Unifokale hyperfunktionelle Karzinome der Schilddrüse

 

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Zusammenfassung

Hintergrund: Die typischen szintigrafischen Zeichen von Schilddrüsenkarzinomen sind hypofunktionelle und afunktionelle Knoten, wobei auch seltene Fälle mit Karzinomen in hyperfunktionellen Knoten publiziert wurden. Das Ziel unserer retrospektiven Arbeit war es, die Frequenz dieser Karzinome bei operierten Patienten zu erfassen und deren demografische und klinische Charakteristika zu beschreiben. Patienten und Methoden: Zwischen 1997 und 2006 wurden 308 Patienten im Zentrum für Endokrine Chirurgie in Belgrad wegen eines unifokalen hyperfunktionellen Knotens operiert. Ergebnisse: Die histopathologische Analyse bewies Malignitäten bei 9 Patienten (um 3 %). Bei 6 Patienten wurde ein papilläres Mikrokarzinom neben einem dominanten hyperfunktionellen Adenom liegend nachgewiesen, während bei den restlichen 3 (um 1 %) ein klinisch offensichtlich hyperfunktionelles Karzinom der Schilddrüse nachgewiesen werden konnte. In 2 Fällen ging es um ein follikuläres und in einem Fall um ein papilläres Karzinom. Alle 3 Patienten waren präoperativ hyperthyreoid. Bei beiden Patienten mit follikulären Karzinomen wurde eine Hemithyreoidektomie durchgeführt, während beim dritten Patienten eine totale Thyreoidektomie durchgeführt wurde und zwar nachdem, per intraoperativer Schnellschnitt Untersuchung, ein papilläres Karzinom nachgewiesen wurde. Schlussfolgerungen: Nach unseren Ergebnissen beträgt die Frequenz der unifokalen hyperfunktionellen Karzinome der Schilddrüse um 1 % aller behandelten hyperfunktionellen Knoten, so dass man, unserer Meinung nach, bei der Behandlung dieser Patienten die Möglichkeit, dass es sich dabei um Karzinome handeln könnte, in Betracht ziehen sollte. 

Abstract

Background: Thyroid gland carcinomas usually appear as afunctional and hypofunctional lesions on thyroid scintigrams, but some rare cases of thyroid carcinoma with scintigraphic hyperfunctional lesions have also been reported. The aim of our retrospective study was to elucidate the frequency of carcinomas in patients operated for solitary hyperfunctional thyroid nodules and to represent their demographic and clinical features. Patients and Methods: During one decade (1997 / 2006), 308 patients were operated for solitary hyperfunctional thyroid nodules in the Centre for Endocrine Surgery in Belgrade. Results: Malignancy was revealed in 9 cases (about 3 %) by histopathological examination. In 6 cases papillary microcarcinomas were found adjacent to dominant hyperfunctional adenomas, while in 3 cases (about 1 %) real hyperfunctional carcinomas were confirmed. Follicular carcinoma was diagnosed in 2 cases and papillary carcinoma in one. All 3 patients were preoperatively hyperthyroid. In both patients with follicular carcinoma we performed lobectomies. In the third case we carried out a total thyroidectomy considering the intraoperative frozen section finding of a papillary carcinoma. Conclusions: According to our results the frequency of solitary hyperfunctioning thyroid carcinomas is about 1 %, so that the possibility that a hyperfunctional nodule is malignant should be considered in the treatment of such lesions. 

