以寰枢椎、颅底巨大转移灶为首发表现的甲状腺滤泡癌漏诊分析

摘要

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。%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.