Abstract:The rate of adolescent obesity continues to increase,and metabolic and bariatric surgery(MBS)remains the most effective weight-loss option.While quality of life generally improves after surgery,adolescents'physiological and psychological immaturity limits their understanding of the risks of obesity and the details of MBS.Additionally,their developmental stage heightens the need for multivitamins and trace elements,making them more susceptible to nutritional challenges and psychosocial issues after surgery.A large body of evidence indicates that severely obese adolescents who undergo MBS,as well as those who receive lifestyle interventions,are at risk of impaired mental health,eating disorders,and reduced health-and weight-related quality of life.Except for active psychosis,suicidal ideation,or substance abuse,these baseline psychosocial impairments are not considered contraindications to MBS.Moreover,despite significant postoperative weight loss and improvements in comorbidities,preoperative mental health functioning is likely to remain unchanged or only temporarily improve after surgery.Greater attention must therefore be given to mental health and nutritional challenges following surgery.Managing postoperative eating disorders and ensuring long-term follow-up requires a collaborative,multidisciplinary approach involving parents.

Abstract:Objective To compare the short-term and long-term outcomes of modified Bacon surgery(MBS)and immediate coloanal anastomosis(ICA)with protective loop ileostomy in the treatment of low rectal cancer.Methods The clinical data of 631 low rectal cancer patients undergoing laparoscopic proctectomy at the Department of Colorectal Surgery,the First Affiliated Hospital of Zhengzhou University between January 2015 and January 2023 was analyzed retrospectively and divided into MBS group and ICA group.Propensity score matching(PSM)was performed in a 1∶1 ratio to balance baseline characteristics between the two groups.Post-matching comparisons were made with respect to the general information,operative-related indicators,postoperative complication rates and anal function.Kaplan-Meier survival curves were generated,and survival analysis was performed using the Log-rank test.Results 342 of 631 patients were successfully matched,including 171 cases in each group,respectively.After matching,no significant differences were observed in baseline characteristics between the two groups(all P＞0.05).Compared with the ICA group,the MBS group exhibited shorter first operation time(170.2±13.7 min vs.191.9±17.4 min,t=-12.821,P＜0.001)and second operation time(45.3±5.0 min vs.66.3±6.7 min,t=-32.693,P＜0.001),lower postoperative pain scores[3(2,3)vs.5(4,5)after the first surgery(Z=-1 1.663,P＜0.001)and 2(2,3)vs.5(4,5)after the second-stage surgery(Z=-14.334,P＜0.001)],lower intraoperative blood loss during the second surgery[10(10,15)mL vs.15(15,20)mL,Z=-11.495,P＜0.001],lower total surgical costs[(91 845±11 109)CNY vs.(110 838±8744)CNY,t=-17.568,P＜0.001],and a lower Clavien-Dindo grades of postoperative complications after the second surgery(Z=-2.193,P=0.028).However,no significant differences were found between the two groups in terms of blood loss during the first surgery,the incidence of postoperative complications after the first surgery,or anal function at 1 year postoperatively.Moreover,no significant differences were observed in the 3-year disease-free survival or overall survival between the two groups(x2=0.285 and 0.208,P=0.593 and 0.648,respectively).Conclusion Modified Bacon surgery is a safe,minimally invasive,economical,and effective surgical procedure,which provides a stoma-sparing alternative for patients expecting anal preservation with low rectal cancer.

