模拟甲状腺肿瘤的甲状腺床神经鞘瘤：一例病例报告

文献信息

中文摘要

甲状腺内神经鞘瘤罕见，而甲状腺床神经鞘瘤更为少见，仅有少数病例报告，且术前鉴别困难。我们报告一名33岁女性，左侧颈部肿块可随吞咽移动，甲状腺功能正常。灰阶B型超声、彩色多普勒血流成像及超声造影显示为不均匀增强的TI-RADS 3病变，术前疑为滤泡性肿瘤。行细针穿刺（FNA）活检，未能获得明确的病理诊断，结果为Bethesda I类。她接受了左叶切除加峡部切除术，病理证实为甲状腺床神经鞘瘤，甲状腺实质未受累；术后恢复良好，甲状腺功能正常。由于其发病率低，该肿瘤在超声上常被误认为甲状腺内结节。完全手术切除是一线治疗，总体预后良好。与甲状腺内神经鞘瘤不同，大多数甲状腺床病变可单独剜除而无需常规甲状腺切除术；对于致密粘连需行甲状腺半切除术，全甲状腺切除术很少需要。考虑到FNA的诊断价值低，对于影像学不典型、FNA无结论或甲状腺边缘不清的病变，建议进行病理科、放射科和外科的多学科会诊。如有需要，应进行超声引导下粗针活检（CNB），以制定适当的治疗方案。

英文摘要

Intrathyroidal schwannomas are rare, and thyroid-bed schwannomas are scarcer, with merely a few case reports and tough preoperative differentiation. We report a 33-year-old female with a swallowing-movable left neck mass and normal thyroid function. Gray-scale B-mode ultrasound, color Doppler flow imaging and contrast-enhanced ultrasound showed showed a heterogeneously enhanced TI-RADS 3 lesion preoperatively suspected as a follicular neoplasm. Fine-needle aspiration (FNA) biopsy was performed, which failed to yield a definitive pathological diagnosis and yielded Bethesda category I. She received left lobectomy plus isthmectomy, and pathology confirmed thyroid-bed schwannoma sparing thyroid parenchyma; she recovered well with normal thyroid function postoperatively. Due to its low incidence, this tumor is often mistaken for an intrathyroidal nodule on ultrasound. Total surgical excision is the first-line therapy with good overall prognosis. Unlike intrathyroidal schwannomas, most thyroid-bed lesions can be enucleated alone without routine thyroidectomy; hemithyroidectomy is needed for dense adhesion, and total thyroidectomy is rarely required. Considering the low diagnostic value of FNA, multidisciplinary consultation of pathology, radiology and surgery is advised for lesions with atypical imaging, inconclusive FNA or ill-defined thyroid margins. Ultrasound-guided core needle biopsy (CNB) should be performed if needed to tailor proper treatment.