CAJ | 학술논문

目的：探讨以寰枢椎及颅底转移灶为首发表现的甲状腺滤泡癌( follicular thyroid carcinoma, FTC)的疾病特征,以减少误诊、漏诊。方法对1例FTC的临床资料进行回顾性分析。结果本例为45岁女性,2年内因颈部不适多次就诊,外院均按颈椎病予理疗,近半年症状逐渐加重,并于颈部触及一包块,外院行颈部彩色多普勒超声(彩超)示耳后实性占位性病变,行CT扫描示上颈部恶性占位并椎体骨质破坏,考虑转移瘤或淋巴瘤可能,遂到我院就诊。复阅外院CT片示左侧寰枢椎、枕骨多发性溶骨性骨质破坏,以颈部包块性质待查(鼻咽癌？淋巴瘤？其他转移癌？)收入院。复查颈部彩超示：甲状腺多发结节,考虑结节性甲状腺肿可能。行左侧颈部包块切除术,术后病理诊断为转移性腺癌。后经全身18 F-脱氧葡萄糖(18 F-FDG) PET-CT检查示左侧甲状腺有高代谢灶(不除外甲状腺癌),遂行双侧甲状腺次全切术,术后病理证实为FTC。术后予131 I及125 I粒子治疗,随访2年病情稳定。结论临床接诊有颈椎和(或)颅底骨质破坏,同时存在甲状腺结节的病例应注意排除甲状腺恶性肿瘤,尤其是FTC的可能,以避免误诊、漏诊。
목적：탐토이환추추급로저전이조위수발표현적갑상선려포암( follicular thyroid carcinoma, FTC)적질병특정,이감소오진、루진。방법대1례FTC적림상자료진행회고성분석。결과본례위45세녀성,2년내인경부불괄다차취진,외원균안경추병여리료,근반년증상축점가중,병우경부촉급일포괴,외원행경부채색다보륵초성(채초)시이후실성점위성병변,행CT소묘시상경부악성점위병추체골질파배,고필전이류혹림파류가능,수도아원취진。복열외원CT편시좌측환추추、침골다발성용골성골질파배,이경부포괴성질대사(비인암？림파류？기타전이암？)수입원。복사경부채초시：갑상선다발결절,고필결절성갑상선종가능。행좌측경부포괴절제술,술후병리진단위전이성선암。후경전신18 F-탈양포도당(18 F-FDG) PET-CT검사시좌측갑상선유고대사조(불제외갑상선암),수행쌍측갑상선차전절술,술후병리증실위FTC。술후여131 I급125 I입자치료,수방2년병정은정。결론림상접진유경추화(혹)로저골질파배,동시존재갑상선결절적병례응주의배제갑상선악성종류,우기시FTC적가능,이피면오진、루진。
Objective To investigate the features of occult follicular thyroid carcinoma (FTC) presenting as skull and super cervical vertebra metastasis in order to avoiding missed diagnosis and misdiagnosis. Methods A case of super cer-vical vertebra and occipital bone metastasis of FTC was reported and related literatures were reviewed. Results This female patient was 45 years old. She visited doctors many times for neck discomfort in the past two years before admission to this hos-pital. During that time she was usually treated with physical therapy as cervical syndrome. Her neck discomfort became more and more serious in the past six months, while a mass was felt in her left neck. Soon after, ultrasonography examination showed that there was a solid lesion in the neck under left ear. Meanwhile, her CT scan showed that there was serious bone destruction with her super cervical vertebra and occipital bone. Then she was hospitalized with the diagnosis of neck lump in our department. It was reported as multiple nodes in her thyroid by ultrasonography, which indicated diagnosis of nodular goi-ter ( suspected as nasopharyngeal carcinoma and leucoma) . Surgical pathology of neck mass indicated that it was a metastatic adenocarcinoma. 18 F-FDG PET-CT showed that there was a hypermetabolic node in the left lobe of thyroid ( suspected as thy-roid carcinoma) . Finally the patient underwent total thyroidectomy and microscopic examination confirmed the FTC diagnosis. She had been followed up for 2 years after total thyroidectomy, during which 131 I and 125 I therapy were given and the patient's condition remains stable now. Conclusion Thyroid malignant tumor, especially FTC should not be considered when there is a concomitance of cervical vertebra and/or skull destruction and thyroid nodule to avoid missed diagnosis and misdiagnosis.