100例甲状腺嗜酸细胞腺瘤的诊治分析

doi:10.19723/j.issn.1671-167X.2020.06.018

摘要/Abstract

摘要：

目的:总结分析甲状腺嗜酸细胞肿瘤(Hürthle cell tumor,HCT)患者的临床资料和预后,以期提高临床医生对该病的认识。方法:回顾性分析2001年1月至2017年2月在北京大学第一医院因甲状腺结节行手术,术后病理确诊为HCT且不合并其他甲状腺恶性肿瘤患者的临床资料,并随访患者。结果:符合上述条件者共100例,均为甲状腺嗜酸细胞腺瘤(Hürthle cell adenoma,HCA),男女比例为1:3.3,其中51例患者因体检行超声检查发现甲状腺结节而就诊,49例有症状的患者中,69.4%的患者表现为无痛性颈部肿物。83.0%的患者合并结节性甲状腺肿(multinodular goiter,MNG)。HCA超声多表现为较大、实性、低回声结节,边界清晰,结节内及周边血流(较)丰富,结节内无钙化,颈部淋巴结无肿大。术中冰冻病理切片(frozen section,FS)诊断HCA的准确率为97.4%。术后29例患者获随访,随访时间(49.2±22.1)个月,均无局部复发或颈部淋巴结转移。6例患者行甲状腺激素替代治疗,1例因替代过量出现甲状腺毒症。结论:HCA好发于女性,常无症状或表现为无痛性颈部肿物,常合并MNG。HCA超声无特征性表现,术中FS可较准确地判断HCT的良恶性。

关键词: 甲状腺, 嗜酸细胞肿瘤, 腺瘤, 诊断

Abstract:

Objective: To summarize and analyze the clinical data and prognosis of the patients with Hürthle cell tumor (HCT) in order to raise the clinicians’ awareness of the disease. Methods: The clinical data on patients with histopathologically proven HCT, without other thyroid carcinomas, were collected retrospectively in Peking University First Hospital from January 2001 to February 2017. All the patients underwent surgery due to thyroid nodules. The follow-up information was also collected. Results: A total of 100 patients were enrolled in the current study. All of them were diagnosed with Hürthle cell adenoma (HCA). There were 77 females and 23 males, with the male-to-female ratio of 1:3.3. The average age of these patients was (52±14) years at the time of operation. Fifty-one patients were found their thyroid nodules accidentally by ultrasonography during their health check-ups. 69.4% of the 49 symptomatic patients presented with painless cervical nodules. 83.0% HCA patients were combined with multinodular goiters (MNGs). 88.4% (76/86) patients were euthyroid and 53.8% (21/39) had increasing thyroglobulin levels. The mean longest diameter of HCAs was (3.2±1.5) cm (range: 0.9-7.3 cm) on ultrasonography. There were a series of sonographic features of HCA, such as larger, solidity, hypoecho, a smooth outline, intranodular vascularization, perinodular vascularization, absence of calcification in nodules and absence of enlarged cervical lymph nodes. Compared with the histological diagnosis, the diagnostic accuracy by frozen section (FS) during operation was 97.4%. Twenty-nine patients were followed up with an average period of (49.2±22.1) months and none of them had local recurrence or cervical lymph node metastasis. Six patients accepted thyroid hormone replacement treatment and one had thyrotoxicosis due to over-dose. Conclusion: HCA is more common in women. It is often found accidentally by ultrasonography during their health check-ups or presented with painless cervical nodules. It is combined with MNG frequently. HCA exhibits numerous sonographic features but not unique. FS during operation is a reliable method to identify HCA with high diagnostic accuracy. Patients with thyroid hormone administration should be monitored for thyroid function after thyroid surgery.

Key words: Thyroid gland, Hürthle cell tumor, Adenoma, Diagnosis

中图分类号:

R736.1

康琦,张继新,高莹,张俊清,郭晓蕙. 100例甲状腺嗜酸细胞腺瘤的诊治分析[J]. 北京大学学报（医学版）, 2020, 52(6): 1098-1101.

Qi KANG,Ji-xin ZHANG,Ying GAO,Jun-qing ZHANG,Xiao-hui GUO. Analysis of diagnosis and treatment of 100 patients with Hürthle cell adenoma[J]. Journal of Peking University (Health Sciences), 2020, 52(6): 1098-1101.

图/表 2

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表2

参考文献 17

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Nonmalignant thyroid diseases	Cases	Ratio
MNG	44	83.0%
HT	2	3.8%
Graves’ disease	2	3.8%
FTA	3	5.7%
HT with FTA	1	1.9%
MNG with HT	1	1.9%

Sonographic features of HCA	Cases	Ratio
Composition
Total	88
Solid	64	72.7%
Solid-cystic	24	27.3%
Margin
Total	88
Well-defined	83	94.3%
Ill-defined	5	5.7%
Echogenicity
Total	44
Hypo-anechoic	1	2.3%
Hypoechoic	23	52.3%
Isoechoic	18	40.9%
Mixed	2	4.5%
Intranodular vascularization
Total	76
Yes	64	84.2%
No	12	15.8%
Perinodular vascularization
Total	20
Yes	19	95.0%
No	1	5.0%
Internal calcifications
Total	85
Yes	7	8.2%
Suspected	1	1.2%
No	77	90.6%
Enlarged cervical lymph nodes
Total	76
Yes	13	17.1%
No	63	82.9%