Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.
Department of Pathology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.
Front Endocrinol (Lausanne). 2020 Apr 22;11:235. doi: 10.3389/fendo.2020.00235. eCollection 2020.
Subcutaneous soft tissue metastasis of follicular thyroid carcinoma (FTC) is rarely diagnosed before surgery for clinicians. We present a case of a 67-year-old man with a history of FTC and papillary thyroid microcarcinoma for 5 years. Multiple protruding subcutaneous nodules of the neck were found and removed from the surface of the sternocleidomastoid muscle. Ultrasound, computed tomography and technetium-99 m pertechnetate single-photon emission computed tomography of the neck were performed before the operation, which unfortunately indicated suspicious malignant lesions. Serum Tg was > 300 ng/ml (0.83-68.0 ng/ml), TSH was 36.580 uIU/ml (0.380-4.340 uIU/ml) and AbTg was negative. The pathologic diagnosis was metastatic FTC, invading the surrounding striated muscle, adipose tissue and vessels. Immunohistochemical staining revealed the tumor cells to be positive for thyroglobulin and TTF-1. The specimens of these nodules were further investigated for TERT promoter mutation and the result revealed mutated type (position g 1,295, 228 C>T). Preoperative diagnosis and prognostic prediction of metastatic FTC may be available through a combination of clinical, multimodal imaging and molecular genetic test (viz. multidisciplinary diagnosis). A long-term standardized follow-up is required for patients with a previous diagnosis of FTC.
甲状腺滤泡癌（FTC）的皮下软组织转移在术前很少被临床医生诊断。我们报告了一例 67 岁男性，有 FTC 和甲状腺乳头状微小癌病史 5 年。发现颈前表面有多个突出的皮下结节，并从胸锁乳突肌表面切除。术前进行了颈部超声、计算机断层扫描和锝-99m 过锝酸盐单光子发射计算机断层扫描，遗憾的是这些检查均提示疑似恶性病变。血清 Tg ＞300ng/ml（0.83-68.0ng/ml），TSH 为 36.580uIU/ml（0.380-4.340uIU/ml），AbTg 阴性。病理诊断为转移性 FTC，侵犯周围横纹肌、脂肪组织和血管。免疫组化染色显示肿瘤细胞对甲状腺球蛋白和 TTF-1 呈阳性。进一步对这些结节的标本进行 TERT 启动子突变检测，结果显示为突变型（位置 g1,295,228C>T）。通过临床、多模态影像学和分子遗传学检测（即多学科诊断）的联合，可能有助于术前诊断转移性 FTC 并进行预后预测。对于之前诊断为 FTC 的患者，需要进行长期的标准化随访。
