Institute of Clinical Medicine, National Cheng Kung University, College of Medicine, Tainan, Taiwan.
J Formos Med Assoc. 2013 Jun;112(6):358-62. doi: 10.1016/j.jfma.2012.07.020. Epub 2012 Oct 18.
Diffuse sclerosing papillary thyroid carcinoma (DSPTC) is a relatively rare variant of papillary thyroid carcinoma with distinct histological features, radiological characteristics, and biological aggressiveness. Compared with conventional papillary thyroid carcinoma, DSPTC is characterized by scattered microscopic tumor islands, diffuse fibrosis, calcification, and abundant lymphocytic aggregation. A preoperative diagnosis is challenging in the absence of nodules and scanty fine needle aspiration cytology samples. We describe a unique DSPTC patient, an 18-year-old woman who presented with a neck mass that grew slowly for 2 years. The palpable neck mass was nontender, well defined, firm, and unmovable. Laboratory studies showed normal thyroid function and positive autoimmune markers: antithyroglobulin antibody = 1:1600 and antimicrosomal antibody = 1:1600. A neck ultrasound showed diffusely prominent microcalcifications with one small vague nodule. Hashimoto's thyroiditis with an accompanying malignancy was suspected. Based on the result of intraoperative pathology reports, the patient was given a total thyroidectomy. Lymph node dissection and histological analysis revealed bilateral DSPTC in addition to lymphocytic thyroiditis in nonmalignant areas of the thyroid. Clinical and histological diagnostic challenges usually occur when DSPTC presents with a diffuse thyroid enlargement, dispersed microscopic tumor islands (frequently without mass formation), extensive fibrosis, and abundant lymphocytic infiltration mimicking thyroiditis.
弥漫硬化性乳头状甲状腺癌（DSPTC）是一种罕见的甲状腺乳头状癌变异型，具有独特的组织学特征、影像学特征和生物学侵袭性。与传统的甲状腺乳头状癌相比，DSPTC 的特征是散布的微小肿瘤岛、弥漫性纤维化、钙化和丰富的淋巴细胞聚集。在没有结节和稀少的细针抽吸细胞学样本的情况下，术前诊断具有挑战性。我们描述了一位独特的 DSPTC 患者，一名 18 岁女性，因颈部肿块缓慢生长 2 年来就诊。可触及的颈部肿块无触痛，边界清楚，质地坚硬，不可移动。实验室研究显示甲状腺功能正常，自身抗体阳性：抗甲状腺球蛋白抗体=1:1600，抗微粒体抗体=1:1600。颈部超声显示弥漫性明显微钙化，伴有一个小的模糊结节。疑诊桥本甲状腺炎伴癌。根据术中病理报告结果，患者行甲状腺全切除术。淋巴结清扫和组织学分析显示除了甲状腺非恶性区域的淋巴细胞性甲状腺炎外，还存在双侧 DSPTC。当 DSPTC 表现为弥漫性甲状腺肿大、散布的微小肿瘤岛（常无肿块形成）、广泛纤维化和丰富的淋巴细胞浸润，类似于甲状腺炎时，通常会出现临床和组织学诊断挑战。
