背景:甲状腺乳头状癌(PTC)是最常见的甲状腺癌类型,PTC和甲状腺髓样癌(MTC)的共存并不常见。虽然在伴有PTC转移的淋巴结中同时发生两种具有小淋巴细胞淋巴瘤(SLL)的癌症非常罕见。本研究提出了一个并发PTC的独特案例,MTC,和SLL,突出了这些共存肿瘤的罕见性。
方法:一名患有甲状腺肿瘤的75岁女性患者接受了甲状腺全切除术,双侧中央颈淋巴结清扫术,右颈部淋巴结清扫术.组织病理学检查显示,左叶有低度甲状腺髓样癌(MTC),右叶有经典甲状腺乳头状癌(PTC)。颈淋巴结有PTC转移,受累淋巴结并发SLL。
结果:PTC共存,同一患者的MTC和SLL很少见,由于文献有限,目前尚无标准化治疗指南.然而,不仅要考虑每种类型肿瘤的治疗方法,还要考虑与治疗相关的潜在风险或冲突。在本文报道的案例中,乳头状癌侵入甲状腺右叶囊并转移到颈部淋巴结,保证放射性碘治疗。然而,考虑到放射性碘对原有淋巴瘤的潜在负面影响,放射性碘治疗被推迟。同时,本病例应持续监测降钙素和甲状腺球蛋白,以监测肿瘤复发.
结论:自MTC以来,PTC,和SLL可能共存,PTC患者应仔细监测其他疾病实体。这一案例强调了提高临床医生意识的必要性,放射科医生,和病理学家关于并发甲状腺肿瘤和异常淋巴结的可能性,指导全面的术前评估和术后监测策略。本研究旨在为常规病理诊断提供警示,为相关研究贡献数据。
BACKGROUND: Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, the coexistence of PTC and medullary thyroid carcinoma (MTC) is uncommon. While the simultaneous occurrence of both cancers with small lymphocytic lymphoma (SLL) in lymph nodes with PTC metastasis is very rare. This study presents a unique case of concurrent PTC, MTC, and SLL, highlighting the exceptional rarity of these coexisting tumors.
METHODS: A 75-year-old female with a thyroid tumor underwent total thyroidectomy, bilateral central neck lymph node dissection, and right radical neck lymph node dissection. Histopathological examination revealed a low-grade medullary thyroid carcinoma (MTC) in the left lobe and classical papillary thyroid carcinoma (PTC) in the right lobe, with PTC metastasis in the cervical lymph nodes and concurrent SLL in the affected lymph nodes.
RESULTS: Coexistence of PTC, MTC and SLL in the same patient is rare, there are currently no standardized treatment guidelines due to the limited literature. However, it is essential to consider not only the treatment for each type of tumor but also the potential risks or conflicts associated with the treatments. In the case reported in this paper, the papillary carcinoma invaded the capsule of the right lobe of the thyroid and metastasized to the cervical lymph nodes, warranting radioactive iodine therapy. However, considering the potential negative impact of radioactive iodine on the pre-existing lymphoma, the radioactive iodine therapy was postponed. Meanwhile, constant monitoring of calcitonin and thyroid globulin should be performed to monitor tumor recurrence as was performed in the present case.
CONCLUSIONS: Since MTC, PTC, and SLL may coexist, patients with PTC deserve careful surveillance for the other disease entities. This case underscores the need for heightened awareness among clinicians, radiologists, and pathologists regarding the possibility of concurrent thyroid tumors and abnormal lymph nodes, guiding comprehensive pre-operative evaluations and postoperative monitoring strategies. This study aims to provide a warning for routine pathological diagnosis and contribute data for related research.