Abstract:Objective To explore the key aspects in the diagnosis and treatment of the diffuse sclerosing variant of papillary thyroid carcinoma(DSVPTC).Methods A retrospective analysis was conducted based on 26 patients with DSVPTC treated at the Department of Thyroid Surgery,Jilin University China-Japan Union Hospital from January 2015 to September 2022.The study encompassed general patient information,ultrasound,fine-needle aspiration cytology,paraffin pathology results,and comprehensive postoperative treatment plans.Relevant literature was also reviewed.Results Among the 26 patients,the majority were females(21/26,80.8％),with an average age of 31.6 years.All patients underwent surgical treatment after preoperative diagnosis,among which 8 cases underwent total thyroidectomy with lymph node clearance(bilateral Ⅵ region,bilateral Ⅱ,Ⅲ,Ⅳ,Ⅴ regions),10 cases underwent total thyroidectomy with lymph node clearance(bilateral Ⅵ region,unilateral Ⅱ,Ⅲ,Ⅳ,Ⅴ regions),1 case underwent total thyroidectomy with lymph node clearance(bilateral Ⅵ region),3 cases underwent unilateral thyroid lobectomy and isthmus resection with lymph node clearance(bilateral Ⅵ region,unilateral Ⅱ,Ⅲ,Ⅳ,Ⅴ regions),and 4 cases underwent unilateral thyroid lobectomy and isthmus resection with lymph node clearance(bilateral Ⅵ region).Postoperative pathology revealed a significantly high rate of cervical lymph node metastasis in these cases(central region:92.3％;lateral neck region:76.9％),and 15 patients of them had concomitant Hashimoto's thyroiditis(57.7％).Additionally,4 patients were found to have concomitant classical papillary thyroid carcinoma(CPTC).Postoperatively,17 patients received iodine-131 treatment and all patients underwent endocrine suppression therapy.With regular follow-ups,the minimum follow-up time was 4 months and the maximum was 88 months.Two patients were lost to follow-up,and the median follow-up time was 19 months.There was no recurrence or metastasis during the follow-up period.Conclusion DSVPTC is more common in young females,characterized by a high rate of lymph node metastasis and complex and variable local imaging.Preoperative diagnosis should be made by combining multiple examinations.Treatment requires a more active and comprehensive strategy.

Abstract:Hepatobiliary surgery is undergoing a digital transformation guided by the principles of precision medicine.Artificial intelligence(AI)can be applied to predict postoperative complications,recurrence risk,and survival outcomes,thereby reshaping surgical planning and decision-making paradigms.Three-dimensional visualization and augmented reality technologies enable real-time navigation of anatomical structures,improving the precision and safety of complex surgical procedures.Big data analytics facilitate multicenter,long-term prognostic studies,providing evidence-based guidance for optimizing treatment strategies.Precision medicine integrates genomic features with anatomical factors to guide individualized determination of surgical extent and adjuvant therapy selection.Advances in xenogeneic liver transplantation have expanded the donor pool;however,the risks of cross-species infection and immune rejection require mitigation through gene-editing technologies and robust ethical oversight.Al-driven intraoperative navigation and robotic surgery challenge the traditional role of surgeons,while the"digital divide",insufficient data standardization,and lack of regulatory frameworks continue to hinder widespread implementation.Future research should rely on high-quality clinical trials to validate the efficacy of emerging technologies,establish standardized data-sharing frameworks across institutions,and,while promoting technological innovation,uphold the core humanistic values of surgery-including clinical judgment and patient safety-to ensure that digital transformation ultimately maximizes improvements in patient outcomes.

Abstract:Medullary thyroid carcinoma(MTC)is a distinct subtype of thyroid carcinoma with higher malignancy than differentiated thyroid carcinoma and regional lymph node metastasis can occur at an early stage.The incidence of superior mediastinal lymph node metastasis is reported to be 18.2％-27.5％.However,such metastases usually lack specific symptoms and are often overlooked due to obstruction by the sternum and clavicle,which limits the detection of lesions by routine ultrasound examination.Therefore,effective diagnostic and assessment modalities are of particular importance.Contrast-enhanced CT of the neck and chest can provide a reliable evaluation of superior mediastinal lymph node metastasis in MTC and its relationship with adjacent critical structures.The novel 68Ga-labeled CTR-FAPI positron emission tomography/computed tomography(68Ga-CTR-FAPI PET/CT)has shown promising diagnostic performance in detecting nodal and distant metastases of MTC.When superior mediastinal lymph node metastasis is present,standardized dissection of the superior mediastinum is currently the only potentially curative approach and has a direct impact on prognosis.Common surgical approaches include transcervical direct dissection,thoracotomy,transcervical endoscopic-assisted dissection,thoracoscopic dissection,and combined transcervical endoscopic-assisted thoracoscopic dissection.Endoscopic surgery offers the advantages of magnification,illumination and extended visualization,helping to overcome the limitations of open surgery imposed by the sternum and clavicle while avoiding the trauma of thoracotomy.For appropriately selected patients,transcervical endoscopic-assisted thoracoscopic or combined approaches can achieve standardized and minimally invasive superior mediastinal lymph node dissection with clinical value warranting further exploration and promotion.In addition,with the advent of novel targeted therapies,especially highly selective RET inhibitors such as pralsetinib and selpercatinib for RET mutations,new therapeutic opportunities have emerged for patients with MTC who were previously unsuitable for complete surgical resection.Preoperative neoadjuvant therapy guided by the patient's tumor mutation profile may yield favorable outcomes.

