肺腺癌甲状腺转移：六例病例系列及文献综述中的诊断陷阱与个体化管理

文献信息

中文摘要

背景： 临床确诊的肺腺癌甲状腺转移较为罕见，且由于影像学、细胞学及免疫表型表现重叠，可能被误认为原发性甲状腺恶性肿瘤。我们旨在描述连续6例患者的诊断陷阱、治疗及结局，并明确甲状腺定向治疗可能合理的有限情形。
病例描述： 2018年9月至2023年9月期间，6例经病理证实为肺腺癌甲状腺转移的患者在一家学术性三级肿瘤医院接受治疗。该队列包括4例男性和2例女性，平均年龄57岁。在本病例系列纳入的6例患者中，2例在发现原发肺部病灶后接受了手术切除。这2例患者中，1例术后复发并随后出现骨转移，另1例在术后出现多发肺内转移及甲状腺转移。其余4例患者在初次发现时已处于晚期，不适合手术，因此接受了全身抗肿瘤治疗。所有6例均在肿瘤分期或治疗后随访期间发现甲状腺转移。检查时，5例患者无特异性临床症状，1例患者表现为可触及的颈部肿块。所有患者均接受了颈部超声和计算机断层扫描（CT）检查。5例患者（病例1和病例3-6）通过超声引导下细针穿刺活检确诊。在剩余1例患者（病例2）中，细胞学结果提示原发性甲状腺髓样癌，而转移性肺腺癌的诊断由甲状腺切除术后组织病理学确立，该甲状腺切除术亦为预防局部功能损害而实施。截至数据截止日期，1例患者仍带瘤生存，4例患者死于转移性疾病，1例患者失访。
结论： 对于当前或既往患有肺腺癌的患者，新发甲状腺病灶应促使考虑转移性疾病，并通过针对性免疫组化组合进行组织学确认。全身治疗仍是大多数患者的主要治疗。甲状腺切除术不应作为常规，仅可在多学科评估后，对于真正孤立/寡转移且适合完全局部控制，或即将发生气道、吞咽或喉部并发症的情况下考虑。从这一小系列中无法推断手术可带来生存获益。

英文摘要

BACKGROUND: Clinically recognized thyroid metastasis from lung adenocarcinoma is rare and may mimic a primary thyroid malignancy because imaging, cytologic, and immunophenotypic findings overlap. We aimed to characterize the diagnostic pitfalls, management, and outcomes of 6 consecutive patients and to define the limited circumstances in which thyroid-directed treatment may be reasonable.
CASE DESCRIPTION: Six patients with pathologically confirmed thyroid metastasis from lung adenocarcinoma were treated at an academic tertiary cancer hospital between September 2018 and September 2023. The cohort included 4 men and 2 women, with a mean age of 57 years. Of the 6 patients included in this case series, 2 underwent surgical resection after their primary lung lesions were identified. One of these 2 patients experienced postoperative recurrence with subsequent bone metastasis, and the other developed multiple intrapulmonary metastases and thyroid metastasis after surgery. The remaining 4 patients already had advanced-stage disease at initial detection and were not eligible for surgery, so they received systemic anti-tumor therapy. Thyroid metastasis was detected in all 6 cases during tumor staging or post-treatment follow-up. At the time of examination, 5 patients had no specific clinical symptoms, while 1 patient presented with a palpable neck mass. All patients underwent neck ultrasound and computed tomography (CT) scanning. The diagnosis was confirmed by ultrasound-guided fine-needle aspiration biopsy in 5 patients (Cases 1 and 3-6). In the remaining patient (Case 2), cytological findings were suggestive of primary medullary thyroid carcinoma, and the diagnosis of metastatic lung adenocarcinoma was established by postoperative histopathology following thyroidectomy, which was also performed to prevent local functional impairment. As of the data cutoff date, 1 patient was still alive with disease, 4 patients died from metastatic disease, and 1 patient was lost to follow-up.
CONCLUSIONS: A new thyroid lesion in a patient with current or previous lung adenocarcinoma should prompt consideration of metastatic disease and tissue confirmation with a focused immunohistochemical panel. Systemic therapy remains the main treatment for most patients. Thyroidectomy should not be routine and may be considered only after multidisciplinary assessment for truly isolated/oligometastatic disease amenable to complete local control or for imminent airway, swallowing, or laryngeal morbidity. No survival benefit from surgery can be inferred from this small series.