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題名 | Clinical Experience of Medullary Thyroid Carcinoma in Chang Gung Memorial Hospital=甲狀腺髓質癌:長庚紀念醫院臨床經驗 |
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作者 | 何正; 林仁德; 萬禹堯; 黃碧玉; 黃鴻碩; 薛純; Ho, Cheng; Lin, Jen-der; Huang, Yu-yao; Huang, Hong-so; Huang, Bie-yu; Hsueh, Chuen; |
期刊 | 長庚醫學 |
出版日期 | 19960600 |
卷期 | 19:2 1996.06[民85.06] |
頁次 | 頁142-148 |
分類號 | 415.931 |
語文 | eng |
關鍵詞 | 髓質癌; 甲狀腺髓質癌; 細胞學檢查; 抑鈣素; 放射碘-131治療; Medullary thyroid carcinoma; Hypercalcitoninemia; Radioactive iodine; Fine-needle aspiration cytology; |
中文摘要 | 我們回顧自1979至1994年之間19例甲狀腺髓質癌的臨床經驗。其中女性15名,男性4名,年齡自23至75歲,平均44.9±13.7歲。全部患者皆有甲狀腺腫(100%),臨床分期為第一期12例(63%),第二期1例(5%),第三期3例(16%),及第四期3例(16%)。所有患者血鈣正常且皆無高血壓。問診發現一例有甲狀腺髓質癌及副甲狀腺機能亢進家族史。其中15例術前接受甲狀腺超音波及細針穿刺術細胞學檢查,11例診斷為惡性腫瘤,其中5例正確診斷為甲狀腺髓質癌。併有頸部淋巴腺轉移共有7例,其原發癌瘤皆大於3公分。所有患者接受甲狀腺切除術,由於術前的低診斷率,故只有7名患者接受術前血清抑鈣素測定,其中6名偏高;16名患者接受術後血清抑鈣素測定,其中8名偏高。在術後血清抑鈣素偏高的患者中,5例接受放射碘-131治療,其中2例第一期患者的血清抑鈣素降至正常,但1例第三期及2例第四期則無效。3名患者接受體外放射線治療,但均無效果。追?期間自0.5至9.4年(平均3.6年),其中3人死亡,1人失?,15人存活。 結論:我們的經驗顯示甲狀腺髓質癌在臺灣有以下特性(1)男女比例1:3.8,女性佔多數;(2)術前甲狀腺細胞學檢查的正確診斷率為42%;(3)多數為術後診斷。 |
英文摘要 | Total 19 cases of medullary thyroid carcinoma (MTC) diagnosed at Chang Gung Memorial Hospital from Jan. 1979 ot Dec. 1994 were studied retrospectively. All of them were pathologicallyl proved. All cases except one were thought as sporadic MTC. The gender distribution showed a female preference with female: male (F:M) ratio of 3.8:1. The mean age at diagnosis was 44.9±13.7 years. The most common clinical presentation was thyroid mass in all (100%). The staging of MTC in our cases demonstrated: 12 (63%) stage I, 1 (5%) stage III, 3 (16%) stage III, and 3 (16%) stage IV. Thyroid ultrasonogrphy with fine-needle aspiration cytology (FNAC) were performed in 15 patients. Eleven cases were diagnosed as malignancy, including 5 cases diagnosed as MTC preoperatively. Neck nodal metastases were noted in 7 cases and all occurred in tumors larger than 3 cm. All cases received operation according to clinical stage. Six of 7 patients who had preoperative calcitonin data showed abnormal high values. After operation, there were 8 patients with persistent hypercalcitoninemia. Of these, 5 recive 131I therapy which induced undetectable calcitonin level in 2 stage I patients. Three cases received external bam radiotherapy but all failed. During a period of 0.5 to 9.4 years follow-up and 15 patients are alive and well. In conclusions, the preliminary data suggests that he medullary thyroid carcinoma in Taiwan has following characteristics: (1) gender distribution showed a female preference; (2) accuracy of preoperative FNAN was 42%; (3) most of the diagnoses of MTC were made postoperatively. |
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