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題名 | Diagnosis and Management of 34 Hurthle Cell Tumors=三十四位何氏細胞瘤的診斷與治療 |
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作者 | 黃雪晶; 林仁德; 黃碧玉; 陳志宏; 薛純; 李寧; 閻紫宸; | 書刊名 | 長庚醫學 |
卷期 | 22:3 1999.09[民88.09] |
頁次 | 頁445-452 |
分類號 | 415.931 |
關鍵詞 | 何氏細胞瘤; 何氏細胞癌; 細針吸引細胞學檢查; 鉈-201; 鎝99-Methoxy-isobutyl-isonitrile; 碘-131癌症全身掃描; Hurthle cell adenoma; Hurthle cell carcinoma; Fine needle aspiration cytology; Thallium-201; Tectnetium-99m methoxy-isobutyl-isonitrile; MIBI; Iodine-131 whole body scan; |
語文 | 英文(English) |
中文摘要 | 背景:對於何氏細胞瘤的診療至今仍有許多爭議,本篇的目的是回顧我們的病例 及經驗,以利未來對此疾病能早期診斷,適切的治療。 方法:我們回溯1990至1996年間,34位於林口長庚醫院經病理診斷為何氏細胞良性 瘤及癌的病例,針對其臨床特徵、甲狀腺超音波、核醫攝影、甲狀腺細針吸引細胞學檢查、 病理報告、術後的追蹤及治療結果做分析。 結果:大部份何氏細胞瘤患者為女性(82.4%)。34例中有9例(26.5%)為何氏細胞癌。在 統計分析中,除了在良性瘤及癌的腫瘤大小呈有意義的差異外(3公分、4公分、p<0.044); 至於性別、年齡、結節數目的多寡、超音波形態的表現均無明顯差異。在術前鎝-99m或碘 131掃描,所有良性及惡性何氏細胞瘤都呈冷結節。在細針吸引細胞學檢查下,我們的敏感 度為78%,特異性只達18%,經過冷凍病理切片,敏感度及特異性各提升至100%及86%。 有兩位何氏細胞癌患者發生術後轉移,一位為頸部淋巴腺轉移,其術後甲狀腺球蛋白為正常, 碘131癌症全身掃描為陰性,但鉈-201及鎝-99 Methoxy-isobutyl-isonitrile (MIBI)癌症全身掃 描為陽性。另一位為上縱隔腔轉移,其甲狀腺球蛋白異常升高,且碘-131癌症全身掃描為 陽性反應。經碘-131放射治療,腫瘤成功消退。 結論:何氏細胞癌及良性瘤除了大小呈有意義的差異外,臨床特徵、超音波及核醫攝影 並不能作為診斷癌症的參考,細胞學檢查也無法分辨何氏細胞瘤為良性或惡性。故所有何氏 細胞瘤患者均應接受手術切除,並以病理切片為最終診斷。若碘-131可被癌細胞所吸收, 則可考慮碘-131放射治療。另鉈-201及鎝-99Methoxy-isobutyl-isonitrile(MIBI)癌症全身掃描 亦可當作癌症追蹤工具。所有病患都應接受更長期的追蹤。 |
英文摘要 | Background: Controversies still exist around the diagnosis and management of Hurthle cell tumors. The aim of this study is to reexamine our experience to improve our methods in the future. Methods: We treated 34 patients with verified Hurthle cell carcinoma and adenoma at Chang Gung Memorial Hospital, Linkou from 1990 through 1996. Clinical characteristics, thyroid ultrasonogram, I, T1, Tc- methoxy- isobutyl- isonitrile (MIBI) and Tc-thyroid scan, fine needle aspiration cytology (FNAC) and histology results were analyzed. Results: Female predominance (82.4%) was noticed among our Hurthle cell tumors. Nine (26.5%) patients had carcinoma. The median size of carcinoma was 4.0 cm, which was significantly larger than the median 3.0 cm for adenoma. No significant differences were found between gender, age, multiplicity or echogenicity between two groups. All 12 adenoma and 3 carcinoma patients who received pre-operative Tc and/or I thyroid scan showed cold nodules. The sensitivity and specificity of detection Hurthle cell carcinoma as indeterminate and malignant using FNAC was 78% and 18% respectively. These improved to 100% and 86% using frozen sections. One carcioma patient developed neck lymph node metastasis, with normal serum thyroglobulin, negative I but positive Tl and Tc-MIBI whole body scans. Another one showed nediastinum metastasis with elevated serum thyroglobulin, detected using I scan, revealed successful regression after I therapeutic scan. Conclusion: Tumor size of carcinoma is significantly larger than adenoma. All patients with FNAC suggestive of Hurthle cell tumors should receive surgery for histological diagnosis to differentiate carcinoma from adenoma. Therapeutic radioiodine ablation is indicated whenever there is I uptake by tumor cells. |
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