Ghali Mohamed Said, Al Hassan Mohamed S, Goyal Rajen, Abdelaal Abdelrahman
Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; Department of General Surgery, Ain Shams University, Cairo, Egypt; Weill Cornell Medicine - Qatar, Doha, Qatar.
Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
Int J Surg Case Rep. 2025 Aug;133:111526. doi: 10.1016/j.ijscr.2025.111526. Epub 2025 Jun 16.
Angioinvasive type of FTC, characterized by vascular invasion with poor prognosis. Thyrolipoma may manifest as a single thyroid lesion or, in conjunction with multiple thyroid lesions. Approximately 5 to 10 % of thyroid nodules are malignant. The coexistence of angioinvasive FTC with a thyrolipoma, further complicates the clinical scenario and may affect the diagnosis of such aggressive disease.
We report a case of a 43-year-old female who presented with thyroid enlargement. Imaging revealed a multinodular goitre, and fine needle aspiration cytology from the right thyroid nodule was suspicious for follicular neoplasm (Bethesda IV). The patient underwent total thyroidectomy, and the histopathological studies confirmed the presence of right thyroid lobe angioinvasive FTC with three foci of vascular invasion with background of lymphocytic Thyroiditis (LT). Interestingly, an incidental finding of thyrolipoma was identified in the left lobe.
Vascular invasion is a known indicator of aggressive diseases and a strong predictor of distant metastasis in FTC, especially when it involves multiple locations. Recurrence rates are highly correlated with the degree of vascular invasion. Thyrolipoma can happen alongside malignant nodules from follicular or papillary thyroid tumours. LT is thought to increase the risk of papillary thyroid tumours and thyroid lymphoma. <5 % of thyroid cancers in LT are FTC.
This case presents a rare combination of thyrolipoma, angioinvasive FTC and LT that were first to be appraised in the literature. Diagnosis hinges on postoperative histopathology, and management must focus on the aggressive FTC component.
血管侵袭性滤泡性甲状腺癌（FTC）的特征为血管侵犯，预后较差。甲状腺脂肪瘤可表现为单个甲状腺病变，或与多个甲状腺病变并存。约5%至10%的甲状腺结节为恶性。血管侵袭性FTC与甲状腺脂肪瘤并存，使临床情况更加复杂，可能影响对这种侵袭性疾病的诊断。
我们报告一例43岁女性，因甲状腺肿大就诊。影像学检查显示为多结节性甲状腺肿，右甲状腺结节细针穿刺细胞学检查怀疑为滤泡性肿瘤（贝塞斯达IV类）。患者接受了全甲状腺切除术，组织病理学研究证实右甲状腺叶存在血管侵袭性FTC，有三个血管侵犯灶，背景为淋巴细胞性甲状腺炎（LT）。有趣的是，在左叶偶然发现了甲状腺脂肪瘤。
血管侵犯是侵袭性疾病的已知指标，也是FTC远处转移的有力预测指标，尤其是当它累及多个部位时。复发率与血管侵犯程度高度相关。甲状腺脂肪瘤可与滤泡性或乳头状甲状腺肿瘤的恶性结节同时出现。LT被认为会增加乳头状甲状腺肿瘤和甲状腺淋巴瘤的风险。LT患者中<5%的甲状腺癌为FTC。
本病例呈现了甲状腺脂肪瘤、血管侵袭性FTC和LT的罕见组合，这在文献中尚属首次报道。诊断取决于术后组织病理学，治疗必须聚焦于侵袭性FTC成分。