Abstract:Sporadic medullary thyroid carcinoma(MTC)accounts for approximately 75％～80％of all MTC cases and frequently presents with lymph node or distant metastases at an early stage,leading to considerable variability in prognosis.Genetic studies have shown that about 60％of cases harbor RET somatic mutations,with the RET M918T mutation being the most common,indicating strong tumor aggressiveness;RAS mutations are generally mutually exclusive with RET alterations.Serum calcitonin(Ctn)is the most sensitive and specific biomarker,and preoperative levels can predict the risk of lymph node metastasis.The doubling times of Ctn and carcinoembryonic antigen(CEA)serve as key prognostic indicators.Ultrasonography combined with CT or MRI enhances the detection of metastatic lesions,while 18F-fluorodeoxyglucose positron emission tomography/computed tomography(18F-FDG PET/CT)and 68Ga-somatostatin receptor imaging are valuable for recurrence surveillance.Surgery remains the cornerstone of treatment,with most guidelines recommending total thyroidectomy with central lymph node dissection.In carefully selected low-risk patients,unilateral lobectomy may be considered,while lateral neck dissection should be individualized.For advanced or unresectable cases,targeted therapy has become an important option,with RET inhibitors demonstrating superior efficacy.Prognostic evaluation should integrate genetic mutation status and dynamic changes in Ctn and CEA to guide individualized follow-up and treatment.In the future,precision medicine strategies based on molecular features are expected to improve survival outcomes and quality of life in patients with sporadic MTC.

Abstract:Minimizing intraoperative bleeding during liver resection is crucial for improving surgical safety and maintaining a clear operative field.Controlling central venous pressure(CVP)is a key measure.Traditional controlled low central venous pressure(CLCVP)techniques rely on anesthetic interventions,which are associated with management complexity and risks of organ injury.Inferior vena cava suspension and clamping(IVCSC)below the liver can physically reduce CVP,avoiding drug-related adverse effects,and is particularly suitable for high-risk patients such as those with cirrhosis or requiring extensive liver resection.However,its application in laparoscopic surgery is limited due to technical difficulties.To address this,Guangdong Provincial People's Hospital has optimized the IVCSC procedure.Specific improvements include establishing an operative plane between the hepatic entrance of the inferior vena cava and the right renal vein while avoiding major vascular branches;creating a suspension channel at the right posterior side of the inferior vena cava;using sutures and a gold-finger dissector to complete suspension;performing clamping along the suture direction with atraumatic clips for safe occlusion;and conducting the entire procedure under direct vision with vigilance for potential bleeding vessels.Following optimization,IVCSC was successfully performed in 103 patients,with the mean operative time shortened to less than 10 minutes and no complications observed.This method can be widely applied in laparoscopic,open,and robotic liver resections,aiming to enhance safety and achieve standardization and proceduralization.

