy-three cases were followed up from 3 to 58 months with (32±18) months, 4 of them underwent operation once again because of local recurrence, no distant metastasis or death happened. ⑤ The proportion of male patients in reoperation patients was significantly higher than that of the first operation patients (P<0.05). The proportion of patients aged <45 years, the average hospitalization time, the average time of drainage tube remove, and the postoperative complications rate had no significant differences between the patients with the first operation and the patients with reoperation (P>0.05). Conclusions For reoperation patients, proportion of male patients is higher. Reoperation is proper treatment for patients with residual lobe or local recurrence or metastasis for differentiated thyroid cancer. Serious complications could be avoided by suitable surgical pattern and careful dissection during operation. Residual lobectomy and selective lymph node dissection are suggested for reoperation.