Lymph node puncture with clear straw-yellow fluid

Introduction In the thyroid cancer examination, a thyroid mass or nodule can be found. The skilled palpation of the neck can provide useful diagnostic data. The hard and swallowing is difficult to fix when moving up and down. The lesion is ipsilateral and hard, such as lymph node puncture. Grass yellow clear liquid, mostly lymph node metastasis of thyroid metastasis. Thyroid carcinoma is the most common thyroid malignancy. It is a malignant tumor derived from thyroid epithelial cells. Most thyroid cancers originate from follicular epithelial cells and can be classified into papillary carcinoma according to pathological type (60%). Follicular adenocarcinoma (20%), but the prognosis is better; follicular adenocarcinoma tumors grow faster, moderately malignant, easy to pass blood transport; undifferentiated cancer has a poor prognosis, the average survival time is 3-6 month. Papillary carcinoma is more common in thyroid cancer.

Cause

The exact cause is still difficult to affirm, but the experimental study and clinical observation of thyroid cancer from epidemiological investigation may be related to the following factors.

(1) Radioactive injury: X-ray irradiation of the thyroid of the experimental mouse can promote thyroid cancer in the animal. Experiments have shown that radioactivity can change the metabolism of thyroid cells, and the synthesis of thyroxine is greatly reduced, and radiation can cause thyroid cells. Abnormal division leads to cancer; on the other hand, the destruction of the thyroid gland and the inability to produce endocrine hormones, and the massive secretion of thyroid stimulating hormone (TSH) can also promote thyroid cell carcinogenesis.

(2) Iodine and TSH: Excessive iodine or iodine deficiency can change the structure and function of the thyroid gland.

(3) Other thyroid diseases: clinical reports of thyroid adenocarcinoma, chronic thyroiditis, nodular goiter or some toxic goiter. However, the relationship between these thyroid diseases and thyroid cancer is still difficult to affirm, taking thyroid adenoma as an example. The vast majority of thyroid adenomas are follicular type, only 20% are papilloma; if thyroid cancer is transformed from adenoma, it is absolutely Most should be follicular, and in fact more than half of thyroid cancer is papillary, and the incidence of thyroid adenoma is estimated to be small.

(4) Genetic factors: About 30% of medullary thyroid carcinoma has a clear family history and often has pheochromocytoma, etc. It is speculated that the occurrence of such cancer may be related to chromosomal genetic factors.

an examination

Related inspection

Blood routine urine positron emission tomography (PET)

Thyroid mass grows faster, there are metastases, and there are obvious compression symptoms, hypothyroidism, thyroid scan cold nodules, or abnormal thyroid CT scan and MRI images. The final diagnosis should be based on pathological biopsy. Papillary thyroid carcinoma.

1. Diagnostic points:

When there is clinical thyroid enlargement, it should be combined with the age of the patient. The following manifestations should consider thyroid cancer.

(1) General information: Special attention should be paid to gender. Therefore, special attention should be paid to understanding the iodine intake of patients, especially if there is a history of long-term iodine deficiency.

(2) Medical history:

1 Current medical history: 50% of childhood thyroid nodules are malignant, and single male nodules in young men should also be alert to the possibility of malignancy. Pay special attention to the location of the mass or nodule, whether it will increase rapidly in a short period of time, whether it is accompanied by swallowing. Difficulties, whether accompanied by flushing of the face, the occurrence of tracheal compression caused by breathing difficulties, the possibility of malignancy is large.

Through the current medical history investigation, it is necessary to have an overall assessment of the patient's thyroid function status. It is necessary to know in detail whether there is an increase in food intake, and should also pay attention to the systemic symptoms (such as headache) with or without tumor metastasis.

2 Past history: Whether you have had a head or neck due to other diseases. Have you ever had thyroid disease, such as chronic lymphocytic thyroiditis.

3 Personal History: Whether there is an environmental history of exposure to nuclear radiation pollution. Whether the occupations involved have important radioactive sources and personal protection.

