甲状腺内胸腺癌诊治策略

doi:10.19538/j.cjps.issn1005-2208.2025.09.20

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (09) : 1066-1070. DOI: 10.19538/j.cjps.issn1005-2208.2025.09.20

讲座

甲状腺内胸腺癌诊治策略

王波，王思思，黄文煜，林炫，何绍峰，赵文新

作者信息 +

文章历史 +

摘要

甲状腺内胸腺癌（ITTC）是一种极罕见的源于甲状腺内异位胸腺组织的恶性肿瘤，组织学特征与胸腺上皮性肿瘤相似。该病多见于中老年人，临床表现以颈部无痛性肿块为主，影像学缺乏特异性，易误诊为原发性甲状腺鳞状细胞癌或未分化癌。确诊依赖病理学及免疫表型，CD5、CD117、p63/p40阳性而甲状腺球蛋白（Tg）、甲状腺转录因子-1（TTF-1）阴性具有重要鉴别价值。Ki-67指数联合坏死范围和有丝分裂活跃度可用于风险评估。治疗以R0切除为核心，常规推荐中央区淋巴结清扫，外侧颈淋巴结清扫仅在证实转移或高危因素存在时可考虑实施。对于高危病人，术后放疗可能提高局部控制率。复发或进展病例中，程序性死亡受体-1（PD-1）/程序性死亡配体-1（PD-L1）抑制剂在高表达人群中显示潜在疗效，靶向治疗仍处于探索阶段。总体而言，ITTC的精准管理需整合形态学、免疫组化与分子学资料，结合多学科综合治疗协作组（MDT）制定个体化方案。未来应依托多中心前瞻性研究，以明确放疗、免疫与靶向治疗的最佳适应证，并验证分子分型及动态监测的临床价值。

Abstract

Intrathyroid thymic carcinoma (ITTC) is an extremely rare malignant tumor arising from ectopic thymic tissue within the thyroid, with histological features resembling thymic epithelial tumors. It predominantly affects middle-aged and elderly individuals and typically presents as a painless cervical mass. Imaging lacks specificity, and ITTC is often misdiagnosed as primary thyroid squamous cell carcinoma or anaplastic carcinoma. Definitive diagnosis relies on pathology and immunophenotyping; positivity for CD5, CD117, and p63/p40, along with negativity for thyroglobulin (Tg) and thyroid transcription factor-1 (TTF-1), provides critical diagnostic value. The Ki-67 index, combined with the extent of necrosis and mitotic activity, can be used for risk assessment. Surgical resection with R0 margins remains the cornerstone of treatment, with routine central lymph node dissection recommended, while lateral neck dissection is reserved for cases with confirmed metastasis or high-risk factors. Postoperative radiotherapy may improve local control in high-risk patients. In recurrent or progressive cases, programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitors have shown potential efficacy in patients with high expression, and targeted therapies are under investigation. Overall, the precise management of ITTC requires integration of morphology, immunohistochemistry, and molecular data, with individualized treatment planning formulated by a multidisciplinary team (MDT). Future multicenter prospective studies are needed to clarify the optimal indications for radiotherapy, immunotherapy, and targeted therapy, and to validate the clinical value of molecular subtyping and dynamic monitoring.

导出引用

王波, 王思思, 黄文煜, 林炫, 何绍峰, 赵文新. 甲状腺内胸腺癌诊治策略[J]. 中国实用外科杂志. 2025, 45(09): 1066-1070 https://doi.org/10.19538/j.cjps.issn1005-2208.2025.09.20

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