囊性为主成分的甲状腺鳞状细胞癌1例误诊分析

Analysis of a case of misdiagnosis of cystic thyroid squamous cell carcinoma

目的探讨囊性为主成分的甲状腺鳞状细胞癌(SCCT)误诊原因。方法分析1例囊性为主成分的SCCT误诊过程,并对其结局随访,结合相关文献进行讨论。结果男,67岁,发现甲状腺结节3年,颈部彩超发现甲状腺右叶囊实性包块,大小63 mm×49 mm×82 mm,因肿瘤较大且压迫气管,行右侧甲状腺腺叶切除术,术后病理报告为结节性甲状腺肿,伴囊性变及腺瘤样结构形成;遂按结节性甲状腺肿出院。术后1个月,病人颈部出现新生物,进行多项检查及多学科会诊后,取颈部新生物做病理活检,结果为原发性SCCT;第一次手术的诊断出现误诊;病人拒绝放疗并出院,随访结局为死亡,复发后生存期为2.5个月。结论原发性甲状腺鳞状细胞癌(PSCCT)是一种极具侵袭性的肿瘤,预后较差,以囊性结节为首发病例的更少见,容易误诊,需结合病史、临床检查及免疫组化等诊断。

Objective To explore the outcome of the squamous cell carcinoma of the thyroid(SCCT)with cystic component.Methods The misdiagnosis process of a case of SCCT with cystic component was summarized and analyzed,and the outcome was fol⁃lowed up,and the relevant literature was discussed.Results A 67-year-old male patient complained of thyroid nodules 3 years ago.Color doppler ultrasound of the neck found a cystic solid mass in the right lobe of the thyroid gland,about 63 mm×49 mm×82 mm.Due to the large tumor and compression of the trachea,the patient underwent right thyroidectomy.The pathological results reported nodular goiter in the right lobe with cystic changes and adenomatous structure formation.The patient was discharged with nodular goiter.One month after surgery,the patient's neck neoplasm was found.After multiple examinations and multidisciplinary consultation,the neck neoplasm was taken for pathological biopsy,and the results showed that the neck neoplasm was primary thyroid squamous cell carcino⁃ma.The patient's first surgery was misdiagnosed.The patient refused radiotherapy for personal reasons and was discharged.The patient was followed up and the outcome was death.The survival time after recurrence was 2.5 months.Conclusions Primary squamous cell carcinoma of the thyroid(PSCCT)is an aggressive tumor with poor prognosis,and cystic nodules as the first case is more rare and easy to be misdiagnosed.The diagnosis should be combined with medical history,clinical examination and immunohistochemistry.