Department of Pathology, The Fourth Affiliated Hospital of Henan University of Science and Technology, Anyang Tumour Hospital, Anyang, Henan Province, China.
J Int Med Res. 2022 Jul;50(7):3000605221099465. doi: 10.1177/03000605221099465.
This current case report presents the detailed clinicopathological analysis of three patients with papillary thyroid carcinoma, each of which presented with the 'snowstorm appearance' on ultrasonography. Ultrasonography of this tumour typically shows a diffusely enlarged thyroid with hypoechoic and heterogeneous internal echoes, and diffusely scattered microcalcifications, which form the 'snowstorm appearance'. Microscopically, case 1 had a large number of psammoma bodies, infiltration of lymphocytes, formation of lymphatic follicles and extensive squamous metaplasia, leading to the diagnosis of a diffuse sclerosing variant of papillary thyroid carcinoma (DSVPTC). Case 2 was diagnosed with follicular papillary thyroid carcinoma. Their tumour had numerous calcifications in the stroma and follicles. Case 3 was diagnosed with a multifocal papillary thyroid carcinoma in the background of Hashimoto's thyroiditis. Their tumour showed calcification in the stroma and follicles, together with cervical lymph node metastasis. DSVPTC is a rare variant of thyroid papillary carcinoma. It has the 'snowstorm appearance' on ultrasound, but this can also be found in follicular papillary carcinoma and multifocal thyroid papillary carcinoma. Papillary thyroid carcinoma with the 'snowstorm appearance' has a large number of peripheral lymph nodes metastases, thus requiring radical surgery and postoperative adjuvant therapy.
本病例报告详细分析了 3 例表现为超声“暴风雪征”的甲状腺乳头状癌患者。这种肿瘤的超声表现通常为弥漫性肿大的甲状腺，呈低回声和不均匀的内部回声，弥漫性散布微钙化，形成“暴风雪征”。显微镜下，病例 1 有大量砂粒体、淋巴细胞浸润、淋巴滤泡形成和广泛的鳞状化生，诊断为弥漫性硬化型甲状腺乳头状癌（DSVPTC）。病例 2 诊断为滤泡状甲状腺乳头状癌。他们的肿瘤在基质和滤泡中有许多钙化。病例 3 诊断为桥本甲状腺炎背景下的多灶性甲状腺乳头状癌。他们的肿瘤在基质和滤泡中显示出钙化，并伴有颈部淋巴结转移。DSVPTC 是甲状腺乳头状癌的一种罕见变体。它在超声上表现为“暴风雪征”，但也可见于滤泡状甲状腺乳头状癌和多灶性甲状腺乳头状癌。表现为“暴风雪征”的甲状腺乳头状癌有大量外周淋巴结转移，因此需要根治性手术和术后辅助治疗。
