基于72例病例的甲状腺内胸腺癌临床病理特征与治疗结局的系统回顾分析

Systematic Review and Analysis of Clinicopathological Characteristics and Treatment Outcomes in Intrathyroidal Thymic Carcinoma: A Study of 72 Cases

摘要: 背景：甲状腺内胸腺癌(Intrathyroidal thymic carcinoma, ITC)是一种罕见的甲状腺恶性肿瘤，因其临床表现隐匿，误诊率较高。手术切除是其主要治疗方式，但关于综合治疗的疗效研究尚不充分。方法：本研究通过系统回顾28篇中外个案报道，共整合72个病例，并对ITC的临床症状、病理特征、鉴别诊断、治疗方案及预后因素进行了统计分析。结果：多数ITC患者以颈部肿块就诊。单纯依靠细针穿刺细胞学检查易导致误诊，而镜下形态学特征与免疫组化标记物(如CD5、CD117)是鉴别诊断的关键。手术是ITC的主要根治手段，颈部淋巴结转移可能提示预后不良。目前，以放化疗为主的综合治疗模式在ITC中的应用证据有限。结论：ITC是甲状腺肿瘤中一种重要的病理类型，准确诊断是规范治疗的前提。本综述系统总结了现有病例的特征，但其综合治疗方案仍有待基于更高级别证据的前瞻性研究以形成共识。

Abstract: Background: Intrathyroidal thymic carcinoma (ITC) is a rare malignant tumor of the thyroid gland. Due to its clinically occult presentation, it is frequently misdiagnosed. Surgical resection remains the primary treatment, yet evidence regarding the efficacy of multimodal therapy is still limited. Methods: This study conducted a systematic review of 28 case reports from both domestic and international literature, integrating a total of 72 cases. Statistical analysis was performed on the clinical manifestations, pathological features, differential diagnosis, treatment strategies, and prognostic factors of ITC. Results: Most ITC patients presented with a neck mass. Diagnosis based solely on fine-needle aspiration cytology often leads to misdiagnosis. Histomorphological characteristics and immunohistochemical markers such as CD5 and CD117 are crucial for accurate differential diagnosis. Surgery serves as the main curative approach for ITC, and cervical lymph node metastasis may indicate a poor prognosis. Currently, evidence supporting the use of comprehensive treatment modalities, primarily radiotherapy and chemotherapy, remains scarce in ITC management. Conclusion: ITC represents a significant pathological subtype among thyroid tumors. Accurate diagnosis is essential for standardized management, and this review provides a systematic summary of the characteristics of reported cases. However, further high-quality prospective studies are needed to establish a consensus on optimal comprehensive treatment strategies.