甲状腺髓样癌的子型及治疗.pptx

甲状腺髓样癌分子分型及治疗解放军第一一七医院戚晓平甲状腺髓样癌的子型及治疗第1页

概况Histologicsubtypesofthyroidcancer①Papillary:approximately80%ofallthyroidmalignancies;

②FollicularandHürthle:approximately11%;

③Medullary:lessthan5%-8%;

④Anaplastic:lessthan2%.

甲状腺髓样癌的子型及治疗第2页

IntroductionMedullarythyroidcancer(MTC)①SporadicMTC:approximately75%;50%somaticRETmutations(p.M918T)-predictapoorprognosis

②HereditaryMTC:approximately25%;98%GermlineRETmutations,MEN2A(~95%)andMEN2B(~5%)

Arisesfromtheneuralcrest-derived,calcitonin-secreting,parafollicularCcellsofthethyroidgland

甲状腺髓样癌的子型及治疗第3页

Introduction①SporadicMTC:asolitaryandunilateralorapalpablecervicallymphnode

②HereditaryMTC:multicentricandbilateraltheuppertomiddlepartsofthethyroidlobes

甲状腺髓样癌的子型及治疗第4页

IntroductionInvolvementofcervicallymphnodesisanearlyandcommonmanifestationintheclinicalcourseofthedisease,with35%to50%ormore,another10%to15%mayhavedistantmetastasesatthetimeofinitialpresentation;

DistantmetastaticspreadofMTCfrequentlyinvolvesthemediastinalnodes,lung,liver(90%),andbones.

甲状腺髓样癌的子型及治疗第5页

p.C611YMEN2A甲状腺髓样癌的子型及治疗第6页

MolecularAberrations(overexpression)

①RETmutations②VEGFR-2③MET④EGFR⑤FGFR⑥RAS(sMTC---56%KRAS+;12%HRAS)(MutationsinRASappeartobemutuallyexclusiveofRETabnormalities)

SomaticRETmutations甲状腺髓样癌的子型及治疗第7页

Molecularpathways①PI3K/Akt/mTOR②MAPK③JNK④RAS/ERKPlaycriticalrolesinregulatingcellproliferation,differentiation,motility,apoptosis,andsurvival

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DiagnosisandMonitoring①FNA,USandCT,MRIorECT(Ct500pg/mL);

②DNAanalysisfortheRETgermlinemutationATA-2015,ETA-,NCCN-Guidelinesrecommend③TheMTCspecimenis