Abstract:Locally advanced thyroid carcinoma(LATC)accounts for 5％-15％of thyroid cancers and often involves adjacent critical nerves,vessels,and organs,resulting in surgical challenges and poor prognosis.Histologic subtypes include papillary thyroid carcinoma,follicular carcinoma,oncocytic carcinoma,poorly differentiated thyroid carcinoma(PDTC),anaplastic thyroid carcinoma(ATC),and high-grade medullary thyroid carcinoma(MTC).At the molecular level,activation of driver genes such as BRAF,RAS,and RET,together with mutations in TP53 and the TERT promoter,is closely associated with the aggressive behavior of LATC.Neoadjuvant therapy has emerged as a novel strategy,aiming to downstage tumors preoperatively,increase resectability,improve functional preservation,and prolong survival.Multitarget tyrosine kinase inhibitors(mTKIs),such as anlotinib and lenvatinib,and highly selective targeted agents,such as RET inhibitors(selpercatinib and pralsetinib),have demonstrated high objective response rates(ORR)in LATC neoadjuvant therapy,with some cases achieving R0 resection.For ATC with BRAF V600E mutation,preoperative therapy with dabrafenib plus trametinib has significantly improved survival.In the field of immunotherapy,programmed death-1(PD-1)and programmed death-ligand 1(PD-L1)inhibitors,either as monotherapy or in combination with targeted therapy,have shown potential efficacy in ATC and PDTC.Although evidence of efficacy is accumulating,optimal timing and management of adverse effects remain to be clarified.Future multicenter clinical studies are needed to establish individualized neoadjuvant therapy systems based on molecular subtyping,thereby advancing LATC toward precision and standardized treatment.

Abstract:Poorly differentiated thyroid carcinoma(PDTC)is a rare pathological subtype of thyroid carcinoma whose morphological characteristics and biological behavior are intermediate between differentiated thyroid carcinoma and anaplastic carcinoma.PDTC is highly invasive,and is prone to recurrence and metastasis.Its diagnostic criteria are not yet unified,and the"Turin Criteria"are widely adopted internationally.Extrathyroidal invasion and distant metastasis are independent risk factors affecting the prognosis of PDTC.Currently,there is no consensus on the treatment strategies for PDTC.Surgery is the primary treatment modality for PDTC,while adjuvant therapies such as radioactive iodine therapy,external beam radiation therapy,and targeted therapy remain controversial.

Abstract:Objective To investigate the clinical value of the modified Overlap esophagojejunal angle-removing anastomosis in totally laparoscopic total gastrectomy.Methods The research group included 21 gastric cancer patients who underwent modified overlapping angle-removing anastomosis with total gastrectomy via laparoscopic surgery at the Department of Gastric and Colorectal Surgery,General Surgery Center,the First Hospital of Jilin University;Department of General Surgery,Liaoyuan People's Hospital;and Department of General Surgery Ⅱ,Liaoyuan Central Hospital between December 2024 and April 2025.The control group of 34 patients received conventional overlapping esophagal-jejunal anastomosis during the same period.The perioperative and short-term postoperative outcomes were compared between the two groups.Results Key steps of the modified Overlap esophagojejunal angle-removing anastomosis:The esophagus was transected horizontally with a linear cutter,an opening was made at the right angle of the esophageal stump,and an Overlap anastomosis was performed with the jejunum under the guidance of a gastric tube.The common anastomosis was closed in two steps using the linear cutter,while simultaneously removing the two weak angles of the esophageal stump.No statistically significant differences were observed in the general characteristics of the patients between the two groups(all P＞0.05).All patients successfully underwent the surgery without conversion to open laparotomy.During dietary follow-up,all patients in the study group resumed semi-liquid or regular diets within 1 month postoperatively and were able to consume regular diets by 3 months postoperatively.No statistically significant differences were found between the two groups in terms of intraoperative hemorrhage volume,postoperative hospital stay,or incidence of anastomotic leakage(all P＞0.05).Compared with the control group,the study group showed significantly shorter esophagojejunal anastomosis time[(27.8±3.7)min vs.(37.9±3.4)min,t=-9.519,P＜0.00 1]and operative time[(203.9±22.7)min vs.(215.1±14.5)min,t=-2.779,P=0.008],with statistically significant differences(all P＜0.05).Conclusion The modified Overlap esophagojejunal angle-removing anastomosis in totally laparoscopic total gastrectomy is operationally straightforward and preliminarily demonstrates safety and feasibility,warranting further validation.

