Vigouroux C, Escourolle H, Mosnier-Pudar H, Thomopoulos P, Louvel A, Chapuis Y, Varet B, Luton J P
Clinique des Maladies endocriniennes et métaboliques, Hôpital Cochin, Paris.
Presse Med. 1996;25(1):28-30.
Two cases of Riedel's thyroiditis demonstrated the difficulties encountered in diagnosis. In the first case, subtotal thyroidectomy was performed due to compressive goiter. The intraoperative macroscopic aspect suggested Riedel's thyroiditis. The pathology report also discussed the diagnosis, despite a major lymphoid component, as dense fibrosis had multilated the thyroid parenchyma. Subsequent clinical course led to the diagnosis of lymphoma. The clinical presentation in the second case was classical with rapid increase in size of a hard thyroid gland. Histology was however atypical showing calcifications and liquid cysts within the fibrous thyroid tissue. The initial signs of Riedel's thyroiditis, a very rare disease, usually suggest neoplasia: ligneous compressive goiter with deep adherences. Histologically, there is invasive fibrous thyroiditis with highly suggestive occlusive phlebitis in certain cases. The origin of the disease remains obscure. The differential diagnosis between a sclerosing form and lymphoma is particularly important for therapeutic management.
两例里德尔甲状腺炎病例显示了诊断中遇到的困难。在第一例中，因压迫性甲状腺肿进行了甲状腺次全切除术。术中宏观表现提示为里德尔甲状腺炎。病理报告也讨论了诊断，尽管有大量淋巴成分，但致密纤维化已破坏甲状腺实质。随后的临床病程导致诊断为淋巴瘤。第二例的临床表现典型，坚硬的甲状腺迅速增大。然而，组织学表现不典型，在纤维性甲状腺组织内可见钙化和液性囊肿。里德尔甲状腺炎是一种非常罕见的疾病，其初始症状通常提示肿瘤形成：伴有深部粘连的木质样压迫性甲状腺肿。组织学上，存在侵袭性纤维性甲状腺炎，在某些病例中伴有高度提示性的闭塞性静脉炎。该病的起源仍不清楚。硬化型与淋巴瘤之间的鉴别诊断对治疗管理尤为重要。
