Chen Huan-Wen, Tseng Fen-Yu, Su Deng-Huang, Chang Yih-Leong, Chang Tien-Chun
Department of Internal Medicine, Far Eastern Memorial Hospital and Far Eastern Polyclinic, Taiwan, ROC.
Acta Cytol. 2006 Mar-Apr;50(2):217-20. doi: 10.1159/000325936.
Papillary thyroid carcinoma (PTC) is often asymptomatic and rarely presents as a painful goiter. Further, the thyroid gland is not easily infected. Therefore, acute suppurative thyroiditis (AST) is unusual. PTC is also seldom combined with AST. We report a case of painful PTC with secondary infection after fine needle aspiration (FNA).
A 19-year-old girl complained of a painful goiter without skin change after an episode of upper airway infection. PTC was diagnosed according to the FNA cytology (FNAC) at another hospital. The goiter became more painful after FNA. The patient's second FNAC at our hospital revealed only many polymorphonuclear leukocytes (PMNs). Antibiotic treatment ameliorated the pain, but the goiter persisted. The third FNAC revealed some PMNs and papillary carcinomatous cells. After total thyroidectomy, pathology revealed ischemic necrosis with a focal PMN aggregation around the needle track and papillary carcinomatous cells nearby. According to the time sequence, secondary infection after FNA was suspected.
A painful goiter is an unusual presentation of PTC. Although FNAC is feasible for studying a thyroid lesion, malignant cells might be missed when secoandary injection and ischemic necrosis occur after FNA. Therefore, aseptic procedures are necessary to prevent bacteria from seeding into the thyroid.
甲状腺乳头状癌（PTC）通常无症状，很少表现为疼痛性甲状腺肿。此外，甲状腺不易感染。因此，急性化脓性甲状腺炎（AST）并不常见。PTC也很少合并AST。我们报告一例在细针穿刺（FNA）后发生继发感染的疼痛性PTC病例。
一名19岁女孩在上呼吸道感染后出现疼痛性甲状腺肿，但皮肤无变化。根据另一家医院的FNA细胞学检查（FNAC）诊断为PTC。FNA后甲状腺肿疼痛加剧。患者在我院的第二次FNAC仅显示大量多形核白细胞（PMN）。抗生素治疗缓解了疼痛，但甲状腺肿持续存在。第三次FNAC显示一些PMN和乳头状癌细胞。全甲状腺切除术后，病理显示缺血性坏死，针道周围有局灶性PMN聚集，附近有乳头状癌细胞。根据时间顺序，怀疑FNA后发生继发感染。
疼痛性甲状腺肿是PTC的一种不寻常表现。虽然FNAC对研究甲状腺病变可行，但FNA后发生继发感染和缺血性坏死时可能会漏诊恶性细胞。因此，必须采取无菌操作以防止细菌植入甲状腺。
