Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Radiology, Chung-Ang University Gwangmyeong Hospital, Gyeonggi-do, Republic of Korea.
Medicine (Baltimore). 2024 Oct 4;103(40):e39944. doi: 10.1097/MD.0000000000039944.
The macrofollicular subtype of papillary thyroid cancer (MFS-PTC) is a rare subtype often leading to a challenging diagnosis. To evaluate the ultrasonographic (US) features and clinical implication of MFS-PTC. Records of 14 patients histologically diagnosed with MFS-PTC at our institution over a period of 16 years were retrospectively reviewed. Preoperative US features, Bethesda categories determined by fine-needle aspiration (FNA) or core needle biopsy (CNB), and final pathology were assessed in all patients with MFS-PTC. Of the 14 MFS-PTC cases, most nodules were noted as smooth marginated, solid or predominantly solid isoechoic on US and were categorized as low suspicion in 12 cases and intermediate suspicion in 2 cases. The median tumor size was 1.2 cm (range, 0.6-5.6 cm). Of 11 cases that underwent FNA or CNB, 4 (36.4%) with Bethesda category II or III underwent the follow-up because of benign-looking appearance on US and benign results in subsequent CNBs. However, the patients underwent delayed surgery (31.3 months, range 12-41 months) because of serially increased tumor size. Seven patients diagnosed with Bethesda type IV, V, and VI subsequently underwent surgery. Gross extrathyroidal extension into subcutaneous fat tissue and lateral lymph node metastasis were noted in a patient who underwent follow-up. No distant metastases or recurrence was detected. MFS-PTC is representative of a benign sonographic appearance of PTC subtypes. Tumor growth on serial US images is the only suspicious finding for MFS-PTC because FNA or CNB is often false negative.
甲状腺滤泡型乳头状癌（macrofollicular subtype of papillary thyroid cancer，MFS-PTC）是一种罕见的亚型，常导致诊断困难。评估 MFS-PTC 的超声（ultrasonographic，US）特征和临床意义。回顾性分析 16 年间在我院经组织学诊断为 MFS-PTC 的 14 例患者的记录。所有 MFS-PTC 患者均评估术前 US 特征、细针抽吸（fine-needle aspiration，FNA）或核心针活检（core needle biopsy，CNB）确定的 Bethesda 分类，以及最终病理。在 14 例 MFS-PTC 病例中，大多数结节的 US 表现为边缘光滑、实性或主要为等回声，12 例被归类为低度可疑，2 例为中度可疑。肿瘤大小中位数为 1.2cm（范围，0.6-5.6cm）。11 例行 FNA 或 CNB 的患者中，4 例（36.4%）因 US 表现为良性外观和随后的 CNB 良性结果而被归入 Bethesda 类别 II 或 III 而进行随访。然而，这些患者因肿瘤大小连续增加而进行了延迟手术（31.3 个月，范围 12-41 个月）。7 例诊断为 Bethesda 类型 IV、V 和 VI 的患者随后接受了手术。在接受随访的患者中，发现肿瘤向皮下脂肪组织和侧方淋巴结有明显的外侵。未发现远处转移或复发。MFS-PTC 是 PTC 亚型中具有良性超声表现的代表。连续 US 图像上的肿瘤生长是 MFS-PTC 的唯一可疑表现，因为 FNA 或 CNB 通常为假阴性。
