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- 女，50岁，发现颈部肿块半月余入院，有会诊结果
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本帖最后由 郁金香07 于 2012-06-05 19:11:02 编辑
和大家考虑的一样，我们当初也纠结于髓样癌和副节瘤之间，但是降钙素反复标均为阴性，后来补标了CK也为阴性，Ki67增殖指数很低，小于1%，问了临床病史，病人身体很好，目前没有肿瘤病史。最后科里集体讨论意见鉴于TTF-1+，TG- ,降钙素-，PR+，CEA+，倾向为髓样癌，但由于降钙素标记为阴性，建议外出会诊，后来上海肿瘤医院会诊为髓样癌。Renghis 老师的文献很好， Calcitonin-negative neuroendocrine tumor of the thyroid: a distinct clinical entity，大家是否有相似的病例？可以总结一下，提出新的亚分类“降钙素阴性的髓样癌”。
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Calcitonin-negative neuroendocrine tumor of the thyroid: a distinct clinical entity.
Source
Division of General Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA. chernyvs@umdnj.edu
Abstract
BACKGROUND:
Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor (NET) that arises from the parafollicular cells (C-cells) of the thyroid gland which produces calcitonin (CT) and is, therefore, a serum and immunohistochemical biomarker of MTC. Here, we describe a patient with another form of NET arising with the thyroid gland. PATIENT
FINDINGS:
This is a forty-year-old woman who underwent total thyroidectomy for a thyroid nodule that had features of an NET on fine needle aspiration. Her serum CT and carcinoembryonic antigen were normal. Surgical pathology showed a well-differentiated NET with immunohistochemical stains positive for markers of follicular cells (thyroglobulin and synaptophysin), positive for neuroendocrine markers (neuron specific enolase and chromogranin A), but negative for CT, the defining marker of MTC.
CONCLUSIONS:
We describe a rare case of a nonmedullary NET of the thyroid gland arising from thyroid follicular cells, not parafollicular cells. We suggest that calcitonin-negative neuroendocrine tumor of the thyroid gland (CNNETT) may be an entity that has not been recognized in the literature. This distinction between MTC and CNNETT may be important, as the treatment and prognosis may differ.
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