Literatur

• 1 Fabbro D, Di Loreto C, Beltrami C A et al. Expression of thyroid specific factors TTF-1 and PAX-8 in human thyroid neoplasm.  Cancer Res. 1994;  54 4744-4749
  PubMedGoogle Scholar
• 2 Kim T S, Asato R, Akamizu T et al. A rare case of hyperfunctioning papillary carcinoma of the thyroid gland.  Acta Otolaryngol Suppl. 2007;  557 55-57
  PubMedGoogle Scholar
• 3 Yaturu S, Fowler M R. Differentiated thyroid carcinoma with functional autonomy.  Endocr Pract. 2002;  8 36-39
  CrossrefPubMedGoogle Scholar
• 4 Appetecchia M, Ducci M. Hyperfunctioning differentiated thyroid carcinoma.  J Endocrinol Invest. 1998;  21 189-192
  PubMedGoogle Scholar
• 5 Pandolfi C, Colecchia M, Gianini A. Hyperfunctioning thyroid carcinoma. Description of a case.  Minerva Endocrinol. 1997;  22 79-82
  PubMedGoogle Scholar
• 6 Majima T, Doi K, Komatsu Y et al. Papillary thyroid carcinoma without metastases manifesting as an autonomously functioning thyroid nodule.  Endocr J. 2005;  52 309-316
  CrossrefPubMedGoogle Scholar
• 7 Lupi A, Orsolon P, Cerisara D et al. “Hot” carcinoma of the thyroid. Case reports and comments on the literature.  Minerva Endocrinol. 2002;  27 53-57
  PubMedGoogle Scholar
• 8 Rubenfeld S, Wheeler T M. Thyroid cancer presenting as a hot thyroid nodule: report of a case and review of the literature.  Thyroidology. 1988;  1 63-68
  PubMedGoogle Scholar
• 9 Iwata M, Kasagi K, Misaki T et al. A patient with two thyroid papillary carcinomas demonstrating hot and cold lesions on ¹¹³I thyroid scintigraphy.  Ann Nucl Med. 2002;  16 355-358
  CrossrefPubMedGoogle Scholar
• 10 Uludag M, Yetkin G, Citgez B et al. Autonomously functioning thyroid nodule treated with radioactive iodine and later diagnosed as papillary thyroid cancer.  Hormones. 2008;  7 175-179
  PubMedGoogle Scholar
• 11 Nishida A T, Hirano S, Asato R et al. Multifocal hyperfunctioning thyroid carcinoma without metastases.  Auris Nasus Larynx. 2008;  35 432-436
  CrossrefPubMedGoogle Scholar
• 12 Blitzer A, Som M L. Thyroid carcinoma in a patient with a coexisting functional adenoma.  Otolaryngol Head Neck Surg. 1979;  87 768-774
  PubMedGoogle Scholar
• 13 Mizukami Y, Michigishi T, Nonomura A et al. Autonomously functioning (hot) nodule of the thyroid gland. A clinical and histopathologic study of 17 cases.  Am J Clin Pathol. 1994;  101 29-35
  PubMedGoogle Scholar
• 14 Mircescu H, Parma J, Huot C et al. Hyperfunctioning malignant thyroid nodule in an 11-year-old girl: pathologic and molecular studies.  J Pediatr. 2000;  137 585-587
  CrossrefPubMedGoogle Scholar
• 15 Als C, Gedeon P, Rösler H et al. Survival analysis of 19 patients with toxic thyroid carcinoma.  J Clin Endocrinol Metab. 2002;  87 4122-4127
  CrossrefPubMedGoogle Scholar
• 16 Harach H R, Sánchez S S, Williams E D. Pathology of the autonomously functioning (hot) thyroid nodule.  Ann Diagn Pathol. 2002;  6 10-19
  CrossrefPubMedGoogle Scholar
• 17 Wong C P, AuYong T K, Tong C M. Thyrotoxicosis: a rare presenting symptom of Hurthle cell carcinoma of the thyroid.  Clin Nucl Med. 2003;  28 803-806
  CrossrefPubMedGoogle Scholar
• 18 Emmrich P, Gauer J, Mättig H. Unifokale Autonomie und Karzinom der Schilddrüse.  Zentralbl Chir. 2001;  126 672-675
  Article in Thieme ConnectPubMedGoogle Scholar
• 19 Ashcraft M W, Van Herle A J. Management of thyroid nodules. II: Scanning techniques, thyroid suppressive therapy, and fine needle aspiration.  Head Neck Surg. 1981;  3 297-322
  CrossrefPubMedGoogle Scholar
• 20 Porterfield J R, Thompson G B, Farley D R et al. Evidence-based management of toxic multinodular goiter (Plummer’s disease).  World J Surg. 2008;  32 1278-1284
