以頸部淋巴結腫為初始表現的潛藏性甲狀腺乳突癌之超音波特點

Ultrasonographic Characteristics of Occult Papillary Thyroid Carcinoma Initial Presented as Cervical Lymph Node Metastasis

張玉君(Yu-Chun Chang) ； 羅武嘉(Wu-Chia Lo) ； 鄭博文(Po-Wen Cheng) ； 廖立人(Li-Jen Liao)

《台灣耳鼻喉頭頸外科雜誌》 47卷4期 (2012/12) Pp. 276-283

https://doi.org/10.6286/2012.47.4.276

摘要

背景：潛藏性甲狀腺乳突癌的定義是指以頸部淋巴結腫為初始表現，但在臨床上甲狀腺觸診未發現腫瘤之情形下稱之。由於潛藏性甲狀腺乳突癌腫瘤尺寸可能很小，這種病例過去通常是先經由頸部的淋巴結切片，病理檢查發現有甲狀腺乳突癌淋巴結轉移，才進一步診斷出原發的甲狀腺癌。近年來由於高解析頭頸部軟組織超音波檢查在耳鼻喉頭頸外科的普及，讓我們得以盡早將這類病人診斷出來。對於以頸部淋巴結腫表現之潛藏性甲狀腺乳突癌之病人，並不為耳鼻喉外科醫師所熟悉，故進行此一類病人的病例回顧。方法：我們自2007年7月至2011年7月期間，本院頭頸部超音波檢查室病人名單中，選取以頸部淋巴結腫表現之潛藏性甲狀腺乳突癌病人進行病例回顧。包括病人的年齡、性別、頸部淋巴結腫表現之位置與時間、超音波特點、細針穿刺檢查結果、病人處置與預後。結果：有10例以頸部淋巴結腫大為表現且合乎潛藏性甲狀腺乳突癌的診斷。病人的年齡分布為26到62歲，平均為42.5歲；女性7例，男性3例。頸部淋巴結的分佈方面，左側7例，右側3例，淋巴結大小平均為短軸8.9mm，長軸14.3mm。9名病人主要頸部淋巴結在超音波下表現為囊腫狀。在經過細針穿刺之細胞學檢查後，有7例證實為轉移性甲狀腺乳突癌，2例因檢體中細胞不足而無法判定，但檢體中驗出甲狀腺球蛋白（thyroglobulin）的存在；1例為疑似腫瘤的不典型細胞。甲狀腺腫瘤於超音波檢查大部分具有不規則腫瘤邊緣微小鈣化點明顯實質狀以及前後徑大於左右徑之超音波特點。病人接受了甲狀腺切除併頸部淋巴結廓清手術，且病理報告均證實為甲狀腺乳突癌併頸部淋巴結轉移；也都接受了碘131之治療。追蹤至目前為止，10例病人並無復發之跡象。結論：對於原因不明的頸部腫塊，頭頸部軟組織超音波檢查對耳鼻喉科醫師是很好的評估工具，一旦有原因不明的頸部腫塊，應例行的為病人兩側頸部包括Level I到VI，及甲狀腺進行詳細的超音波探查。

關鍵字

超音波 ； 細針穿刺切片 ； 潛藏性甲狀腺乳突癌

並列摘要

BACKGROUND: When papillary thyroid carcinoma shows clinically apparent cervical node metastasis, but its primary lesion is too small to be palpated, it is known as occult papillary thyroid carcinoma (OTPC). Because the primary lesion of OPTC is small, it is virtually undetectable and the diagnosis is through histological examination of lymph node metastasis. High-resolution ultrasound is becoming more popular in the head and neck field for earlier diagnosis of patients. Because otolaryngologists are often unfamiliar with the diagnosis of OTPC, this study describes the management of these patients.METHODS: From July 2007 to July 2011, patients diagnosed with OPTC were reviewed and data on their age, sex, and size of neck lumps, ultrasound characteristics, and results of needle biopsy, management, and prognosis were collected.RESULTS: Ten patients (7 women and 3 men) diagnosed with OTPC were examined. Their mean age was 42.5 years. Left laterality was observed in 7 cases and right laterality in 4 cases. The mean size of the dominant lymphadenopathy in the short-axis was 8.9 mm and 14.3 mm in the long-axis. Nine patients had cystic lymph node metastasis. All neck lymphadenopathy underwent ultrasound-guided fine-needle aspiration. Seven cases had metastatic thyroid papillary carcinoma, 2 cases were non-diagnostic but had elevated thyroglobulin in cystic fluid, and 1 case was atypia and ”suspicious for neoplasm.” Most thyroid tumors had typical ultrasound characteristics of thyroid papillary carcinoma such as solid content, irregular border, microcalcification, and taller-than-wide shapes. All patients had total thyroidectomy and neck lymph node dissection; the pathology showed thyroid papillary carcinoma with neck metastasis. These patients are still living diseasefree after radioactive iodine therapy.CONCLUSIONS: In the work-up of neck mass, head and neck soft tissue ultrasound provides a useful tool for otolaryngologists. All neck levels, including Levels I to VI and the thyroid gland, must be examined carefully.

並列關鍵字

ultrasound ； fine-needle aspiration cytology ； occult papillary thyroid carcinoma