Follicular Adenoma and Carcinoma of the Thyroid Gland
Follicular Adenoma and Carcinoma of the Thyroid Gland
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DOI：
10.1634/theoncologist.2010-0405
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发表时间：
2011-01-01
期刊：
影响因子：
5.8
通讯作者：
Phitayakorn, Roy
中科院分区：
文献类型：
--
作者：
McHenry, Christopher R.;Phitayakorn, Roy
甲状腺滤泡性肿瘤包括良性滤泡性腺瘤和滤泡性癌。目前，滤泡性癌不能单独根据细胞学、超声或临床特征与滤泡性腺瘤区分。甲状腺滤泡状癌的发病机制可能与碘缺乏及多种癌基因和/或microRNA的激活有关。基因突变的分子检测的进展可能很快允许术前区分滤泡性癌和滤泡性腺瘤。在此之前，患有滤泡性肿瘤的患者应该接受诊断性甲状腺叶切除术和峡部切除术，这是良性滤泡性腺瘤或微创滤泡性癌的明确治疗。浸润性滤泡癌需要额外的治疗，包括完整的甲状腺切除术，术后放射性碘消融，全身扫描和促甲状腺激素抑制剂量的甲状腺激素。少于10%的滤泡癌患者会有淋巴结转移，对于肉眼可见的疾病患者，应保留隔室导向的颈淋巴结清扫术。定期随访包括病史和体格检查、宫颈超声和血清TSH、甲状腺球蛋白和抗甲状腺球蛋白抗体水平。其他影像学检查保留给血清甲状腺球蛋白水平升高和宫颈超声阴性的患者。全身转移最常见的是肺和骨，较少见的是脑、肝和皮肤。显微镜下的转移用高剂量的放射性碘治疗。孤立的肉眼可见的转移瘤可以切除，生存率提高。与侵袭性滤泡癌患者的80%相比，微创滤泡癌患者的总体十年生存率为98%。肿瘤学家2011; 16：585 - 593
Follicular neoplasms of the thyroid gland include benign follicular adenoma and follicular carcinoma. Currently, a follicular carcinoma cannot be distinguished from a follicular adenoma based on cytologic, sonographic, or clinical features alone. The pathogenesis of follicular carcinoma may be related to iodine deficiency and various oncogene and/or microRNA activation. Advances in molecular testing for genetic mutations may soon allow for preoperative differentiation of follicular carcinoma from follicular adenoma. Until then, a patient with a follicular neoplasm should undergo a diagnostic thyroid lobectomy and isthmusectomy, which is definitive treatment for a benign follicular adenoma or a minimally invasive follicular cancer. Additional therapy is necessary for invasive follicular carcinoma including completion thyroidectomy, postoperative radioactive iodine ablation, whole body scanning, and thyrotropin suppressive doses of thyroid hormone. Less than 10% of patients with follicular carcinoma will have lymph node metastases, and a compartment-oriented neck dissection is reserved for patients with macroscopic disease. Regular follow-up includes history and physical examination, cervical ultrasound and serum TSH, and thyroglobulin and antithyroglobulin antibody levels. Other imaging studies are reserved for patients with an elevated serum thyroglobulin level and a negative cervical ultrasound. Systemic metastases most commonly involve the lung and bone and less commonly the brain, liver, and skin. Microscopic metastases are treated with high doses of radioactive iodine. Isolated macroscopic metastases can be resected with an improvement in survival. The overall ten-year survival for patients with minimally invasive follicular carcinoma is 98% compared with 80% in patients with invasive follicular carcinoma. The Oncologist 2011;16:585-593