4 Family history: medullary carcinoma has a family genetic predisposition, and similar patients in the family can provide diagnostic clues.

(3) Physical examination: a thyroid mass or nodule can be found, and a skilled palpation of the neck can provide useful diagnostic data, which is fixed when the quality is hard or swallowed, and the lesion is fixed on the same side, such as lymph node puncture. Grass yellow clear liquid, mostly lymph node metastasis of thyroid metastasis.

Most of the thyroid cancers are single nodules. The nodules can be round or elliptical. Some nodules are irregular in shape, hard and have no obvious tenderness. They often adhere to the surrounding tissues and cause limited or fixed activity. Multiple nodules, And can have tenderness.

1 oppression and invasive signs: thyroid cancer can compress and invade surrounding tissues and organs when it is large, often have difficulty breathing, and may have corresponding clinical manifestations.

2 type of cancer syndrome: medullary thyroid carcinoma can have hyperthyroidism.

(4) Auxiliary examination: In clinical practice, benign or malignant tumors of the thyroid gland are characterized as "thyroid nodules", except for most "hot" nodules, other types of nodules or imaging findings "Unexpected nodules (accidental tumors)" should think of the possibility of thyroid tumors; some thyroid cancers can also secrete TH independently, so they can also be expressed as "hot nodules", so in fact, all thyroid nodules should be excluded first. Thyroid tumors (sometimes, thyroid cancer can only be diagnosed under the microscope), there are no or swollen lymph nodes around.

1 The lung or bone has a metastatic lesion of unknown origin;

2 serum calcitonin increased, greater than 600g / L.

Differential diagnosis

Tuberculous lymphadenitis has fever, sweating, fatigue, and increased blood sedimentation, which is more common in young adults. Often accompanied by tuberculosis, the lymph nodes are uneven in texture, some are lighter (cheese-like), some are hard (fibrosis or calcification), and adhere to each other, and adhere to the skin, so the activity is poor. This type of patient is tuberculin test and blood tuberculosis antibody positive.

Malignant lymphoma can also be seen in any age group, its lymphadenopathy is often painless, progressive swelling, from large soybeans to jujube, medium hardness. Generally, it has no adhesion to the skin, and does not fuse with each other in the first and middle stages. In the later stage, the lymph nodes can grow to a large size, and can also be fused into a large piece, the diameter of which is more than 20cm, invading the skin, and it will not heal after rupture. In addition, it can invade the mediastinum, liver, spleen and other organs, including the lungs, digestive tract, bones, skin, breast, nervous system and so on. The diagnosis requires a biopsy. Clinically, malignant lymphoma is often misdiagnosed, with superficial lymph node enlargement as the first manifestation, 70% to 80% of patients diagnosed with lymphadenitis or lymph node tuberculosis at the time of initial diagnosis, resulting in delay in treatment.

Giant lymph node hyperplasia

It is a rare disease that is easily misdiagnosed. Often manifested as unexplained lymphadenopathy, mainly invading the chest, with the most mediastinum, but also invading the hilar and lungs. Other affected sites include the neck, retroperitoneum, pelvis, armpits, and soft tissue. Often misdiagnosed as thymoma, plasma cell tumor, malignant lymphoma. Understanding the pathology and clinical manifestations of this disease is extremely important for early diagnosis.

Pseudo lymphoma

Tumors can often form in areas outside the lymph nodes, such as the eyelids, pseudo-lymphoma of the stomach, and lymphatic polyps of the digestive tract. It is generally considered to be a reactive hyperplasia caused by inflammation.

Lymph node metastasis

Lymph nodes are often hard and uneven in texture, and the primary lesion can be found. Very few systemic lymphadenopathy. Thyroid mass grows faster, there are metastases, and there are obvious compression symptoms, hypothyroidism, thyroid scans, cold nodules, or abnormal thyroid CT scans and MRI images. The final diagnosis should be based on pathological biopsy. Papillary thyroid carcinoma.

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