  CrossrefPubMedGoogle Scholar
• 21 Stocker D J, Burch H B. Thyroid cancer yield in patients with Graves’ disease.  Minerva Endocrinol. 2003;  28 205-212
  PubMedGoogle Scholar
• 22 Ardito G, Mantovani M, Vincenzoni C et al. Hyperthyroidism and carcinoma of the thyroid gland.  Ann Ital Chir. 1997;  68 23-27
  PubMedGoogle Scholar
• 23 Ahuja S, Ernst H. Hyperthyroidism and thyroid carcinoma.  Acta Endocrinol. 1991;  124 146-151
  PubMedGoogle Scholar
• 24 Schröder S, Marthaler B. Autonomie und Malignität bei Schilddrüsentumoren.  Pathologe. 1996;  17 349-357
  CrossrefPubMedGoogle Scholar
• 25 Tardy M, Tavernier E, Sautot G et al. A case of hyperthyroidism due to functioning metastasis of differentiated thyroid carcinoma. Discussion and literature review.  Ann Endocrinol. 2007;  68 39-44
  CrossrefPubMedGoogle Scholar
• 26 Takano T, Miyauchi A, Ito Y et al. Thyroxine to triiodothyronine hyperconversion thyrotoxicosis in patients with large metastases of follicular thyroid carcinoma.  Thyroid. 2006;  16 615-618
  CrossrefPubMedGoogle Scholar
• 27 Pucci A, Suppo M, Lucchesi G et al. Papillary thyroid carcinoma presenting as a solitary soft tissue arm metastasis in an elderly hyperthyroid patient. Case report and review of the literature.  Virchows Arch. 2006;  448 857-861
  CrossrefPubMedGoogle Scholar
• 28 Ikejiri K, Furuyama M, Muranaka T et al. Carcinoma of the thyroid manifested as hyperthyroidism caused by functional bone metastasis.  Clin Nucl Med. 1997;  22 227-230
  CrossrefPubMedGoogle Scholar
• 29 Ghose M K, Genuth S M, Abellera R M et al. Functioning primary thyroid carcinoma and metastases producing hyperthyroidism.  J Clin Endocr. 1971;  33 639-646
  CrossrefPubMedGoogle Scholar
• 30 Michigishi T, Mizukami Y, Shuke N et al. An autonomously functioning thyroid carcinoma associated with euthyroid Graves disease.  J Nucl Med. 1992;  33 2024-2026
  PubMedGoogle Scholar
• 31 Elizabeth D, Rosen B I, Jerald B et al. Management of the hot thyroid nodule.  Am J Surg. 1995;  170 481-483
  CrossrefPubMedGoogle Scholar
• 32 Khan O, Ell P J, Maclennan K A et al. Thyroid carcinoma in an autonomously hyperfunctioning thyroid nodule.  Postgrad Med J. 1981;  57 172-175
  CrossrefPubMedGoogle Scholar
• 33 Hoving J, Piers D A, Vermey A et al. Carcinoma in hyperfunctioning thyroid nodule in recurrent hyperthyroidism.  Eur J Nucl Med. 1981;  6 131-132
  PubMedGoogle Scholar
• 34 Kusic Z, Becker D V, Saenger E L et al. Comparison of technetium-99m and iodine-123 imaging of thyroid nodules: correlation with pathologic findings.  J Nucl Med. 1990;  31 393-399
  PubMedGoogle Scholar
• 35 Alagöl F, Tanakol R, Boztepe H et al. Anaplastic thyroid cancer with transient thyrotoxicosis: case report and literature review.  Thyroid. 1999;  9 1029-1032
  CrossrefPubMedGoogle Scholar
• 36 Eriksson M, Ajmani S L, Mallette L E. Hyperthyroidism from thyroid metastasis of pancreatic adenocarcinoma.  JAMA. 1977;  238 1276-1278
  CrossrefPubMedGoogle Scholar
• 37 Edmonds C J, Thompson B D. Hyperthyroidism induced by secondary carcinoma in the thyroid.  Clin Endocrinol. 1978;  8 411-415
  CrossrefPubMedGoogle Scholar
• 38 Miyakawa M, Sato K, Hasegawa M et al. Severe thyrotoxicosis induced by thyroid metastasis of lung adenocarcinoma: a case report and review of the literature.  . 2001;  11 883-888
  PubMedGoogle Scholar

Dr. R. Zivic

Dr. Dragisa Misovic Hospital · Surgery Clinic

M.Tepica 1

11000 Belgrade

Serbia

Phone: +38 / 16 37 70 52 97

Fax: +38 / 11 12 66 96 92

Email: zivicr@sbb.rs