Occult Thyroid Carcinoma without Malignant Thyroid Gland Findings during Preoperative Examination: Report of Three Cases
Occult Thyroid Carcinoma without Malignant Thyroid Gland Findings during Preoperative Examination: Report of Three Cases
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术前检查未发现甲状腺恶变的隐匿性甲状腺癌三例报告
DOI：
10.1155/2020/4249067
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发表时间：
2020
影响因子：
1.1
通讯作者：
Masuda Munetaka
中科院分区：
文献类型：
--
作者：
Toda Soji;Iwasaki Hiroyuki;Suganuma Nobuyasu;Okubo Yoichiro;Hayashi Hiroyuki;Masudo Katsuhiko;Nakayama Hirotaka;Masuda Munetaka
隐匿性甲状腺癌的临床表现和甲状腺外肿瘤的发现是罕见的。术前检查甲状腺未见恶性，故诊断困难。我们遇到一个71岁的男性原发性异位甲状腺癌引起上腔静脉综合征。虽然甲状腺未发现恶性肿瘤，但骨转移活检导致甲状腺癌的诊断。骨转移灶的HE染色显示乳头状癌的核特征，免疫染色显示甲状腺球蛋白和PAX‐8阳性。第二例患者为84岁男性，因血液中甲状腺球蛋白水平高，患有纵隔肿瘤并疑似甲状腺癌。病理表现为甲状腺乳头状癌。最后一个病例是一名56岁的女性，术前甲状腺检查未发现恶性，但颈部淋巴结转移。淋巴结穿刺液甲状腺球蛋白水平对术前诊断有重要意义。我们行甲状腺全切除术加双侧改良颈部清扫术。病理显示左叶1毫米乳头状癌。所有这些病例都很难诊断。然而，我们结合各种检查的结果，如放射成像、血液检查和免疫组织学检查来诊断我们的病人。
Occult thyroid carcinoma preceded by clinical manifestations and findings from extrathyroidal tumors is rare. The lack of malignant findings in the thyroid during the preoperative examination makes diagnosis difficult. We encountered a 71‐year‐old man with a primary ectopic thyroid carcinoma causing superior vena cava syndrome. Although no malignant findings were found in the thyroid gland, biopsy of bone metastases led to the diagnosis of thyroid cancer. HE staining of bone metastases revealed nuclear features of papillary carcinoma, and immunostaining was positive for thyroglobulin and PAX‐8. The second case involved an 84‐year‐old man with a mediastinal tumor and suspected thyroid cancer because of high thyroglobulin levels in blood. The pathological tumor finding was papillary thyroid cancer. The last case was that of a 56‐year‐old woman lacking preoperative thyroid examination malignant findings, but with cervical lymph node metastasis. The thyroglobulin level of the lymph node puncture fluid was useful for preoperative diagnosis. We performed total thyroidectomy plus bilateral modified neck dissection. Pathology revealed a 1 mm papillary carcinoma in the left lobe. All of these cases were difficult to diagnose. However, we combined the results of various tests such as radiographic imaging, blood tests, and immunohistological tests to diagnose our patients.