Tiroid Papiller Kanseri ile Kronik Lenfositik Tiroidit Birlikteliği

Yıl 2007, Cilt: 1 Sayı: 3, 151 - 154, 20.11.2007

Reyhan Ersoy

Öz

Tiroid kanseri ile lenfositik tiroidit arasındaki etiyolojik ilişki bir tartışma konusu olmaya devam etmektedir. Lenfositik tiroiditin neop-lazma sekonder olarak mı geliştiği ya da tiroiditin tiroid kanseri için predispozan mı olduğu konusu hala açıklığa kavuşmamıştır. Kronik lenfositik tiroiditli hastalarda, tiroid kanseri insidansı konusunda pek çok seride çok farklı sonuçlar bildirilmiştir. Bu birliktelikte immünolojik ve otoimmün mekanizmalann rolü olduğu öne sürülmektedir. Biz papiller tiroid kanserli (PTK) hasta grubumuzda kronik lenfositik tiroidit varlığını araştırmayı ve bu birlikteliğin görüldüğü hastaların tümör özelliklerini belirlemeyi amaçladık.

Ankara Atatürk Eğitim ve Araştırma Hastanesinde üç yıllık dönemde (2004-2007) medüller tiroid kanseri dışında, differansiye tiroid kanserleri nedeniyle operasyon uygulanmış olgu serimizi retrospektif olarak gözden geçirdik. Papiller tiroid kanseri nedeniyle öpere edilen 58 hasta, cerrahi öncesi ve sonrası klinik verileri, laboratuvar tesderi ve patolojik bulgulan ile değerlendirildi.

Elli sekiz hastanın 16’sında tiroid kanseri ile birlikte lenfositik tiroidit birlikte görülmekte idi. Bu on altı hastada saptanan toplam 17 tümörün histopatolojik incelemesinde; 15 tümörde PTK, 2 tümörde PTK-folliküler varyant saptandı. Tümör boyutları 11 tümörde <10mm, 6 tümörde >10 mm idi.

Çalışma grubumuzda PTK ve lenfositik tiroidit birlikteliğini %27.6 (58 hastada 16 olgu) olarak saptadık. Bu çalışmada olgu serimiz sunuldu ve ilgili literatür gözden geçirildi.

Abstract
The etiologic relationship between thyroid carcinoma and lymphocytic thyroiditis still remains a point of dispute, because it is unclear whether thyroiditis is induced secondarily by neoplasm. The incidence of thyroid carcinoma in chronic lymphocytic thyroiditis has been variously reported in many published series. The role of immunological and autoimmune mechanisms has been suggested about this topic. We aimed to evaluate the coexistent papillary thyroid carcinoma (PTC) with chronic lymphocytic thyroiditis, and described the tumor characteristics, in our patients with PTC.
We examined the relationship by retrospectively reviewing our series of patients treated for differentiated nonmedullary thyroid carcinoma at Ankara Ataturk Training and Research Hospital over a 3-year period (2004-2007). Fifty-eight patients with PTC undergoing surgery were examined. The clinical data, laboratory tests and pathologic findings performed before and after surgery were evaluated.
There were 16 patients of thyroid cancer associated with lymphocytic thyroiditis. Fifteen PTC and 2 FTC-follicular variant were determined in 17 tumors of 16 patients histopathologically. Tumor size were <10 mm in 11, and >10mm in 6 tumors.
We estimate the coexistence of PTC and lymphocytic thyroiditis in 27.6% (16 of 58) in our study group. In this study, we present our case series and also review the associated literature.

