Diffuse sclerosing variant of thyroid carcinoma presenting as Hashimoto thyroiditis: a case report

Scientific paper - Case study

• Title (croatian): Difuzno sklerozirajući oblik papilarnog karcinoma štitnjače nalik Hashimoto tireoiditisu: prikaz slučaja
• Author: Anamarija Vukasović
• Author: Sanja Kusačić Kuna
• Author: Karmen Trutin Ostović
• Author: Drago Prgomet
• Author: Tomislav Banek
• Author's institution: University of Zagreb; School of Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences

Abstract (english)

The aim of report is to present a case of a rare diffuse sclerosing variant of a papillary thyroid carcinoma. A 15-year old girl referred for ultrasound examination because of painless thyroid swelling lasting 10 days before. An ultrasound of the neck showed diffusely changed thyroid parenchyma, without nodes, looking as lymphocytic thyroiditis Hashimoto at first, but with snow-storm appearance, predominantly in the right lobe. Positive thyroid peroxidase antibodies (TPO-AT) also suggested Hashimoto thyroiditis. Repeated US-FNAB (fine needle-aspiration biopsy) of the right lobe revealed diffuse sclerosing variant of papillary thyroid carcinoma and patient underwent total thyreoidectomy. Patohistologic finding confirmed diffuse sclerosing variant of a papillary thyroid carcinoma in the both thyroid lobes and several metastatic lymph nodes. Two months later patient recived radioablative therapy with 3700 MBq (100 mCi) of 1-131 followed by levothyroxine replacement. At the moment, patient is without evidence of local or distant metastases and next regular control is scheduled in 6 months. In conclusion, a diffuse sclerosing variant is rare form of papillary thyroid carcinoma that echographically looks similar to Hashimoto thyroiditis and sometimes could be easily overlooked.

Abstract (croatian)

Opisan je slučaj petnaestogodišnje djevojke upućene na ultrazvučni pregled zbog bezbolnog zadebljanja štitnjače
nastalog 10-ak dana prije dolaska na obradu. Bolesnica je bila eutiroidna uz povišena antitijela na peroksidazu (TPO-
-At) što je postavilo sumnju na postojanje autoimunog limfocitnog tireoiditisa. Ultrazvučnim pregledom verificirane su
difuzne promjene ehostukture u parenhimu oba režnja štitnjače nalik kroničnom limfocitnom Hashimoto tireoiditisu.
Međutim, obzirom na prisutnost punktiformnih kalcifikata unutar desnog režnja štitnjače, ipak je, unatoč nepostojanju
nodoznih promjena u štitnjači učinjena citološka punkcija pod kontrolom ultrazvuka, te je potvrđena sumnja na difuzno
sklerozirajući oblik papilarnog karcinoma u desnom režnju štitnjače. Učinjena je totalna tireoidektomija sa
selektivnom disekcijom limfnih čvorova na vratu, a patohistološki nalaz je potvrdio dijagnozu difuzno sklerozirajućeg
karcinoma u desnom režnju štitnjače s fokalnim žarištima tumora i u lijevom režnju, infiltraciju kapsule štitnjače, kao i
više pozitivnih limfnih čvorova obostrano na vratu. Dva mjeseca kasnije bolesnici je aplicirana radiojodna ablacija sa
3700 MBq (100 mCi) I-131, a potom je stavljena na supresijsku terapiju L-tiroksinom. U ovom trenutku bolesnica je bez
evidentnih znakova lokalnih ili distalnih metastaza i očekuje redovitu kontrolnu obradu predviđenu za oko 6 mjeseci.
Kod mlađih bolesnika sa bezbolnim povećanjem štitnjače i promjenama ehostrukture u smislu kroničnog tireoiditisa
Hashimoto, ali sa difuznim punktiformnim kalcifikatima unutar režnjeva potrebno je svakako imati u vidu i ovu rijetku
vrstu papilarnog karcinoma. Stoga je u takvim slučajevima unatoč nepostojanju nodoznih promjena neophodno učiniti
ciljanu citološku punkciju koja nam pomaže u postavljanju točne dijagnoze.

• Keywords (english): Adolescent; Carcinoma / diagnosis; Carcinoma / pathology; Carcinoma / radiotherapy; Carcinoma, Papillary; Diagnosis, Differential; Female; Hashimoto Disease / diagnosis; Hashimoto Disease / pathology; Hashimoto Disease / radiotherapy; Humans; Thyroid Cancer, Papillary; Thyroid Neoplasms / diagnosis; Thyroid Neoplasms / pathology; Thyroid Neoplasms / radiotherapy
• Language: english
• Publication type: Scientific paper - Case study
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Collegium Antropologicum
• Numbering: vol. 36, no. S. 2, pp. 219-221
• p-ISSN: 0350-6134
• URN:NBN: urn:nbn:hr:105:262013
• Publication: 2012-11
• Document URL: https://hrcak.srce.hr/96610
• Type of resource: Text
• Access conditions: Open access
• Created on: 2024-03-27 19:47:04