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目的:探讨青少年与成人远处转移性甲状腺乳头状癌(PTC)临床病理特征差异。方法:回顾分析2003-07-01-2012-05-01就诊于北京协和医院核医学科的879例甲状腺癌患者中,伴远处转移的PTC患者76例,分为A组(≤21岁21例)和B组(>21岁55例),对比两组临床、病理、影像学及血清学特征。结果:A组滤泡型和经典型各占44.44%,实体型11.11%。B组滤泡型43.75%,经典型34.38%,实体型18.75%,硬化型3.13%。A组肿瘤更易累及双侧腺体(P=0.002),其多灶、甲状腺外侵犯及淋巴结转移发生率分别较B组高14.15%、13.73%和6.52%,差异无统计学意义,P>0.05。131I全身显像显示,A组肺部转移灶90.48%表现为双肺弥漫性摄碘增高,B组双肺转移灶仅44.68%,呈弥漫性摄碘增高,其余则表现为局灶性摄碘增高(21.28%),甚至不摄碘(34.04%),P=0.002。首次131I治疗前促甲状腺激素(s-TSH)≤30mIU/L时,A组刺激性甲状腺球蛋白(s-Tg)平均值比B组高131.43%,当s-TSH>90mIU/L时,A组s-Tg平均值比B组低20.46%,差异无统计学意义,P>0.05。结论:青少年和成人远处转移性PTC均以滤泡亚型多见。青少年患者局部侵袭性高于成人,肺部转移灶更多表现为双肺弥漫摄碘。
Objective: To investigate the clinicopathological features of metastatic thyroid papillary carcinoma (PTC) in adolescents and adults. Methods: A retrospective analysis of 763 PTC patients with distant metastasis from 879 cases of thyroid cancer treated in Department of Nuclear Medicine, Peking Union Medical College Hospital from July 2003 to July 2012 was divided into group A (≤21 years 21 Cases) and group B (> 21 years old and 55 cases). The clinical, pathological, imaging and serological features of the two groups were compared. Results: A group of follicular and classic accounted for 44.44%, solid type 11.11%. Group B follicular 43.75%, classic 34.38%, solid 18.75%, sclerosis 3.13%. The incidence of multiple lesions, extra-thyroid extranodal invasion and lymph node metastasis in group A was 14.15%, 13.73% and 6.52% higher than that in group B, respectively, with no significant difference (P> 0.05) .131I whole body imaging showed that 90.48% of lung metastases in group A showed diffuse uptake of iodine in both lungs, only 44.68% of double lung metastases in group B, showing diffuse uptake of iodine, while others showed focal uptake Iodine increased (21.28%), even without iodine (34.04%), P = 0.002. The mean s-Tg of group A was 131.43% higher than that of group B when the thyroid-stimulating hormone (s-TSH) ≤30mIU / L before the first 131I treatment. When s-TSH> 90mIU / L, Group s-Tg average 20.46% lower than the B group, the difference was not statistically significant, P> 0.05. CONCLUSION: Follicular subtypes are more common in adolescent and adult distant metastatic PTC. Local aggressiveness in adolescent patients than adults, lung metastases more manifestations of diffuse lung iodine.