Abstract:Objective To evaluate the diagnostic value of the Chinese Thyroid Imaging Reporting and Data System(C-TIRADS)combined with BRAF V600E mutation testing in differentiating benign and malignant Bethesda System for Reporting Thyroid Cytopathology(BSRTC)category Ⅲ nodules of different sizes.Methods A retrospective analysis was performed on the clinical data of 161 patients(161 nodules)diagnosed as BSRTC category Ⅲ by fine-needle aspiration(FNA)at The First Affiliated Hospital of Zhengzhou University between March 2020 and November 2023.According to the maximum diameter,patients were divided into a ≤10 mm group(n=125)and a＞10 mm group(n=36).Postoperative histopathology was used as the gold standard.Receiver operating characteristic(ROC)curves were plotted to compare the diagnostic performance of C-TIRADS,BRAF V600E testing,and their combination for BSRTC category Ⅲ nodules of different sizes.Results Postoperative pathology revealed 108 malignant and 53 benign nodules.In the ≤10 mm group,the sensitivity,specificity,and accuracy of C-TIRADS were 72.6％,86.7％,and 76.0％,respectively;those of BRAF V600E testing were 79.0％,100.0％,and 84.0％,respectively;and those of the combined method were 91.6％,86.7％,and 90.4％,respectively.Compared with C-TIRADS or BRAF V600E testing alone,the combined method significantly improved sensitivity(P＜0.001,P=0.002)and accuracy(P＜0.001,P＜0.001),and its diagnostic efficacy was superior to C-TIRADS alone(AUC:0.944 vs.0.796,P=0.003).In the＞10 mm group,the sensitivity,specificity,and accuracy of C-TIRADS were 84.6％,91.3％,and 88.9％,respectively;those of BRAF V600E testing were 61.5％,100.0％,and 86.1％,respectively;and those of the combined method were 84.6％,91.3％,and 88.9％,respectively.The diagnostic performance of the combined method showed no significant difference compared with C-TIRADS or BRAF V600E testing alone(P＞0.05).Conclusion C-TIRADS combined with BRAF V600E mutation testing provides better diagnostic efficacy for BSRTC category Ⅲ nodules with a maximum diameter of ≤10 mm and helps improve diagnostic accuracy in small BSRTC category Ⅲ nodules.

Abstract:Mixed thyroid malignancies are rare tumors characterized by the coexistence of two or more distinct histological types within the same thyroid gland.Common forms include papillary thyroid carcinoma(PTC)combined with medullary thyroid carcinoma(MTC),PTC combined with follicular thyroid carcinoma(FTC),MTC combined with FTC,and differentiated thyroid carcinoma(DTC)combined with anaplastic thyroid carcinoma(ATC).The components may display tightly interwoven,partially separated,or spatially independent patterns,leading to the formation of mixed tumors,composite tumors,or collision tumors.The underlying pathogenesis remains unclear,with major hypotheses including the incidental theory,microenvironmental alteration theory,and stem cell theory.Diagnosis relies on imaging studies,fine-needle aspiration or core needle biopsy combined with immunohistochemistry and genetic testing(e.g.,BRAF,RET mutations),with postoperative pathology serving as the diagnostic gold standard.Treatment strategies should be guided by the most aggressive component.Surgery is the primary modality and is often combined with radioactive iodine therapy,thyroid hormone suppression,targeted therapy,or immunotherapy.Tumors containing an MTC component require dynamic monitoring of serum calcitonin(Ctn)and carcinoembryonic antigen(CEA),whereas those with an ATC component often necessitate multimodal chemoradiotherapy and targeted therapy.Prognosis depends on the most malignant component:PTC-FTC subtypes generally have favorable outcomes,while those involving ATC or sarcomatous components are associated with extremely poor survival.Overall,mixed thyroid malignancies exhibit marked clinical heterogeneity,necessitating individualized management and long-term follow-up.

