Analysis Of The 15 Cases Of Medullary Thyroid Carcinoma And Review Of The Literature

Background and objective:Medullary thyroid carcinoma(MTC) accounts for 5-8% of all thyroid cancers. It originates from parafollicullar cells, its prognosis is worse than that of differentiated thyroid carcinoma, RET pro-oncogene have been identified as the main cause of MTC, most MTC were similar to other typers of thyroid cancers. The clinical manifestations in most patients were the cervical mass. The preoperative diagnosis of MTC was difficult, so most of surgical doctors are not familiar with MTC. This study was designed to discuss the epidemiology, clinical manifestation, pathogenesis, diagnosis, treatment and prognosis of this uncommon disease, in order to advance the cognition of MTC.Methods:Retrospectively analyze the clinical data of 15 patients with MTC treated in our hospital from June 1997 to June 2006. The patients were followed up from 30 months to 152 months(Median:78 months), and the follow-up rate was 80%(12/15).Results:There were 15 cases,8 male,7 female, the ratio for men to women is 1.14:1. The median age of patinent at dignosis medullary thyroid carcinoma was 49 years old (range 28-69 years). Ultrasound was done in all patients, with 9(60%,9/15)) cases of enlarged lymph nodes, The diagnosis and the choice of operative methods mainly depend on intra-operative pathology. The operative program of medullary thyroid carcinoma most used was total affected lobectomy plus isthmuss and opposite subtotal lobectomy plus central compartment neck dissection, account for 46.7%(7/15). The diagnosis of MTC in the 15 patients was confirmed by pathology. Of them,10 (66.7%,10/15) had lymph nodes metastases. According to AJCC staging system,3(20%,3/15)cases were in stageⅠ, 2 (13.3%,2/15) in stageⅡ,4 (26.7%,4/15) in stageⅢ,5 (33.3%,5/15) in stage IV,1 case was lymph node recurrence, the stage was not certain. The patients were followed up from 30 months to 152 months,6(25.0%) cases recurrent:2 cases had lymph nodes metastases,3 cases had distant metastases,1 case had persistent postoperative high carcinoembryonic antigen.2 cases died during the follow-up period. 1,5 and 10 year survival rate was 91.7%,91.7%,83.3%.Conclusions:The diagnosis of MTC depends on endocrine biochemical tests (CI,CEA), B-Ultrasonographtan, FNA and RET mutation testing. Early diagnosis and treatment are very important for patients, and operation is the primary treatment. An aggressive surgical approach at the initial operation is essential to achieve a curative effect in patient with MTC.