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目的:提高临床医生对以癌胚抗原(CEA)升高为首发表现的甲状腺髓样癌(MTC)的认识,探讨诊治方法。方法:回顾分析2例以CEA升高为首发表现的MTC患者的临床资料,并复习文献对该病的临床表现、诊断、治疗进行讨论。结果:2例患者均行甲状腺患侧叶全切除,术中冷冻病理检查证实为MTC,再行对侧叶全切除,并双侧Ⅵ区淋巴结清扫冷冻病理检查,发现淋巴结均无转移而结束手术。手术2个月内CEA恢复正常,随访3～24个月,无肿瘤复发及转移。结论:以CEA升高为首发表现的MTC临床罕见,临床鉴别CEA升高疾病时应考虑到MTC的可能,治疗的基本术式为全甲状腺切除加双侧Ⅵ区淋巴结清扫。
Objective: To improve clinicians’ understanding of medullary thyroid carcinoma (MTC) with the appearance of carcinoembryonic antigen (CEA) as the first manifestation, and to explore the methods of diagnosis and treatment. Methods: The clinical data of 2 patients with MTC who presented with CEA elevation were retrospectively reviewed. The clinical manifestations, diagnosis and treatment of the disease were reviewed. Results: Two patients underwent total resection of the lateral lobes of the thyroid gland. The intraoperative frozen pathology was confirmed as MTC, and the resection of the lateral lobes was performed. The bilateral Ⅵ lymph nodes were dissected and frozen for pathological examination, and no lymph node metastasis was found . The CEA returned to normal within 2 months of operation, followed up for 3 to 24 months without tumor recurrence and metastasis. CONCLUSION: MTC with CEA as the first episode is rare in clinical practice. It is necessary to consider the possibility of MTC in clinical diagnosis of elevated CEA. The basic surgical treatment is total thyroidectomy plus bilateral Ⅵ lymph node dissection.