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目的:探讨原发性甲状腺鳞状细胞癌(SCCT)的临床、超声及病理特征以及治疗和预后。方法:回顾性分析2010年1月—2015年12月收治的7例原发性SCCT患者的临床表现、超声声像图特征、术后病理结果和综合治疗效果。结果:7例原发性SCCT占同期全部甲状腺癌的0.96%(7/728),其中男3例,女4例,平均年龄62.7岁。所有患者均可触及颈部肿块,4例伴呼吸困难,2例伴声音嘶哑,1例伴吞咽困难。病灶超声声像图均表现为形态不规则的实性混合性回声光团,5例肿块侵透甲状腺被膜,2例伴有微钙化,4例有异常颈部淋巴结。手术治疗5例(甲状腺癌联合根治术2例,局部广泛切除术2例,姑息性切除术并同时行预防性气管切开1例),2例仅行粗针穿刺活检。患者病理均证实为SCCT,3例合并结节性甲状腺肿,2例合并甲状腺乳头状癌,7例肿瘤细胞P63免疫组化均阳性。5例手术患者术中,4例术后行放疗或放疗+化疗,1例未行综合治疗;2例粗针穿刺活检患者行单纯放疗或放疗+化疗。仅1例行根治性切除术联合术后放疗的患者生存期超过1年,其余均在半年内死亡。结论:原发性SCCT恶性程度高,病情发展迅速,预后差。其临床表现及超声声像图具有一定的特征性,有助于术前诊断,免疫组化对鉴别诊断非常重要,积极的综合治疗可能改善患者预后。
Objective: To investigate the clinical, ultrasonographic and pathological characteristics of primary thyroid squamous cell carcinoma (SCCT) and its treatment and prognosis. Methods: The clinical manifestations, echocardiographic features, postoperative pathological findings and comprehensive treatment of 7 patients with primary SCCT admitted from January 2010 to December 2015 were retrospectively analyzed. Results: Seven cases of primary SCCT accounted for 0.96% (7/728) of total thyroid cancer in the same period, including 3 males and 4 females, with an average age of 62.7 years. All patients had palpable neck mass, 4 patients with dyspnea, 2 with hoarseness and 1 with dysphagia. Echocardiography showed heterogeneous solid mixed echo echocardiography. Five masses penetrated the thyroid gland, two with microcalcifications, and four with abnormal cervical lymph nodes. Surgical treatment of 5 cases (thyroid cancer combined radical mastectomy in 2 cases, local broad excision in 2 cases, palliative resection and simultaneous prophylactic tracheotomy in 1 case), 2 cases only thick needle biopsy. The pathology of the patients was confirmed as SCCT, 3 with nodular goiter, 2 with papillary thyroid carcinoma, and 7 with P63 immunohistochemistry. Five patients underwent surgery. Four patients underwent radiotherapy or radiotherapy + chemotherapy after operation. One patient did not receive combined treatment. Two patients underwent needle biopsy with radiotherapy alone or radiotherapy plus chemotherapy. Only one patient who underwent radical resection combined with postoperative radiotherapy survived for more than one year and the rest died within six months. Conclusion: The primary SCCT has a high degree of malignancy, rapid progression and poor prognosis. Its clinical manifestations and ultrasonography have certain characteristics, contribute to preoperative diagnosis, immunohistochemistry is very important for differential diagnosis, and active comprehensive treatment may improve the prognosis of patients.