A Recurrent Hurthle Cell Carcinoma: Decision Making of Diagnosis and Therapeutic Strategy

甲狀腺嗜酸细胞癌之復發：診斷決策與治療方針

黃聖德(Sheng-Te Huang) ； 吳建德(Jiann-Der Wu) ； 陳建欽(Chien-Chin Chen)

《南臺灣醫學雜誌》 16卷1期 (2020/06) Pp. 39-43

https://doi.org/10.6726/MJST.202006_16(1).0006

摘要

Hurthle cell carcinoma (HurCC) was considered as an oxyphilic type of follicular cell carcinoma (FCC), but is a specific entity according to the newest World Health Organization blue book. The diagnosis for thyroid neoplasms relies on the ultrasonography and fine needle aspiration. However, the invasiveness of follicular or Hurthle cell neoplasms is unable to be determined by pre-operative cytology or images. The microscopically vascular or capsular invasion is the definitive standard of follicular carcinoma and Hurthle cell carcinoma. While HurCC has a favorable outcome, the recurrence of HurCC is seldom reported. The clinical strategies for differential diagnosis and treatment are educational. Herein, we report a case of recurrent HurCC, presenting as a neck mass, and discuss the thinking processes, diagnostic pitfalls, and our therapeutic strategies. We aim to share our experience to clinical physicians in case of managing a neck mass, ruling in or out recurrent FCC or HurCC.

關鍵字

hurthle cell carcinoma ； follicular carcinoma ； thyroid cancer ； recurrent ； ultrasonography

並列摘要

甲狀腺嗜酸细胞癌以往被認為是甲狀腺濾泡細胞癌其下的一種亞型，但最新的世界衛生組織藍皮書將之視為自成一格的甲狀腺癌分類。診斷甲狀腺癌必須依賴超音波以及細針抽吸細胞學檢查。然而，不論是甲狀腺濾泡細胞癌或甲狀腺嗜酸细胞癌，都無法以開刀前的細胞學檢查或是影像檢查來確認是否有侵襲性，惡性診斷必須依靠切除腫瘤後的組織判讀，顯微鏡下出現血管性或包囊性侵犯才是惡性診斷的標準。甲狀腺嗜酸细胞癌治療預後良好，復發的案例並不常見。於此分享一甲狀腺嗜酸细胞癌復發案例，對臨床診斷思路及治療策略有教育意義。本案例闡釋從患者觸摸到頸部腫塊、鑑別診斷過程中的思路及陷阱、到最後的治療方案。透過此案例分享，提供臨床醫師處理頸部腫塊時，懷疑或排除濾泡細胞癌或嗜酸细胞癌復發的參考。

並列關鍵字

甲狀腺嗜酸细胞癌 ； 甲狀腺濾泡細胞癌 ； 甲狀腺癌 ； 復發 ； 超音波