Calaisselvane Umasankary, Srinivasamurthy Banushree Chandrasekhar, Sangma Mima Maychet B, Gowri M Shyamala
Department of Pathology, Indira Gandhi Medical College and Research Institute, Puducherry, India.
Department of General Surgery, Indira Gandhi Medical College and Research Institute, Puducherry, India.
Indian J Otolaryngol Head Neck Surg. 2025 Jan;77(1):477-481. doi: 10.1007/s12070-024-05137-1. Epub 2024 Oct 22.
Thyroid cancer remains one of the leading endocrine malignancies with Conventional Papillary Thyroid Carcinoma (CVPTC) being the most commonly reported cancer. Caseating granulomatous inflammation is an unusual presentation in the thyroid even in places with high incidence of tuberculosis. The association of CVPTC with caseating granulomatous inflammation is infrequent. It can occur as a result of chronic inflammation which subsequently leads to DNA damage by producing nitric oxide and reactive oxygen species resulting in carcinogenesis. Other than tuberculosis, necrotizing granulomas in the thyroid can also be found in association with fungal diseases, plasma cell granulomas and palpation thyroiditis. We report a case of a 46-year-old lady who presented with neck swelling and dysphagia. Examination of the neck showed a firm, non-tender swelling involving the right lobe of the thyroid that moved with deglutination. The thyroid profile was normal. Ultrasound neck revealed a solitary nodule in the right lobe of the thyroid with heterogeneous architecture and increased vascularity. Fine needle aspiration (FNA) suggested Nodular colloid goitre (Bethesda Category II). Intraoperatively, the gland was stony hard and was found adherent to the underlying muscles with no obvious lymphadenopathy. A gross examination of the right hemithyroidectomy specimen revealed a single nodule with the cavity filled with multiple grey-white papillary excrescences along with an adjacent cystic cavity filled with colloid. Histopathological examination was suggestive of unifocal conventional papillary thyroid carcinoma with surrounding caseating granulomatous inflammation involving the right lobe of the thyroid (pT2 Nx Mx). CVPTC with coexisting caseating granulomatous inflammation is a rare presentation. The exact pathology of caseating granulomatous inflammation in our case is unknown. However, chronic inflammation might have played a role in tumorigenesis.
甲状腺癌仍然是主要的内分泌恶性肿瘤之一，传统型乳头状甲状腺癌（CVPTC）是最常报告的癌症。干酪样肉芽肿性炎症在甲状腺中是一种不常见的表现，即使在结核病高发地区也是如此。CVPTC与干酪样肉芽肿性炎症的关联并不常见。它可能是慢性炎症的结果，慢性炎症随后通过产生一氧化氮和活性氧导致DNA损伤，进而引发癌变。除了结核病，甲状腺中的坏死性肉芽肿还可与真菌疾病、浆细胞肉芽肿和触诊性甲状腺炎相关。我们报告一例46岁女性，她因颈部肿胀和吞咽困难就诊。颈部检查发现一个质地硬、无压痛的肿块，累及甲状腺右叶，随吞咽动作移动。甲状腺功能检查正常。颈部超声显示甲状腺右叶有一个孤立结节，结构不均匀且血管增多。细针穿刺活检（FNA）提示结节性胶样甲状腺肿（贝塞斯达分类II类）。术中发现腺体坚硬如石，与下方肌肉粘连，未发现明显淋巴结肿大。右侧甲状腺叶切除标本的大体检查显示一个单个结节，腔内充满多个灰白色乳头状赘生物，还有一个相邻的充满胶样物的囊腔。组织病理学检查提示为单灶性传统型乳头状甲状腺癌，伴有累及甲状腺右叶的周围干酪样肉芽肿性炎症（pT2 Nx Mx）。CVPTC合并干酪样肉芽肿性炎症是一种罕见的表现。我们病例中干酪样肉芽肿性炎症的确切病理情况尚不清楚。然而，慢性炎症可能在肿瘤发生过程中起了作用。
