Vukasović Anamarija, Kuna Sanja Kusacić, Ostović Karmen Trutin, Prgomet Drago, Banek Tomislav
Department of Nuclear Medicine, Dubrava University Hospital, Zagreb, Croatia.
Coll Antropol. 2012 Nov;36 Suppl 2:219-21.
The aim of report is to present a case of a rare diffuse sclerosing variant of a papillary thyroid carcinoma. A 15-year old girl referred for ultrasound examination because of painless thyroid swelling lasting 10 days before. An ultrasound of the neck showed diffusely changed thyroid parenchyma, without nodes, looking as lymphocytic thyroiditis Hashimoto at first, but with snow-storm appearance, predominantly in the right lobe. Positive thyroid peroxidase antibodies (TPO-AT) also suggested Hashimoto thyroiditis. Repeated US-FNAB (fine needle-aspiration biopsy) of the right lobe revealed diffuse sclerosing variant of papillary thyroid carcinoma and patient underwent total thyreoidectomy. Patohistologic finding confirmed diffuse sclerosing variant of a papillary thyroid carcinoma in the both thyroid lobes and several metastatic lymph nodes. Two months later patient recived radioablative therapy with 3700 MBq (100 mCi) of 1-131 followed by levothyroxine replacement. At the moment, patient is without evidence of local or distant metastases and next regular control is scheduled in 6 months. In conclusion, a diffuse sclerosing variant is rare form of papillary thyroid carcinoma that echographically looks similar to Hashimoto thyroiditis and sometimes could be easily overlooked.
本报告旨在呈现一例罕见的弥漫性硬化型乳头状甲状腺癌病例。一名15岁女孩因无痛性甲状腺肿大前来接受超声检查，该症状持续了10天。颈部超声显示甲状腺实质弥漫性改变，无结节，起初看起来像桥本淋巴细胞性甲状腺炎，但呈现暴风雪样外观，主要位于右叶。甲状腺过氧化物酶抗体（TPO-AT）阳性也提示桥本甲状腺炎。对右叶进行重复超声引导下细针穿刺活检（US-FNAB），结果显示为弥漫性硬化型乳头状甲状腺癌，患者随后接受了甲状腺全切术。病理检查结果证实双侧甲状腺叶及多个转移性淋巴结均为弥漫性硬化型乳头状甲状腺癌。两个月后，患者接受了3700MBq（100mCi）的1-131放射性消融治疗，随后进行左甲状腺素替代治疗。目前，患者无局部或远处转移迹象，下一次定期复查安排在6个月后。总之，弥漫性硬化型是乳头状甲状腺癌的一种罕见形式，在超声检查中与桥本甲状腺炎相似，有时容易被忽视。