Abstract:Rare thyroid malignancies[including anaplastic thyroid carcinoma(ATC),medullary thyroid carcinoma(MTC),primary thyroid lymphoma(PTL),primary squamous cell carcinoma of thyroid(PSCCT),poorly differentiated thyroid carcinoma(PDTC),and primary thyroid sarcoma(PTS)]constitute less than 10％of all thyroid malignancies but account for over 50％of thyroid cancer-related deaths,posing a major clinical challenge.These malignancies are characterized by high aggressiveness,diagnostic difficulty,high rates of metastasis at initial presentation,limited treatment options,and poor prognosis.The key challenges in current management include diagnostic delays,inaccurate staging,and a lack of standardized treatment guidelines.Although the prognosis for many patients has improved in recent years with the advent of targeted drugs and innovations in surgical techniques and concepts,the overall survival rate has not shown significant improvement.To address the diagnosis and treatment of these patients,it is imperative to establish a surgeon-led multidisciplinary team(MDT)approach and a comprehensive standardized management system throughout the entire diagnosis and treatment process for rare thyroid malignancies.Future efforts should focus on conducting larger-scale,higher-quality clinical research to acquire a deeper understanding of the clinical characteristics of these diseases,investigate the response and resistance mechanisms of targeted therapies,and promote the development of highly selective kinase inhibitors and immunotherapeutic agents,thereby improving treatment outcomes for patients with rare thyroid malignancies.

Abstract:The whole-course management of medullary thyroid carcinoma(MTC)relies heavily on dynamic monitoring of serum calcitonin(Ctn)and carcinoembryonic antigen(CEA).During the diagnostic and therapeutic stages,a comprehensive strategy of"Ctn as the primary indicator,CEA as a complementary marker,with imaging and genetic testing as supplements"should be established,providing crucial evidence for determining the extent of surgery,assessing metastatic risk,and guiding individualized interventions.In postoperative follow-up,patients with a Ctn doubling time(DT)of less than 6 months have a 10-year survival rate of only approximately 25％,while a shortened CEA DT indicates an increased risk of visceral metastasis.The synergistic monitoring system of Ctn and CEA runs through the entire process of diagnosis,surgery,and prognostic management of MTC,and serves as a cornerstone for optimizing individualized therapeutic strategies.

Abstract:Anaplastic thyroid carcinoma(ATC)is a rare but highly aggressive thyroid malignancy with an extremely poor prognosis,and the median survival time is only 4-6 months.Traditional therapeutic modalities,including surgery,radiotherapy,and chemotherapy,provide limited overall efficacy.With advances in molecular biology,the genomic landscape of ATC has been gradually elucidated.Common alterations include BRAF V600E,TP53 mutations,TERT promoter mutations,and gene fusions involving NTRK,RET,and ALK,affecting signaling pathways such as RAS/RAF/MEK/ERK and PI3K/AKT/mTOR.Targeted therapies against specific alterations(e.g.,dabrafenib plus trametinib,larotrectinib,selpercatinib,pralsetinib)have markedly improved survival in selected patients.In the field of immunotherapy,programmed death-1(PD-1)and programmed death-ligand 1(PD-L1)inhibitors(e.g.,spartalizumab,pembrolizumab),administered alone or in combination with targeted therapy or radiotherapy,have shown promising efficacy.Combined immunotherapy and targeted therapy,such as the PD-L1 inhibitor atezolizumab with vemurafenib and cobimetinib,has significantly prolonged survival in patients harboring BRAF V600E mutations.Supportive care,including airway management,nutritional support,and management of adverse effects,remains essential.Multidisciplinary collaboration and individualized precision therapy are central to optimizing ATC management.Future research should focus on mechanisms of resistance and therapeutic strategies for patients without BRAF mutations.

