Kusunoki Takeshi, Homma Hirotomo, Kidokoro Yoshinobu, Yoshikawa Akihisa, Tanaka Kumiko, Kubo Satoko, Wada Ryo, Ikeda Katsuhisa
Department of Otorhinolaryngology, Juntendo University of Medicine, Shizuoka Hospital, Shizuoka.
Department of Pathology, Juntendo University of Medicine, Shizuoka Hospital, Shizuoka.
Clin Pract. 2020 Oct 16;10(4):1276. doi: 10.4081/cp.2020.1276. eCollection 2020 Oct 15.
We experienced a case of huge chronic thyroiditis with malignant lymphoma that caused dyspnea with tracheal stenosis, dysphagia with esophagus stenosis and recurrent nerve paralysis. In this case, thyroidectomy was performed and, after the surgery, there was no sign of breathing or swallowing difficulties, and it was confirmed by the postoperative computed tomography that the tracheal stenosis had improved. We considered two possible explanations for the preoperative right recurrent nerve paralysis. In the first, the right recurrent nerve could have suffered from mechanical stimulation such as compression and traction to the recurrent nerve due to enlargement of the malignant lymphoma together with chronic thyroiditis. The second possible explanation was that malignant cells had invaded neurons. We could not distinguish between the two possibilities, since this right recurrent nerve was spared and could not be examined histopathologically.
我们遇到了一例巨大慢性甲状腺炎合并恶性淋巴瘤的病例，该病例导致气管狭窄引起呼吸困难、食管狭窄导致吞咽困难以及喉返神经麻痹。在该病例中，实施了甲状腺切除术，术后未出现呼吸或吞咽困难的迹象，术后计算机断层扫描证实气管狭窄已改善。对于术前右侧喉返神经麻痹，我们考虑了两种可能的解释。第一种是右侧喉返神经可能受到机械性刺激，例如由于恶性淋巴瘤与慢性甲状腺炎共同肿大对喉返神经造成压迫和牵拉。第二种可能的解释是恶性细胞侵犯了神经元。由于右侧喉返神经得以保留且无法进行组织病理学检查，我们无法区分这两种可能性。
