Klonaris D, Kefalogianni T, Karakostas E, Mastorakis G, Lagoudianakis G
Department of Otorhinolaryngology - Head and Neck Surgery, General Hospital of Heraklion "Venizeleio-Pananeio", Heraklion, Crete, Greece.
Department of Oral and Maxillofacial Surgery, General Hospital of Heraklion "Venizeleio-Pananeio", Heraklion, Crete, Greece.
Hippokratia. 2020 Apr-Jun;24(2):88-90.
Cutaneous metastasis of papillary thyroid carcinoma is rare and is a hallmark of a locally aggressive tumor.
We present a unique case of cutaneous thyroid carcinoma sixteen years after total thyroidectomy for multi-nodular goiter. The tumor originated from the upper anterior thoracic wall's skin and was found to invade the rostral half of the sternum's external periosteum and the caudal part of the right sternocleidomastoid muscle. Wide local excision of the neoplasm was performed with macroscopically free margins and right selective neck dissection (lymph node levels IV and V). The skin deficit was reconstructed with a right pectoralis major island flap. The histopathologic findings displayed a papillary thyroid carcinoma with Hürthle cell predominance and microscopically positive margins at the excised portion of the sternocleidomastoid muscle. The patient was placed on close follow-up, and nine months postop, there are no clinical signs of recurrence.
To our knowledge, this is the first case of cutaneous thyroid carcinoma following benign thyroidectomy. A possible mechanism for this incidence is the malignant transformation of benign thyroid cells inoculated into the skin. Dissecting along the fascial planes during thyroidectomy and preserving the thyroid capsule establishes a clean surgical field and minimizes the chance of inoculation of thyroid cells into the adjacent structures. Close follow-up and a high level of suspicion for skin lesions in patients with thyroid disease are warranted in all cases. HIPPOKRATIA 2020, 24(2): 88-90.
甲状腺乳头状癌的皮肤转移罕见，是局部侵袭性肿瘤的一个标志。
我们呈现了一例独特的皮肤甲状腺癌病例，该病例发生在因多结节性甲状腺肿行全甲状腺切除术后16年。肿瘤起源于胸前壁上部皮肤，发现侵犯胸骨外骨膜的上半部分和右侧胸锁乳突肌的尾部。对肿瘤进行了广泛的局部切除，切缘肉眼无肿瘤残留，并进行了右侧选择性颈部清扫（IV和V区淋巴结）。皮肤缺损用右侧胸大肌岛状皮瓣修复。组织病理学检查结果显示为以许特莱细胞为主的甲状腺乳头状癌，在胸锁乳突肌切除部分镜下切缘阳性。患者接受密切随访，术后9个月无复发的临床迹象。
据我们所知，这是良性甲状腺切除术后发生皮肤甲状腺癌的首例病例。这种发病的可能机制是接种到皮肤中的良性甲状腺细胞发生恶性转化。甲状腺切除术中沿筋膜平面进行解剖并保留甲状腺被膜可建立一个清洁的手术视野，并将甲状腺细胞接种到相邻结构的机会降至最低。在所有病例中，对甲状腺疾病患者进行密切随访并对皮肤病变保持高度怀疑是必要的。《希波克拉底》2020年，第24卷（第2期）：88 - 90页。
