甲状腺髓样癌并发甲状腺乳头状癌：6例病例分析_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

王晶晶 ^1,2 , 罗雪 ³ , 高庆军 ³ , 何洪浩 ² ,  李涛浪 ¹ ,  赵代伟 ²

1. ;
2. ;
3. ;

Corresponding author：

李涛浪, Email: 0078029@sina.com; 赵代伟, Email: zhaodw@hotmail.com

Keywords：

甲状腺乳头状癌; 甲状腺髓样癌; 碰撞癌

DOI：

10.7507/1007-9424.202501116

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

目的总结甲状腺髓样癌（medullary thyroid carcinoma，MTC）并发甲状腺乳头状癌（papillary thyroid carcinoma，PTC）的疾病特征及诊治经验。方法通过回顾性分析2018–2024年期间就诊于遵义医科大学附属医院及贵州医科大学附属医院行初次手术且术后石蜡诊断为碰撞型（MTC-PTC）及MTC和PTC混合型（mixed medullary and papillary thyroid carcinoma，MMPTC）患者的临床病理特征及随访预后资料。结果共收集到6例患者，其中1例为MMPTC且为遗传性MTC，基因检测发现其RET及BRAF^V600E同时突变；5例MTC-PTC患者中女性居多（男∶女=2∶3），其中有4例行PTC癌灶BRAF^V600E突变检测结果发现有2例发生BRAF^V600E突变。6例患者均行全甲状腺切除术+双侧中央区淋巴结清扫，术后6例患者均遵医嘱行促甲状腺激素抑制治疗，均未接受碘-131治疗及放化疗。6例患者中位随访时间30个月，1例生化性持续，3例生化性治愈，6例患者随访期间均未发现结构性复发及远处转移或死亡。结论 MTC并发PTC的发病率低，其中MMPTC更为罕见，其病因仍不清楚。目前临床上术前诊断主要依靠细针抽吸细胞学检查及血清降钙素检测。超一半的患者为微小MTC并发微小PTC，根治性手术及术后随访必不可少，其预后取决于患者就诊时MTC的最晚分期。

