Occult Thyroid Cancer Presenting as Endotracheal Invasion Report of Two Cases and Literature Review

以氣管內侵襲爲起始表現的隱性甲狀腺癌－二病例報告及文獻回顧

簡明德(Min-Te Chien) ； 秦建弘(Chien-Hung Chin) ； 趙東瀛(Tung-Ying Chao) ； 黃玄贏(Hsuan-Ying Huang) ； 林孟志(Meng-Chih Lin)

《胸腔醫學》 23卷3期 (2008/06) Pp. 221-227

https://doi.org/10.29806/TM.200806.0012

摘要

以氣管內侵襲(endotracheal invasion)為起始表現的隱性甲狀腺癌(occult thyroid cacner)極為罕見。我們提出兩個因為咳嗽與咳血的病例，胸部X光片顯示在氣管的部位有腫塊的陰影；頸部與甲狀腺的理學檢查並無異常的發現。支氣管鏡檢查發現有一氣管內腫瘤(endotracheal tumor)，手術與切片證實為甲狀腺乳突癌(papillary thyroid carcinoma)併發氣管內侵襲。其中一位病人在積極的外科治療後達到長期存活；然而另一位病人則因上呼吸道阻塞而死亡。回顧英文文獻，只有一個相似的病例被發表過。我們認為隱性甲狀腺癌應列入氣管內腫瘤的一個鑑別診斷。即使頸部的理學檢查缺乏明顯的甲狀腺異常，亦不能排除局部侵襲性甲狀腺癌的可能性。積極的外科治療，包括原發腫瘤與受影響氣管的局部切除，可以提供病人長期存活的機會。

關鍵字

氣管內侵襲 ； 氣管內腫瘤 ； 隱性甲狀腺癌 ； 甲狀腺乳突癌

並列摘要

Occult thyroid cancer presenting initially as endotracheal invasion is extremely rare. Two patients presented to our chest clinic with hemoptysis and cough. The chest radiograph showed a filling defect in the tracheal air column. Physical examination of the neck and thyroid revealed unremarkable findings. An endotracheal tumor was noted by bronchoscopy. The pathologic examination of the surgical specimens confirmed the diagnosis of occult papillary thyroid carcinoma with transmural tracheal invasion. One patient had longterm survival after radical surgery, while the other expired because of the complication of progressive upper airway obstruction. No similar cases have been described in the literature. We believe endotracheal invasion by occult thyroid cancer should be considered in the differential diagnosis of endotracheal tumor. The absence of a clinically detectable thyroid abnormality does not exclude the possibility of locally advanced thyroid cancer. Aggressive surgical resection of the primary tumor and the involved trachea can provide the opportunity for long-term survival.

並列關鍵字

endotracheal invasion ； endotracheal tumor ； occult thyroid cancer ； papillary thyroid carcinoma