Siddaraju Neelaiah, Viswanathan Vinod Kumar, Saka Vinod Kumar, Basu Debdatta, Shanmugham Chandrakumar
Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
Acta Cytol. 2007 Nov-Dec;51(6):911-5. doi: 10.1159/000325869.
Malignant pleural effusion in association with mesothelioma, bronchogenic carcinoma and breast carcinoma is common, although less frequently reported with other malignancies. We report a follicular variant of papillary thyroid carcinoma (FVPTC), diagnosed on fine needle aspiration cytology (FNAC) of thyroid and lymph nodes and subsequently proved to have metastasized to the pleural cavity.
A 46-year-old man presented with history of breathlessness, thyroid swelling, pleural effusion and bilateral cervical lymphadenopathy. FNAC of the thyroid swelling and the lymph nodes showed features of FVPTC with cervical lymph node metastasis. Pleural fluid examination led to suspicion of pleural involvement by metastatic deposit, confirmed by subsequent pleural biopsy.
Thyroid malignancies presenting with pleural effusion are rare. In this case, although pleural fluid cytology suggested involvement of pleura, a definitive diagnosis could be rendered only on pleural biopsy. An ancillary aid, such as immunocytochemistry, could have helped establish pleural involvement on routine pleural fluid cytology alone. This case emphasizes the possible existence of rare cases of FVPTC that may be associated with a dismal prognosis. In our case, initial diagnosis of FVPTC could be made only on correlating FNA features of thyroid aspirate with those of lymph node aspirate.
恶性胸膜腔积液与间皮瘤、支气管源性癌和乳腺癌相关较为常见，尽管与其他恶性肿瘤相关的报道较少。我们报告一例甲状腺乳头状癌滤泡型（FVPTC），通过甲状腺及淋巴结细针穿刺细胞学检查（FNAC）诊断，随后证实已转移至胸膜腔。
一名46岁男性，有呼吸急促、甲状腺肿大、胸腔积液和双侧颈部淋巴结病病史。甲状腺肿大及淋巴结的FNAC显示为FVPTC伴颈部淋巴结转移。胸腔积液检查怀疑有转移灶累及胸膜，随后的胸膜活检得以证实。
以胸腔积液为表现的甲状腺恶性肿瘤较为罕见。在本病例中，尽管胸腔积液细胞学提示胸膜受累，但只有通过胸膜活检才能做出明确诊断。辅助手段，如免疫细胞化学，可能有助于仅通过常规胸腔积液细胞学检查确定胸膜受累情况。本病例强调了可能存在罕见的FVPTC病例，其预后可能较差。在我们的病例中，只有将甲状腺穿刺物的FNA特征与淋巴结穿刺物的特征相关联，才能做出FVPTC的初步诊断。
