模拟恶性肿瘤的里德尔甲状腺炎：一例致命的手术结局

文献信息

中文摘要

目的： 里德尔甲状腺炎（RT）是一种罕见的纤维炎性疾病，在临床和影像学上可模拟恶性肿瘤。我们报告一例异常广泛且最终致命的病例，并强调其诊断和治疗教训。
方法： 一例40岁男性的病例报告，回顾临床、影像学、组织病理学和随访数据，按照CARE指南报告。
结果： 患者表现为右侧颈胸肿块（64×45×115 mm），环形包绕颈总动脉、锁骨下动脉和无名血管，并延伸至纵隔。三次组织学操作均无诊断结果，FDG PET/CT显示强烈摄取（SUVmax 8.15）。由于不能排除恶性肿瘤，进行了根治性整块切除术。病程并发双侧声带麻痹、霍纳综合征、纵隔炎、骨髓炎和气管无名动脉瘘。组织学显示闭塞性静脉炎、席纹状纤维化和74个IgG4阳性浆细胞/HPF（IgG4:IgG 44%），尽管血清IgG4正常，仍确认RT。患者于术后约20个月死于复发性气管无名动脉瘘。
结论： RT可模拟恶性肿瘤，当因诊断不确定性而进行根治性手术时，可能致命。在考虑根治性手术前，充分的组织取样并加做IgG4免疫染色至关重要。

英文摘要

PURPOSE: Riedel thyroiditis (RT) is a rare fibroinflammatory disorder that can mimic malignancy clinically and radiologically. We report an unusually extensive, ultimately fatal case and highlight its diagnostic and therapeutic lessons.
METHODS: Case report of a 40-year-old man, with review of the clinical, imaging, histopathological and follow-up data, reported in accordance with the CARE guidelines.
RESULTS: The patient presented with a right cervicothoracic mass (64 × 45 × 115 mm) circumferentially encasing the common carotid, subclavian and innominate vessels with mediastinal extension. Three tissue procedures were non-diagnostic and FDG PET/CT showed intense uptake (SUVmax 8.15). Radical en bloc resection was undertaken because malignancy could not be excluded. The course was complicated by bilateral vocal-cord paralysis, Horner syndrome, mediastinitis, osteomyelitis and a tracheo-innominate fistula. Histology showed obliterative phlebitis, storiform fibrosis and 74 IgG4-positive plasma cells/HPF (IgG4:IgG 44%), confirming RT despite normal serum IgG4. The patient died of a recurrent tracheo-innominate fistula approximately 20 months postoperatively.
CONCLUSION: RT can mimic malignancy and, when radical surgery is undertaken for diagnostic uncertainty, may prove fatal. Adequate tissue sampling with IgG4 immunostaining is essential before contemplating radical surgery.