原发性甲状腺棘球蚴囊肿：一例病例报告

文献信息

中文摘要

引言与重要性： 棘球蚴囊肿是由细粒棘球绦虫幼虫引起的人畜共患感染，最常累及肝脏和肺。甲状腺受累极为罕见，约占所有人类棘球蚴病例的1%，并带来显著的诊断挑战，尤其是在流行地区。
病例介绍： 一名来自农村地区的48岁女性，有5年缓慢增大的颈前肿块病史，近期进展为吞咽困难和发声困难。她报告经常食用来自可能被污染水源灌溉田地的生蔬菜。超声显示左甲状腺叶有一个复杂的囊性病变（WHO-IWGE CE1型），细针穿刺未能诊断。由于进行性压迫症状且无法排除恶性肿瘤，行全甲状腺切除术。术中意外发现棘球蚴囊肿，采用高渗盐水灌注和仔细切除进行处理。组织病理学证实为原发性棘球蚴囊肿，与淋巴细胞性甲状腺炎和结节性甲状腺肿共存。分期检查未发现其他器官受累。她术后接受阿苯达唑治疗，12个月随访时无病生存。
临床讨论： 本病例突出了甲状腺棘球蚴囊肿的诊断陷阱，由于其非特异性表现，术前很少被怀疑。当怀疑棘球蚴病时，细针穿刺具有潜在危险性且禁忌。手术切除并采取杀原头节预防措施仍是主要治疗手段，术中溢出时推荐术后使用阿苯达唑。与淋巴细胞性甲状腺炎和结节性甲状腺肿的共存拓宽了与甲状腺棘球蚴病相关的病理谱。
结论： 对于来自流行地区且具有适当流行病学危险因素的患者，在囊性甲状腺病变的鉴别诊断中应考虑棘球蚴囊肿。高度的怀疑指数、怀疑棘球蚴病时避免细针穿刺，以及遵循棘球蚴手术原则，对于获得最佳结局至关重要。

英文摘要

INTRODUCTION AND IMPORTANCE: Hydatid cyst is a zoonotic infection caused by the larval form of Echinococcus granulosus, with the liver and lungs being the most frequently involved organs. Thyroid gland involvement is exceptionally rare, accounting for approximately 1% of all human hydatid cases and posing significant diagnostic challenges, particularly in endemic regions.
CASE PRESENTATION: A 48-year-old woman from a rural area presented with a 5-year history of a slowly enlarging anterior neck mass, with recent progression to dysphagia and dysphonia. She reported regular consumption of raw vegetables from fields irrigated with potentially contaminated water. Ultrasound revealed a complex cystic lesion in the left thyroid lobe (WHO-IWGE type CE1), and fine-needle aspiration was non-diagnostic. Total thyroidectomy was performed due to progressive compressive symptoms and the inability to exclude malignancy. Intraoperatively, a hydatid cyst was unexpectedly encountered and managed with hypertonic saline instillation and careful excision. Histopathology confirmed a primary hydatid cyst co-existing with lymphocytic thyroiditis and multinodular goiter. Staging investigations revealed no other organ involvement. She received postoperative albendazole and remained disease-free at 12-month follow-up.
CLINICAL DISCUSSION: This case highlights the diagnostic pitfalls of thyroid hydatid cysts, which are rarely suspected preoperatively due to their non-specific presentation. Fine-needle aspiration is potentially hazardous and contraindicated when hydatid disease is suspected. Surgical excision with scolicidal precautions remains the mainstay of treatment, and postoperative albendazole is recommended in cases of intraoperative spillage. The co-occurrence with lymphocytic thyroiditis and multinodular goiter broadens the spectrum of pathology associated with thyroid hydatid disease.
CONCLUSION: Hydatid cyst should be considered in the differential diagnosis of cystic thyroid lesions in patients from endemic regions with appropriate epidemiological risk factors. A high index of suspicion, avoidance of FNA when hydatid disease is suspected, and adherence to principles of hydatid surgery are essential for optimal outcomes.