Khurshied Saleh, Nisa Mehrun, Abdul Malik Wafa, Mansoor Hassan, Sabih Rayyan
Otolaryngology-Head and Neck Surgery, Pakistan Institute of Medical Sciences, Islamabad, PAK.
Medicine and Surgery, Pakistan Institute of Medical Sciences, Islamabad, PAK.
Cureus. 2025 Apr 9;17(4):e81978. doi: 10.7759/cureus.81978. eCollection 2025 Apr.
The most prevalent type of thyroid gland cancer is called papillary thyroid carcinoma, which typically manifests as a painless thyroid mass in women over 50 years of age. Fine-needle aspiration cytology (FNAC) and ultrasonography (USG) are used to make the diagnosis, and the patient's symptoms and these results determine the course of treatment. We reported a rare case of follicular variant papillary thyroid cancer in a young woman, diagnosed at an unusual age of 22 years, who had three thyroid surgeries intended to completely remove the disease but were unable to do so. The woman was diagnosed with a case of follicular variant of papillary thyroid carcinoma (FVPTC) initially 10 years back, and a hemithyroidectomy was done for diagnostic purposes. Later on, with the diagnosis of FVPTC, a complete thyroidectomy was done at the same time, and the patient recovered uneventfully. For the next 10 years, the patient remained asymptomatic with no complaint and was on oral thyroxine with six-monthly follow-up with thyroid function tests, which were normal. It was 10 years after the complete thyroidectomy that the patient had a neck USG for a nonthyroidal disease, and it was incidentally found that there was a thyroid remnant in the isthmus region even after the complete thyroidectomy, and this silently persisted for more than 10 years; the thyroidal nature of this tissue was confirmed on thyroid scan and computed tomography. The patient had another surgery (3rd surgery) 10 years after the initial two surgeries, but the surgeon could not find any thyroid tissue with the naked eye and shaved off all the tissue in front of the trachea. The histopathology report later showed only muscle and fibroadipose tissue, revealing the inability to surgically remove this resistant carcinoma even after three surgeries. Following that, the case was discussed in a multidisciplinary team meeting, and it was decided that no further intervention was required in this asymptomatic patient, as the patient was biochemically normal and was planned to be closely monitored with routine follow-ups. Thus, there could be a chance of remnant being left behind even after complete thyroidectomy, and the patient may be totally asymptomatic, giving the impression that this tumor was beyond the limits of surgery in our case.
最常见的甲状腺癌类型是乳头状甲状腺癌，通常表现为50岁以上女性甲状腺无痛性肿块。细针穿刺细胞学检查（FNAC）和超声检查（USG）用于进行诊断，患者的症状和这些检查结果决定治疗方案。我们报告了一例罕见的年轻女性滤泡状变异型乳头状甲状腺癌病例，该患者在22岁这一不寻常的年龄被诊断出此病，她接受了三次甲状腺手术，旨在完全切除病灶，但均未能成功。该女性10年前最初被诊断为滤泡状变异型乳头状甲状腺癌（FVPTC），并进行了半甲状腺切除术以明确诊断。后来，在确诊为FVPTC后，同时进行了全甲状腺切除术，患者恢复顺利。在接下来的10年里，患者一直无症状，无任何不适，口服甲状腺素并每六个月进行一次甲状腺功能检查，结果均正常。全甲状腺切除术后10年，患者因非甲状腺疾病进行颈部超声检查时，偶然发现即使在全甲状腺切除术后，峡部区域仍有甲状腺残余组织，且这种情况无症状地持续了10多年；经甲状腺扫描和计算机断层扫描证实了该组织的甲状腺性质。在最初的两次手术后10年，患者又进行了一次手术（第三次手术），但外科医生肉眼未发现任何甲状腺组织，于是刮除了气管前方的所有组织。组织病理学报告后来显示只有肌肉和纤维脂肪组织，表明即使经过三次手术也无法手术切除这种顽固性癌肿。此后，该病例在多学科团队会议上进行了讨论，决定对这位无症状患者不再进行进一步干预，因为患者生化指标正常，并计划通过定期随访进行密切监测。因此，即使在全甲状腺切除术后仍有可能残留甲状腺组织，而且患者可能完全无症状，这给我们造成了一种该肿瘤无法通过手术切除的印象。
