Tiroidin küçük kanserleri

Özet

TÜTF Genel Cerrahi AD'da 01.01.1989-22.06.1999 tarihleri arasında tiroid ameliyatı geçiren 556 hastadan 59'unda (% 10.61) malignite tespit edildi. Bunlar içinden tümör çapı 1.5 cm ya da daha küçük bulunan 20 hastaya (% 33.90) ait hastane kayıtları retrospektif olarak incelendi. Tüm hastalarda anamnez ve muayeneden sonra tiroid USG, sintigrafi yapıldı. Malinite şüphesi olan hastalara İİAB, servikal lenf adenopatisi olanlara lokal anestezi altında eksizyonel biopsi yapıldı. Gerektiğinde peroperatuar frozen section uygulandı. Çıkarılan tüm dokuların parafin incelemesi yapıldı. Hastalardan 1'i erkek, 19'u kadın ve yaş ortalaması 37.20 (15-60) bulundu. Histopatolojik incelemede hastaların 12'sinde sağ lobda, 6'sında sol lobda, 1'inde istmusta ve diğer bir tanesinde ise her iki tiroid lobunda tümör saptandı. 17 hastada tek, bir hastada multifokal, bir hastada 3, bir hastada ise 2 odakta tümör saptandı. Ortalama tümör büyüklüğü; 10.15 mm (5-15 mm) olup 12'sinde tümör çapı 10 mm yada daha küçük ölçüldü. Hastaların 11 'inde papiller, 6'sında mikst tip (Papiller-folliküler), 2'sinde Hürthle hücreli ve 1'inde de folliküler kanser bulundu. Hastalardan 2'sinde preop. İİAB, 2'sinde servikal lenf nodu biopsisi ve 1'inde ise hem İİAB hem de servikal lenf nodu biopsisi ile tam konuldu. Hastalardan 9'unda (% 45) frozen section ile tümör tanısı konulurken, 6 hastada (% 30) tanı parafin kesitlerde konuldu. 14 hastada total tiroidektomi uygulanıp servikal lenf nodu tutulumu olan 3 hastaya ilaveten modifiye radikal boyun diseksiyonu uygulandı. Hastalardan 2'sinde lezyon tarafına total, karşı loba totale yakın, 2 hastada lezyon tarafına totale yakın, karşı tarafa subtotal lobektomi ve kalan 2 hastaya bilateral subtotal lobektomi uygulandı.

Abstract

The hospital records of the patients, who had been operated on through 1989-1999 because of the thyroid pathologies were evaluated retrospectively. There were 556 patients in this period and 59 of them had thyroid tumour. The greatest size of the tumour was 1.5 cm or less in 20 (% 33.90) of them. This group is named as small carcinoma of the thyroid. Patients were evaluated by physical examination, thyroid ultrasonography (US) and scintigraphy. FNAC was applied for the patients who were suspicious for carcinoma. If there were cervical lymph node metastasis, exicional biopsy was applied under local anaesthesia. All the tissues examined in paraffin blocks. One of the patients was male, remaining 19 were female. Mean age of the patients was 37.20 years (15-60). In 12 of the patients the tumour was located in the right lobe, in the 6 of the patients it was located in the left lobe. It was located in the isthmus of the thyroid in one of the patients and both of the lobes in another one. There was one focus in 17 of the patients, 2 foci in one patient, 3 foci in one patient again and multiple foci in another one. Mean tumour size was 10.15 mm (5-15 mm). Twelve of the patients have a tumour 10 mm or smaller in its greatest dimensions. The tumour types were as follows, papillary carcinoma in 11 of the patients, mixt type (papillary and follicular) in 6 of the patients, Hürthle cell carcinoma in 2 of them and pure follicular carcinoma in one of the patients. Tumour was diagnosed by FNAC in 2 of the patients, exicional biopsy of the cervical lymph node and FNAC and exicional biopsy of the cervical lymph node together in one of the patients preoperatively. The diagnosis was confirmed by means of frozen section for 9 of the patients and permanent sections for 6 of the patients. Fourteen of the patients were treated with total thyroidectomy and modified radical neck dissection was applied to three of them. Total lobectomy for the tumour containing lobe and subtotal lobectomy for the contrlateral lobe was applied for 2 of the patients. Near total lobectomy for one lobe and subtotal lohectomy for the contrlateral lobe was applied for 2 of them. Two of the patients were treated with bilateral subtotal lobectomy.