Anahtar Kelimeler

Hashimoto hastalığı, tiroid kanseri, prevalans

Kaynakça

• 1. Dailey ME, Lindsay S, Shaken R. Relation of thyroid neoplasms to Hashimoto’s disease of the thyroid gland. Arch Surg 1955;70:291-7.
• 2. Woolner LB, McConaley WM, Beahrs OH. Struma lym-phomatosa (Hashimoto’s thyroiditis) and releated thyroid disorders. J Clin Endocrinol Metab 1959;19:53-83.
• 3. Hirabayashi RN, Lindsay S. The relation of the thyroid carcinoma and cronic thyroiditis. Surg Gynecol Obstet 1965;121:243-52.
• 4. Crile Jr G. Struma lymphomatosa and carcinoma of the thyroid. Gynecol Obstet Invest 1978;147:350-2.
• 5. Segal K, Ben-Bassat M, Avraham A, Har-El G, Sidi J. Hashimoto’s thyroiditis and carcinoma of the thyroid gland. Int Surg 1985;70:205-9.
• 6. DeGroot LJ, Kaplan EL, McCormick M, Straus FH. Natural history, treatment, and course of papillary thyroid carcinoma. J Clin Endocrinol Metab 1990;71:414-24.
• 7. Matsubayashi S, Kawai K, Matsumoto Y. The correlation between papillary thyroid carcinoma and lymphocytic infiltration in the thyroid gland. J Clin Endocrinol Metab 1995;80:3421-4.
• 8. Kashima K, Yokoyama S, Noguchi S. Chronic thyroiditis as a favorable prognostic factor in papillary thyroid carcinoma. Thyroid 1998;8:197-202.
• 9. Loh KC, Greenspan FS, Dong F, Miller TR, Yeo PPB. Influence of lymphocytic thyroiditis on the prognostic outcome of patients with papillary thyroid carcinoma. J Clin Endocrinol Metab 1999;84:45 8-63.
• 10. Tamimi DM. The association between chronic lymphocytic thyroiditis and thyroid tumors. Int Surg Pathol 2002; 10: 141-6.
• 11. Pisanu A, Piu S, Cois A, Uccheddu A. Coexisting Hashimoto’s thyroiditis with differentiated thyroid cancer and benign thyroid diseases: indications for thyroidectomy. Chir Itai 2003;55:365-72.
• 12. Intidhar LS, Chhbouni AM, Kraiem T, Attia N, Gritli S, El May A, Ben Slimane F. Thyroid carcinoma and Hashimoto’s thyroiditis. Ann Otolaryngol Chir Cervicofac 2006;123:175-8.
• 13. AACE/AME Task Force on Thyroid Nodules, American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the diagnosis and management of thyroid nodules. Endocr Pract 2006, 12: 65-102.
• 14. Erdoğan G, Erdoğan MF, Emral R. Iodine status and goiter prevalence in Turkey before mandatory iodization. J Endocrinol Invest 2002;25:224-8.
• 15. Okayasu I. The relationship of lymphocytic thyroiditis to the development of thyroid carcinoma. Endocr Pathol 1997;8: 225-30.
• 16. Ott RA, Calandra DB, McCall AR, Shah KH, Lawrence AM, Paloyan E. The incidence of thyroid carcinoma in patients with Hashimoto’s thyroiditis and solitary cold nodules. Surgery 1985;98:1202-6.
• 17. Ott RA, McCall AR, McHenry C. The incidence of thyroid carcinoma in Hashimoto’s thyroiditis. Am Surg 1987;53:442-5.
• 18. Okayasu I, Fujiwara M, Hara Y, Tanaka Y, Rose NR. Association of chronic lymphocytic thyroiditis and thyroid papillary carcinoma. Cancer 1995;76:2312-8.
• 19. Kamma H, Fujii K, Ogata T. Lymphocytic thyroiditis in juvenile thyroid carcinoma. Cancer 1988;62:1988-93.
• 20. Selzer G, Kahn LB, Albertyn L. Primary malignant tumor of the thyroid gland: a clinicopathologic study of 254 cases. Cancer 1977;40:1501-10.
• 21. Bagnasco M, Venuti D, Paolieri F, Torre G, Ferrini S, Can-onica GW. Phenotypic and functional analysis at the clonal level of infiltrating T lymphocytes in papillary carcinoma of the thyroid: prevalance of cytotoxic T cells with natural killer-like or lymphokine-activated killer activity’. J Clin Endocrinol Metab 1989;69:832-6.