甲状腺转移癌（MTT）是其他器官恶性肿瘤通过血行、淋巴或直接侵犯转移至甲状腺的继发性恶性肿瘤，常见原发肿瘤包括肾细胞癌、肺癌、乳腺癌、消化道肿瘤及黑色素瘤等。MTT临床症状缺乏特异性，易误诊为原发性甲状腺癌，常表现为甲状腺结节或颈部肿块。转移机制以血行播散最常见，其次为淋巴途径及直接侵犯，分子机制涉及BRAF、KRAS、EML4-ALK等基因突变及信号通路异常。诊断依赖影像学、细针穿刺活检及免疫组化标记物，其中甲状腺球蛋白（Tg）、甲状腺转录因子-1（TTF-1）、碳酸酐酶Ⅸ（CAⅨ）、Napsin A、PAX8、GATA3及S-100等有助于鉴别原发癌与转移癌。治疗策略需综合原发癌类型及转移范围，手术可改善局部控制并缓解压迫症状，孤立性转移配合原发灶治疗可延长生存；全身治疗包括化疗、放疗、靶向及免疫治疗，部分病例因分子分型指导而获益。不同原发肿瘤预后差异显著，肾细胞癌原发者生存率较高，而肺癌、消化道肿瘤和黑色素瘤原发者生存较差。总体而言，MTT诊治需依托多学科综合策略，结合病理学与分子学检测，以实现个体化治疗并改善病人生存结局。
Abstract
Metastatic thyroid tumor (MTT) refers to a secondary thyroid malignancy originating from other organ cancers through hematogenous spread, lymphatic dissemination, or direct invasion. Common primary tumors include renal cell carcinoma, lung cancer, breast cancer, gastrointestinal malignancies, and melanoma. Clinical manifestations of MTT lack specificity, often mimicking primary thyroid carcinoma, with presentations such as thyroid nodules or cervical masses. Hematogenous spread is the most frequent metastatic route, followed by lymphatic spread and direct invasion. At the molecular level, alterations such as BRAF, KRAS, and EML4-ALK mutations and signaling pathway abnormalities are implicated. Diagnosis relies on imaging, fine-needle aspiration (FNA), and immunohistochemical markers. Thyroglobulin (Tg), thyroid transcription factor-1 (TTF-1), carbonic anhydrase Ⅸ (CAⅨ), Napsin A, PAX8, GATA3, and S-100 are valuable in differentiating primary from metastatic tumors. Treatment strategies depend on the type of primary tumor and the extent of metastasis. Surgery can improve local control and relieve compressive symptoms, while resection of isolated metastases combined with treatment of the primary lesion may prolong survival. Systemic therapies include chemotherapy, radiotherapy, targeted therapy, and immunotherapy, with some patients benefiting from molecularly guided regimens. Prognosis varies substantially with the primary tumor: patients with renal cell carcinoma have relatively better survival, whereas those with lung cancer, gastrointestinal malignancies, or melanoma exhibit poorer outcomes. Overall, the management of MTT requires a multidisciplinary approach integrating pathology and molecular testing to achieve individualized therapy and improved patient survival.
关键词
甲状腺转移癌 /
转移机制 /
影像学诊断 /
细针穿刺 /
免疫组化 /
外科治疗 /
全身治疗 /
预后
Key words
thyroid metastases /
metastatic mechanisms /
imaging diagnosis /
fine-needle aspiration /
immunohistochemistry /
surgical treatment /
systemic therapy /
prognosis
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