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摘要:
目的 探讨甲状腺转移癌的超声特征。 方法 回顾性分析本院1988年4月至2013年7月收治的10例甲状腺转移癌患者的临床资料, 分析其超声图像及超声报告, 记录并总结甲状腺转移癌的超声特征。 结果 1例肺癌及1例食管癌患者的转移灶表现为甲状腺增大, 弥漫性回声不均, 余8例表现为甲状腺结节。8例表现为甲状腺结节的超声特征:5例多发, 3例单发; 2例病灶累及右侧叶, 1例病灶累及左侧叶, 5例病灶累及双侧叶; 结节平均最大径为3.8 cm(0.6~6.6 cm); 5例边界不清, 3例边界尚清; 7例病灶形态不规则, 1例报告中未描述; 7例表现为低回声, 1例表现为高回声; 2例病灶为囊实性, 6例表现为实性; 6例伴点状、条状强回声, 1例无强回声, 1例报告中未描述; 彩色多普勒血流成像显示:4例病灶内血流丰富, 1例周边内部条状血流, 1例周边见少许血流信号, 1例无血流, 1例报告中未描述。甲状腺转移灶与原发病灶具有相似的超声特征。 结论 甲状腺转移癌超声表现多种多样, 多表现为甲状腺结节, 也可表现为弥漫性回声不均。结节的超声表现多为多发、体积较大、边界不清、形态不规则、实性、低回声、钙化、血流丰富。了解甲状腺转移癌的超声特征有利于可疑病例的发现。 Abstract:Objective To investigate the sonographic characteristics of secondary thyroid cancer. Methods The clinical records of 10 patients with histologically proven metastasis to thyroid who were treated in Peking Union Medical College Hospital between April 1988 and July 2013 were retrospectively reviewed. The ultrasound images and reports were reviewed, and the sonographic characteristics of the metastatic thyroid cancer were summarized. Results In 1 patient with lung cancer and 1 with esophageal cancer, the metastatic lesions were presented as enlarged thyroid gland and uneven diffuse echo; in the remaining 8 patients, thyroid nodules were found. In the 8 lesions, 5 were multiple and 3 were solitary; right lobe was involved in 2 cases, left lobe in 1 case, and both lobes in 5 cases; the maximal size of the metastatic nodule averaged 3.8 cm (ranged between 0.6 and 6.6 cm); 5 were ill-defined and 3 were well-defined; 7 were irregular and 1 wasn't reported; 7 were hypoechoic and 1 was hyperechoic; 6 were solid and 2 were solid and cystic; calcification was observed in 6 cases; rich blood flow was detected in 4 cases, blood flow was detected in internal and peripheral parts of the lesion in 1 case, few bloodflow was seen in peripheral part of the lesion in 1 case, and no blood flow in 1 case. The sonographic characteristics of the secondary thyroid cancer were similar to those of the primary tumor. Conclusions The sonographic characteristics of secondary thyroid cancer are diverse, among which the thyroid nodule is a common manifestation and uneven diffuse echo can also be observed. The sonographic features that help to identify secondary thyroid cancer include multiple and large lesions, with ill-defined and irregular borders; the mass is solid, hypoechoic, and calcified, with rich blood flow. Ultrasound helps to select suspicious nodule for fine needle aspiration or surgery. -
Key words:
- thyroid cancer /
- secondary cancer /
- ultrasound
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图 1 51岁女性患者，16年前诊断为左乳癌并治疗，6年前诊断为右乳癌并治疗，因发现甲状腺肿物5个月就诊，甲状腺超声发现甲状腺多发极低回声伴钙化，双侧颈部淋巴结肿大，手术切除甲状腺病理符合转移性乳腺癌
A.甲状腺左叶见一4.0 cm×3.4 cm×1.6 cm低回声区，形态欠规则，边界欠清，内可见强回声(箭头)；B.彩色多普勒显像示内部未探及明显血流，周边可探及少许血流
图 2 72岁男性患者，30个月前因右肾癌行右肾切除，查体发现甲状肿物半年就诊，甲状腺超声发现腺体内见多个低回声，手术切除甲状腺病理符合转移性肾细胞癌
A.左叶见低回声结节，边界尚清，内可见数个无回声区(箭头)；B.能量多普勒显像示周边及内部可见丰富血流
表 1 10例甲状腺转移癌患者的临床特征
病例 性别 年龄
(岁)主诉 肿瘤原发
部位原发肿瘤
病理学结果原发肿瘤发现至转移
间隔时间(月)其他部位转移 1 男 72 查体发现甲状腺肿物 肾脏 肾透明细胞癌 30 肱骨，腹腔内多发转移(胰腺、门
静脉、肠系膜静脉、脾静脉、左肾)2 男 36 咳嗽，颈部肿物 肺 - 0 颈部淋巴结、肋骨 3 男 49 声嘶、咳嗽，呼吸困难，进食哽噎 气管 中-低分化鳞癌 0 无 4 女 51 自行发现甲状腺肿物，声嘶及甲亢
症状乳腺 低分化乳腺浸润
性导管癌192 无 5 女 51 声嘶、吞咽困难 乳腺 右乳腺癌 72 无 6 男 64 自觉颈部不适，颈部增大，CT左
叶增大，憋气、干咳肾脏 肾透明细胞癌 108 双肺、左肾上腺、皮下、腹腔多发
转移7 男 66 声嘶 胰腺 - 0 颈部淋巴结及纵膈淋巴结 8 女 49 干咳、声嘶，饮水呛咳，颈部肿物 乳腺 浸润性导管癌 120 颈部淋巴结 9 男 68 咳嗽、憋气伴声嘶 肺来源可能 - 0 无 10 男 63 进行性吞咽困难，声嘶 食管 中低分化鳞癌 2 颈部及锁骨上淋巴结 -:未知 
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表 2 8例甲状腺转移结节的超声特征
病例 原发肿瘤 部位 数目 大小(cm) 形态 边界 回声 囊性 钙化 血流 1 肾脏 双侧叶 多发 5.3 不规则 清 低回声 囊实性 钙化 丰富 2 肺 双侧叶 多发 0.6 不规则 清 低回声 实性 钙化 无 3 气管 右侧叶 单发 6.6 不规则 不清 低回声 实性 钙化 丰富 4 乳腺 双侧叶 多发 4.0 不规则 不清 低回声 实性 钙化 周边少许血流 5 乳腺 双侧叶 多发 - 不规则 不清 低回声 实性 钙化 丰富 6 肾脏 左侧叶 单发 6.6 不规则 清 低回声 囊实性 钙化 丰富 7 胰腺 双侧叶 多发 2.2 - 不清 低回声 实性 - - 8 乳腺 右侧叶 单发 1.6 不规则 不清 低回声 实性 无 内部周边条状血流 -：报告中未描述
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表 3 甲状腺转移癌与原发病灶超声特征比较
病例 病灶 超声特征 数目 回声 形态 边界 囊性 钙化 血流 1 肾脏原发病灶 单发 低回声 不规则 清 不规则的无回声 无 丰富血流 甲状腺转移病灶 多发 低回声 不规则 清 不规则的无回声 点状 丰富血流 4 乳腺原发病灶 多发 低回声 不规则 不清 无 点状 周边不规则血流 甲状腺转移病灶 多发 低回声 不规则 不清 无 点状及条状 周边少许血流 8 乳腺原发病灶 单发 低回声 不规则 不清 无 无 - 甲状腺转移病灶 单发 低回声 不规则 不清 无 无 周边内部条状血流
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