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	何林烨, 王艺超, 李志辉. 2022年中国甲状腺癌流行情况分析: 基于《中国肿瘤登记年报》2005–2018年数据. 中国普外基础与临床杂志, 2024, 31(7): 790-795.
3.	Zheng R, Zhang S, Zeng H, et al. Cancer incidence and mortality in China, 2016. J Natl Cancer Cent, 2022, 2(1): 1-9.
4.	Weng D, He L, Chen X, et al. Integrated analysis of transcription factor-mRNA-miRNA regulatory network related to immune characteristics in medullary thyroid carcinoma. Front Immunol, 2023, 13: 1055412. doi: 10.3389/fimmu.2022.1055412.
5.	中国医师协会外科医师分会甲状腺外科医师委员会, 中国抗癌协会甲状腺癌专业委员会, 中国研究型医院学会甲状腺疾病专业委员会. 甲状腺髓样癌诊断与治疗中国专家共识(2020版). 中国实用外科杂志, 2020, 40(9): 1012-1020.
6.	Wells SA, Asa SL, Dralle H, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid, 2015, 25(6): 567-610.
7.	张竞轶, 王建华, 黄驰, 等. 甲状腺混合性髓样-乳头状癌伴混合性淋巴结转移1例报道并文献复习. 中国普外基础与临床杂志, 2023, 30(7): 849-854.
8.	李圆梦. 甲状腺髓样癌的临床及病理研究: 诊治与预后分子标志物的初步探索. 北京: 中国医学科学院, 2024.
9.	Guerreiro V, Costa C, Oliveira J, et al. Mixed medullary-papillary thyroid carcinoma with mixed lymph node metastases: A case report. Clin Case Rep, 2021, 9(5): e04165. doi: 10.1002/ccr3.4165.
10.	Dikbas O, Duman AA, Guvendi GF. Medullary thyroid carcinoma and papillary thyroid carcinoma in the same patient as a collision tumour. Case Rep Endocrinol, 2019, 2019: 4038628. doi: 10.1155/2019/4038628.
11.	Yang Y, Zhang J, Wang J. Mixed medullary-papillary thyroid carcinoma with mixed lymph node metastases: a case report and review of the literature. Cancer Manag Res, 2024, 16: 1285-1291.
12.	Kim WG, Gong G, Kim EY, et al. Concurrent occurrence of medullary thyroid carcinoma and papillary thyroid carcinoma in the same thyroid should be considered as coincidental. Clin Endocrinol (Oxf), 2010, 72(2): 256-263.
13.	Thomas A, Mittal N, Rane SU, et al. Papillary and medullary thyroid carcinomas presenting as collision tumors: A case series of 21 cases at a tertiary care cancer center. Head Neck Pathol, 2021, 15(4): 1137-1146.
14.	Zhang D, Yang M, Zhang X, et al. Thirty synchronous medullary and papillary thyroid carcinomas. Front Endocrinol (Lausanne), 2023, 14: 1153248. doi: 10.3389/fendo.2023.1153248.
15.	Fallahi P, Patrizio A, Stoppini G, et al. Simultaneous occurrence of medullary thyroid carcinoma and papillary thyroid carcinoma: A case series with literature review. Curr Oncol, 2023, 30(12): 10237-10248.
16.	Ciampi R, Romei C, Pieruzzi L, et al. Classical point mutations of RET, BRAF and RAS oncogenes are not shared in papillary and medullary thyroid cancer occurring simultaneously in the same gland. J Endocrinol Invest, 2017, 40(1): 55-62.
17.	杨明宇. 甲状腺髓样癌并发乳头状癌的特异性研究. 长春: 吉林大学, 2024.
18.	Ryan N, Walkden G, Lazic D, et al. Collision tumors of the thyroid: A case report and review of the literature. Head Neck, 2015, 37(10): E125-129.
19.	Chalikandy A, Loharkar S, Basu S. Clinicopathological characteristics of collision tumours of thyroid in the clinical setting of medullary thyroid carcinoma. J Laryngol Otol, 2024 Oct 25: 1-6.
20.	Ziaolhagh R, Sadrizadeh A, Shabany BP, et al. A case report of simultaneous medullary and papillary carcinoma of thyroid. Endocr Regul, 2021, 55(2): 83-88.
21.	Kiess AP, Agrawal N, Brierley JD, et al. External-beam radiotherapy for differentiated thyroid cancer locoregional control: A statement of the American Head and Neck Society. Head Neck, 2016, 38(4): 493-498.
22.	Raue F, Frank-Raue K. Long-Term Follow-up in Medullary Thyroid Carcinoma. Recent Results Cancer Res, 2015, 204: 207-225.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. 何林烨, 王艺超, 李志辉. 2022年中国甲状腺癌流行情况分析: 基于《中国肿瘤登记年报》2005–2018年数据. 中国普外基础与临床杂志, 2024, 31(7): 790-795.
3. Zheng R, Zhang S, Zeng H, et al. Cancer incidence and mortality in China, 2016. J Natl Cancer Cent, 2022, 2(1): 1-9.
4. Weng D, He L, Chen X, et al. Integrated analysis of transcription factor-mRNA-miRNA regulatory network related to immune characteristics in medullary thyroid carcinoma. Front Immunol, 2023, 13: 1055412. doi: 10.3389/fimmu.2022.1055412.
5. 中国医师协会外科医师分会甲状腺外科医师委员会, 中国抗癌协会甲状腺癌专业委员会, 中国研究型医院学会甲状腺疾病专业委员会. 甲状腺髓样癌诊断与治疗中国专家共识(2020版). 中国实用外科杂志, 2020, 40(9): 1012-1020.
6. Wells SA, Asa SL, Dralle H, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid, 2015, 25(6): 567-610.
7. 张竞轶, 王建华, 黄驰, 等. 甲状腺混合性髓样-乳头状癌伴混合性淋巴结转移1例报道并文献复习. 中国普外基础与临床杂志, 2023, 30(7): 849-854.
8. 李圆梦. 甲状腺髓样癌的临床及病理研究: 诊治与预后分子标志物的初步探索. 北京: 中国医学科学院, 2024.
9. Guerreiro V, Costa C, Oliveira J, et al. Mixed medullary-papillary thyroid carcinoma with mixed lymph node metastases: A case report. Clin Case Rep, 2021, 9(5): e04165. doi: 10.1002/ccr3.4165.
10. Dikbas O, Duman AA, Guvendi GF. Medullary thyroid carcinoma and papillary thyroid carcinoma in the same patient as a collision tumour. Case Rep Endocrinol, 2019, 2019: 4038628. doi: 10.1155/2019/4038628.
11. Yang Y, Zhang J, Wang J. Mixed medullary-papillary thyroid carcinoma with mixed lymph node metastases: a case report and review of the literature. Cancer Manag Res, 2024, 16: 1285-1291.
12. Kim WG, Gong G, Kim EY, et al. Concurrent occurrence of medullary thyroid carcinoma and papillary thyroid carcinoma in the same thyroid should be considered as coincidental. Clin Endocrinol (Oxf), 2010, 72(2): 256-263.
13. Thomas A, Mittal N, Rane SU, et al. Papillary and medullary thyroid carcinomas presenting as collision tumors: A case series of 21 cases at a tertiary care cancer center. Head Neck Pathol, 2021, 15(4): 1137-1146.
14. Zhang D, Yang M, Zhang X, et al. Thirty synchronous medullary and papillary thyroid carcinomas. Front Endocrinol (Lausanne), 2023, 14: 1153248. doi: 10.3389/fendo.2023.1153248.
15. Fallahi P, Patrizio A, Stoppini G, et al. Simultaneous occurrence of medullary thyroid carcinoma and papillary thyroid carcinoma: A case series with literature review. Curr Oncol, 2023, 30(12): 10237-10248.
16. Ciampi R, Romei C, Pieruzzi L, et al. Classical point mutations of RET, BRAF and RAS oncogenes are not shared in papillary and medullary thyroid cancer occurring simultaneously in the same gland. J Endocrinol Invest, 2017, 40(1): 55-62.
17. 杨明宇. 甲状腺髓样癌并发乳头状癌的特异性研究. 长春: 吉林大学, 2024.
18. Ryan N, Walkden G, Lazic D, et al. Collision tumors of the thyroid: A case report and review of the literature. Head Neck, 2015, 37(10): E125-129.
19. Chalikandy A, Loharkar S, Basu S. Clinicopathological characteristics of collision tumours of thyroid in the clinical setting of medullary thyroid carcinoma. J Laryngol Otol, 2024 Oct 25: 1-6.
20. Ziaolhagh R, Sadrizadeh A, Shabany BP, et al. A case report of simultaneous medullary and papillary carcinoma of thyroid. Endocr Regul, 2021, 55(2): 83-88.
21. Kiess AP, Agrawal N, Brierley JD, et al. External-beam radiotherapy for differentiated thyroid cancer locoregional control: A statement of the American Head and Neck Society. Head Neck, 2016, 38(4): 493-498.
22. Raue F, Frank-Raue K. Long-Term Follow-up in Medullary Thyroid Carcinoma. Recent Results Cancer Res, 2015, 204: 207-225.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Latest Articles甲状腺髓样癌并发甲状腺乳头状癌：6例病例分析

Abstract Full text Figures/Tables Video References Cited by

Format

Content