Thyroid Head and Neck Cancer Foundation, New York, New York, USA.
Thyroid. 2013 Jan;23(1):79-83. doi: 10.1089/thy.2012.0192.
Thyroid carcinoma with tracheal invasion is uncommon; however, this is significantly more prevalent than primary tracheal tumors. Rare tracheal tumors at the level of the thyroid can be misinterpreted as invasive thyroid cancer upon initial diagnosis. We present a series of tumors within the tracheal wall that were initially misdiagnosed as isolated, but aggressive, thyroid cancer, and later diagnosed to be different histopathologic entities.
The series consisted of four women and five men, all but two age 60 or older, who were initially diagnosed with tracheal invasion from differentiated thyroid carcinoma (DTC). Eight had obstructive airway symptoms and one experienced gagging and choking sensations. Preoperatively, the patients underwent fine-needle aspiration (FNA) and imaging studies. A complete resection of the involved airway in combination with the thyroid gland was performed in all patients.
In this series of patients, the final diagnosis was tracheal stenosis, recurrent laryngeal nerve schwannoma, papillary thyroid carcinoma (PTC) with benign intratracheal thyroid tissue, adenoid cystic carcinoma, and squamous cell carcinoma, each in one patient. Two patients had a tracheal chondrosarcoma, and two patients had collision tumors (PTC with laryngeal squamous cell carcinoma). All patients were misunderstood preoperatively as having isolated DTC with aggressive involvement of the trachea. An accurate diagnosis in these cases was difficult due to misleading FNA readings, thought due to the FNA needle passing through the thyroid before reaching the trachea or a tumor that abuts both structures on imaging. Primary tracheal tumors and a nontumorous lesion, as well as benign thyroidal masses, mimicked invasive thyroid carcinoma in this preoperative setting.
Various entities other than thyroid cancer can masquerade as invasive thyroid cancer. In patients with an FNA showing thyroid tissue or suggesting PTC, but also have obstructive or other airway symptoms, physician awareness is needed to consider the distinct possibility of a primary tracheal lesion. Obtaining the correct preoperative diagnosis is essential for accurate surgical planning for patients with tracheal tumors.
甲状腺癌侵犯气管并不常见；然而，这种情况比原发性气管肿瘤更为常见。罕见的甲状腺水平的气管肿瘤在初始诊断时可能被误诊为侵袭性甲状腺癌。我们报告了一系列最初误诊为孤立但侵袭性甲状腺癌的气管壁肿瘤，后来被诊断为不同的组织病理学实体。
该系列包括 4 名女性和 5 名男性，除了 2 名年龄在 60 岁或以上，其余均被最初诊断为分化型甲状腺癌（DTC）侵犯气管。8 例有气道阻塞症状，1 例有呛咳和窒息感。术前，患者接受了细针穿刺（FNA）和影像学检查。所有患者均行受累气道与甲状腺的完全切除术。
在这一系列患者中，最终诊断为气管狭窄、喉返神经神经鞘瘤、伴有良性气管内甲状腺组织的甲状腺乳头状癌（PTC）、腺样囊性癌和鳞状细胞癌，各 1 例。2 例患者有气管软骨肉瘤，2 例患者有碰撞瘤（PTC 伴喉鳞状细胞癌）。所有患者术前均被误诊为孤立性 DTC 伴气管侵袭性生长。由于误导性的 FNA 读数，这些病例的准确诊断很困难，认为是由于 FNA 针在到达气管之前穿过了甲状腺，或者是一个肿瘤同时累及这两个结构。在这种术前情况下，原发性气管肿瘤和非肿瘤性病变以及良性甲状腺肿块均类似于侵袭性甲状腺癌。
除甲状腺癌以外的各种实体瘤均可伪装为侵袭性甲状腺癌。对于 FNA 显示甲状腺组织或提示 PTC，但也有气道阻塞或其他症状的患者，医生需要注意考虑原发性气管病变的可能性。获得正确的术前诊断对于气管肿瘤患者的准确手术计划至关重要。
