甲状腺叶切除术中，组织胞浆菌病模拟恶性淋巴结病。
Histoplasmosis mimicking malignant adenopathy during diagnostic thyroid lobectomy.
机构信息
Section of Endocrine Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles.
Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles.
出版信息
JAMA Otolaryngol Head Neck Surg. 2014 Jul;140(7):664-6. doi: 10.1001/jamaoto.2014.806.
IMPORTANCE
Benign granulomatous disease may mimic malignant disease in the evaluation of mediastinal or pulmonary lesions. However, histoplasmosis as a cause of cervical lymphadenopathy is relatively rare. We report the first case of Histoplasma infection mimicking malignant adenopathy discovered during diagnostic thyroid lobectomy.
OBSERVATIONS
A 2.5-cm, calcified, right paratracheal lymph node intimately involving the recurrent laryngeal nerve was discovered during lobectomy for a follicular lesion of undetermined significance with a positive NRAS mutation. Although metastatic thyroid cancer was the most probable diagnosis, results of gross inspection of the bisected thyroid nodule suggested a benign process. Partial removal of the node, sparing the nerve, established the diagnosis of Histoplasma capsulatum infection.
CONCLUSIONS AND RELEVANCE
Histoplasmosis is a rare cause of cervical adenopathy that should be considered in cases in which a discordance arises between the malignant gross appearance of the adenopathy and the benign gross appearance of an associated thyroid nodule.
重要性
在评估纵隔或肺部病变时，良性肉芽肿性疾病可能模仿恶性疾病。然而，组织胞浆菌病作为颈淋巴结病的病因相对较少见。我们报告首例在诊断性甲状腺叶切除术中发现的表现为恶性淋巴结病的组织胞浆菌感染。
观察结果
在因意义未明的滤泡性病变行甲状腺叶切除术中，发现一个 2.5 厘米、钙化的右气管旁淋巴结，与喉返神经紧密相连，且 NRAS 突变呈阳性。尽管转移性甲状腺癌是最可能的诊断，但对半切甲状腺结节的大体检查结果提示为良性过程。保留神经的淋巴结部分切除确立了荚膜组织胞浆菌感染的诊断。
结论和相关性
组织胞浆菌病是颈淋巴结病的罕见病因，如果淋巴结病的恶性大体外观与相关甲状腺结节的良性大体外观之间出现不一致，应考虑该病。
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