Оксифильно-клеточные опухоли щитовидной железы

Abstract

The diagnosis and treatment of oxyphillc-cell tumors (OCT) of the thyroid have been the subject of much controversy. The authors describe 11 years' experience in treating 159 patients with OCTs, of them there were 102(64%) adenomas, 15 (9%) follicular carcinomas, 38 (24%) papillary carcinomas, and 4 (2.5%) tumors of unknown malignancy potential. Among the follicular carcinomas, their miniinvasive forms were prevalent (11/15; 73%). The size of follicular carcinomas was significantly more than that of adenomas (36.5 vs 17 mm; p < 0.001) and that of widely invasive carcinomas was more than miniinvasive ones (50.5 vs 33 mm; p < 0.04). In papillary thyroid carcinoma, multiple foci were found in 3S%, extrathyroid invasion In 10%, and regional metastases in 36%. No distant metastases were detected in any of the patients with papillary or follicular carcinomas. OCT commonly developed in the presence of thyroiditis (papillary carcinoma in 74% of cases, adenoma in 40%, and follicular carcinoma in 33%). Multiple adenomas (12%) and a concomitance of adenomas and papillary carcinoma (20%) were frequently encountered. Surgical treatment was made as thyroidectomy (31%), hemithyroidectomy (64%), subtotal thyroidectomy (5%) supplemented by cervical fat excision (44%). Among 102 patients followed up for 6-126 months (median 24 months), a relapse was detected in 4 (4%) patients, including 3 patients with multifocal adenomas and associated papillary carcinoma after hemithyroidectomy (in the residual tissue (n = 3) and lymph node metastases (n = 2) and 1 patient after thyroidectomy (cervical lymph nodes). The clinical behavior of cancer arising from oxyphilic cells is similar to that of поп-oxyphilic cancer. Hemithyroidectomy suffices in solitary OCT without signs of extrathyroid invasion and regional or distant metastases. Thyroidectomy is recommended for multiple tumors because of the high relapse rate (33%) in residual tissue.