Papillary Thyroid Carcinoma of a Diffuse Sclerosing Variant: Ultrasonographic Monitoring from a Normal Thyroid Gland to Mass Formation

Kim, Hye Seong; Han, Boo‐Kyung; Shin, Jung Hee; Ko, Eun Young; Sung, Chang Ohk; Oh, Young Lyun; Song, Sang Yong

doi:10.3348/kjr.2010.11.5.579

Cited by 17 publications

(11 citation statements)

References 8 publications

(14 reference statements)

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“…However, punctate bright internal echoes in an ectopic thymus are created by fat against lymphoid tissue rather than microcalcifications . This can be particularly problematic in young patients, given that the diffuse sclerosing variant of papillary thyroid carcinoma tends to have a diffuse pattern of microcalcifications imparting a snowstorm appearance on ultrasound, and can truly mimic thymic tissue on ultrasound . In addition, this variant of papillary thyroid carcinoma tends to be more commonly reported in young patients and associated with a worse prognosis than conventional papillary thyroid carcinoma, so clinicians do not want to miss or delay the diagnosis, which may prompt referral to radiology for an ultrasound‐guided biopsy.…”

Section: Discussionmentioning

confidence: 99%

Cytomorphology and sonographic features of ectopic thymic tissue diagnosed in paediatric FNA biopsies

et al. 2018

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Ectopic thymic tissue is rarely present as a neck mass or thyroid nodule on FNA biopsy. The ultrasound imaging findings reveal a well-defined fusiform lesion with punctate bright echoes that could be misinterpreted as papillary thyroid carcinoma. The aspirates show a small lymphoid population, immunophenotypically compatible with thymic T-cells, in addition to scattered epithelial cells. Therefore, knowledge of the typical ultrasonographic and cytopathological features can help make a definitive diagnosis and avoid more invasive procedures in paediatric patients.

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Section: Discussionmentioning

confidence: 99%

Cytomorphology and sonographic features of ectopic thymic tissue diagnosed in paediatric FNA biopsies

et al. 2018

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“…However, the diffuse nature of DSVPTC often mimics chronic thyroiditis on US images and leads to treatment delay, particularly in the absence of a focal solid mass (14,15). In the present case, thyroid ultrasonography revealed diffuse enlargement of each lobe and heterogenous echogenicity without focal solid mass formation.…”

Section: Discussionmentioning

confidence: 65%

“…Although DSVPTC is rare (16), it is important for clinicians to recognize and consider the possibility of this disease, particularly because of its clinical resemblance to Hashimoto's thyroiditis (3,9). Patients are frequently misdiagnosed and treated for Hashimoto's thyroiditis (7,9,14). In the present case, the clinical presentation and serological findings were all indicative of Hashimoto's thyroiditis.…”

Section: Discussionmentioning

confidence: 68%

“…Currently, ultrasound (US) is generally considered to be the most accurate imaging modality for the evaluation and characterization of thyroid nodules (13). Since DSVPTC always permeates the entire gland causing diffuse thyroid enlargement without a dominant nodule, which is difficult to diagnose using US, it is more commonly diagnosed as Hashimoto's thyroiditis (12,14,15). The present study was the first, to the best of our knowledge, to report shear wave elastography (SWE) diagnosis of DSVPTC of the thyroid.…”

Section: Introductionmentioning

confidence: 99%

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Shear wave elastography diagnosis of the diffuse sclerosing variant of papillary thyroid carcinoma: A case report

Xue

Huang

et al. 2016

Molecular and Clinical Oncology

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Abstract. The present study aimed to report the shear wave elastography (SWE) findings in a patient with the diffuse sclerosing variant of papillary thyroid carcinoma (DSVPTC). Since patients with DSVPTC may present with typical clinicopathological features and initially appear to have Hashimoto's thyroiditis, a thorough clinical evaluation and an early diagnosis are important. A 20-year-old female patient presented with a 1-month history of a neck mass and sore throat. Conventional ultrasound and SWE were performed using an AIXPLORER system with 14-5 MHz linear transducer. The patient had undergone total thyroidectomy and bilateral neck lymph node dissection, and an intraoperative pathology consultation to confirm the malignancy of lymph node metastasis. Pathological diagnosis was DSVPTC in both lobes, with lymph node metastases in the bilateral neck. The clinical presentation and serological findings were all indicative of Hashimoto's thyroiditis. Thyroid ultrasonography revealed diffuse enlargement of the both lobes, heterogenous echogenicity without mass formation, diffuse scattered microcalcifications and poor vascularization. SWE revealed stiff values of the thyroid: The mean stiffness was 99.7 kpa, the minimum stiffness was 59.1 kpa and the maximum stiffness was 180.1 kpa. The maximum stiffness of the DSVPTC (180.1 kpa) was higher compared with the diagnostic criteria of malignant thyroid nodules (65 kPa). SWE may be considered as a novel and valuable method to diagnose DSVPC.

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“…Diffuse sclerosing variant of papillary thyroid carcinoma (DSV-PTC) is a rare aggressive form of papillary thyroid carcinoma [ 3 ]. DSV-PTC has been described as a “wolf in sheep's clothing” [ 4 ] and presentation is often indicative of benign disease [ 5 , 6 ]. We describe the case of a lady whose clinical presentation was suggestive of benign Riedel's thyroiditis but following extensive investigation was shown to have DSV-PTC.…”

Section: Introductionmentioning

confidence: 99%

A Case Report Demonstrating How the Clinical Presentation of the Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma Can Mimic Benign Riedel’s Thyroiditis

Walsh

Griffin

Ryan

et al. 2015

Case Reports in Endocrinology

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A 44-year-old female presented with a two-month history of a neck mass, sore throat, hoarseness, and intermittent dysphagia. Examination revealed a “woody” hard swelling arising from the right lobe of the thyroid. Clinically this was felt to be classical Riedel's thyroiditis (RT). Thyroid ultrasound showed a diffusely enlarged, low echogenicity thyroid with a multinodular goitre. An abnormal nodule extending across the isthmus was noted. Following a nondiagnostic fine needle aspiration, an open core biopsy was performed. This showed dense sclerotic fibrosis punctuated by nodular mononuclear inflammatory cells, which obscured follicular epithelial cells consistent with a fibrosing thyroiditis (Riedel's thyroiditis). A biopsy of pretracheal lymph nodes showed a sclerotic process throughout the lymph nodes and nests of epithelium bands with squamous differentiation obscured by a fibrous process. These findings raised the differential diagnosis of diffuse sclerosing variant of papillary thyroid carcinoma (DSV-PTC) with metastasis to lymph nodes. A total thyroidectomy and pretracheal lymph node dissection were performed. The final histological diagnosis was DSV-PTC. When managing a patient with presumed RT it is important to consider malignancy in the differential. DSV-PTC is one of the more aggressive forms of thyroid cancer but with early diagnosis and appropriate treatment patients may have excellent outcomes.

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Papillary Thyroid Carcinoma of a Diffuse Sclerosing Variant: Ultrasonographic Monitoring from a Normal Thyroid Gland to Mass Formation

Cited by 17 publications

References 8 publications

Cytomorphology and sonographic features of ectopic thymic tissue diagnosed in paediatric FNA biopsies

Cytomorphology and sonographic features of ectopic thymic tissue diagnosed in paediatric FNA biopsies

Shear wave elastography diagnosis of the diffuse sclerosing variant of papillary thyroid carcinoma: A case report

A Case Report Demonstrating How the Clinical Presentation of the Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma Can Mimic Benign Riedel’s Thyroiditis

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