Abstract:The overall prognosis of thyroid cancer is favorable.However,once it progresses to advanced disease,it becomes a major threat to patient survival.Diagnosis and treatment of advanced thyroid cancer involve complex,multidisciplinary and multimodal processes.In 2024,the European Society of Endocrine Surgeons(ESES)convened an expert panel to address issues related to the definition,preoperative management,and therapeutic strategies for advanced thyroid cancer,culminating in a consensus statement that reflects the heightened attention of European and North American experts to this entity.The consensus defines advanced thyroid cancer across three domains-local,regional,and distant metastatic disease-and explicitly includes anaplastic thyroid carcinoma(ATC)within the advanced category.It emphasizes comprehensive preoperative evaluation using multimodal imaging,endoscopy,and molecular testing,together with optimization of comorbidities and nutritional status.Multidisciplinary team(MDT)care is central to crafting individualized treatment plans.Therapeutic strategies are anchored in achieving the greatest possible curative-intent resection of the primary tumor and metastatic foci,integrated with targeted therapy,radiotherapy,and neoadjuvant therapy as appropriate.For differentiated thyroid carcinoma(DTC),medullary thyroid carcinoma(MTC),and ATC,surgery remains pivotal,with careful attention to balancing local control and quality of life.Molecular testing guides the rational use of targeted agents,including multikinase inhibitors(MKIs)and therapies directed at RET,BRAF,and NTRK alterations.Overall,the consensus provides a structured framework for defining and managing advanced thyroid cancer and underscores the roles of precision medicine and MDT care in improving survival and quality of life.

Abstract:Papillary thyroid carcinoma(PTC)is the most common thyroid malignancy,and a subset of subtypes exhibits moderate to high aggressiveness;accurate recognition is pivotal for prognostic assessment and individualized management.The fifth edition of the World Health Organization(WHO)classification emphasizes an integrated histologic-molecular diagnostic paradigm and,for the first time,explicitly designates high-risk histologic subtypes,including the tall cell subtype,hobnail subtype,and columnar cell subtype.Although the diffuse sclerosing subtype and the solid/trabecular subtype are categorized as intermediate risk,they likewise carry a considerable risk of metastasis.Distinct molecular profiles characterize these subtypes:the diffuse sclerosing subtype frequently harbors RET fusions;the tall cell subtype commonly shows BRAF V600E and TERT promoter mutations;and the hobnail subtype is closely associated with TP53 mutations.High-grade PTC,defined by tumor necrosis and a high mitotic rate,demonstrates biological behavior approaching that of poorly differentiated thyroid carcinoma.Standardized pathologic diagnosis requires adequate sampling in combination with immunohistochemistry and molecular testing to minimize misdiagnosis or underdiagnosis.Molecular subtyping further informs risk stratification and selection of targeted therapies.Overall,the diagnosis of rare PTC subtypes is transitioning from morphology alone to integrated molecular pathology,thereby laying the foundation for precision medicine and individualized treatment.

Abstract:Primary thyroid lymphoma(PTL)is a rare form of extranodal lymphoma of the thyroid,accounting for 1％-5％of thyroid malignancies.It occurs predominantly in middle-aged and elderly women,with more than 80％of cases associated with Hashimoto's thyroiditis.Patients typically present with a rapidly enlarging thyroid mass within a short period,often accompanied by compressive symptoms or B symptoms.Its clinical manifestations resemble those of anaplastic thyroid carcinoma or thyroiditis,leading to frequent misdiagnosis.Histologically,diffuse large B-cell lymphoma(DLBCL)is the most common subtype,followed by mucosa-associated lymphoid tissue(MALT)lymphoma,with significant differences in aggressiveness and prognosis between subtypes.Ultrasound-guided core needle biopsy combined with immunohistochemistry(e.g.,CD20,Ki-67)and fluorescence in situ hybridization(FISH)for MYC,BCL2,and BCL6 constitutes the diagnostic gold standard.Treatment strategies are based on pathological subtype and disease stage.DLBCL is usually managed with R-CHOP chemotherapy combined with radiotherapy,while localized MALT lymphoma confined to the thyroid may be cured with definitive radiotherapy.Surgery is mainly reserved for urgent airway management or diagnostically challenging cases.Prognostic assessment relies on the International Prognostic Index(IPI),serum lactate dehydrogenase(LDH)levels,and positron emission tomography-computed tomography(PET/CT).Advanced age,DLBCL subtype,high IPI score,and TP53 mutation are adverse prognostic factors.Overall,PTL is highly sensitive to radiotherapy and chemotherapy;early-stage MALT lymphoma has an excellent prognosis,whereas aggressive DLBCL carries a poorer outcome.Multidisciplinary collaboration is essential to improve therapeutic efficacy and enhance patient survival and quality of life.