甲状腺嗜酸细胞癌诊治策略

doi:10.19538/j.cjps.issn1005-2208.2025.09.19

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (09) : 1062-1065. DOI: 10.19538/j.cjps.issn1005-2208.2025.09.19

讲座

甲状腺嗜酸细胞癌诊治策略

王源源1，傅星淏1，吴国洋2

作者信息 +

文章历史 +

摘要

甲状腺嗜酸细胞癌（OCA）是一种罕见的甲状腺恶性肿瘤，起源于甲状腺滤泡细胞，其特征为胞质内含大量嗜酸性颗粒。该肿瘤具有高度侵袭性和较高复发风险，临床诊治面临挑战。研究结果表明，线粒体DNA突变及MAP激酶通路（RAS/RAF/MEK/ERK）异常在OCA的发生发展中具有重要作用，同时PI3K/AKT/mTOR通路的激活亦与侵袭性和耐药性相关。诊断主要依赖细针穿刺细胞学检查（FNA），但由于Hürthle细胞多样性限制了其准确性，结合分子标记物检测及影像学检查可提高诊断可靠性。手术切除仍为首选治疗方式，尤其在肿瘤直径大或存在淋巴结转移时需行全甲状腺切除；放射性碘治疗（RAI）因摄取率低而疗效有限。近年来，多激酶抑制剂（MKI）及免疫检查点抑制剂在晚期或复发病例中显示出一定疗效。预后与肿瘤大小、淋巴结转移及血管侵犯密切相关，需长期随访，监测血清甲状腺球蛋白及影像学变化。多学科联合诊疗（MDT）模式有助于优化个体化治疗方案。整体而言，OCA的诊治正向精准化与综合化发展，分子机制研究和新兴靶向治疗为改善病人生存率和生活质量提供了新的可能。

Abstract

Oncocytic carcinoma of the thyroid (OCA) is a rare malignant tumor arising from thyroid follicular cells, characterized by cytoplasm enriched with abundant eosinophilic granules. It exhibits highly aggressive behavior and a high risk of recurrence, posing major challenges in clinical management. Research has demonstrated that mitochondrial DNA mutations and alterations in the MAPK pathway (RAS/RAF/MEK/ERK) are critically involved in tumorigenesis, while activation of the PI3K/AKT/mTOR pathway contributes to invasiveness and therapeutic resistance. Diagnosis primarily relies on fine-needle aspiration (FNA), but the heterogeneity of Hürthle cells limits its accuracy. The integration of molecular marker detection and imaging modalities can improve diagnostic reliability. Surgical resection remains the cornerstone of treatment, with total thyroidectomy recommended in cases of large tumors or lymph node metastasis. The efficacy of radioactive iodine (RAI) therapy is limited due to poor iodine uptake. In recent years, multikinase inhibitors (MKIs) and immune checkpoint inhibitors have shown therapeutic potential in advanced or recurrent cases. Prognosis is closely correlated with tumor size, lymph node involvement, and vascular invasion, necessitating long-term surveillance with serum thyroglobulin measurement and imaging follow-up. Multidisciplinary team (MDT) management plays an essential role in optimizing individualized treatment strategies. Overall, diagnostic and therapeutic approaches for OCA are advancing toward precision and integration, with molecular studies and emerging targeted therapies offering new opportunities to improve survival and quality of life.

导出引用

王源源1, 傅星淏1, 吴国洋2. 甲状腺嗜酸细胞癌诊治策略[J]. 中国实用外科杂志. 2025, 45(09): 1062-1065 https://doi.org/10.19538/j.cjps.issn1005-2208.2025.09.19

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