目的:通过对两个罕见病例的科学描述。手术切除多结节性甲状腺肿,随后的组织病理学研究显示结节病的孤立肺外表现,这种罕见的诊断包括症状学,临床发现,需要说明的是诊断和治疗管理。
方法:诊断:甲状腺左侧甲状腺冷淋巴结闪烁显像;超声引导穿刺(细胞学检查,非可疑)。
方法:选择性甲状腺切除术,没有宏观异常,手术策略和技术方面没有异常。组织病理学检查:甲状腺完整切除标本,肉芽肿性炎症与结节病一致。
方法:在以下诊断中没有结节病的进一步表现。
方法:超声,右甲状腺理想腺体的不均匀结节(37×30×35毫米),回声较差,周围血管形成;闪烁显像显示甲状腺的单焦自主性(实验室参数,血清甲状腺球蛋白水平升高[632ng/mL])。
方法:计划右半甲状腺切除术,证实甲状腺实质结节性结构,没有可疑淋巴结.组织病理学研究:33毫米卵泡,结节状,甲状腺实质包裹结构(诊断为滤泡性腺瘤);第二意见:甲状腺低分化癌,血管浸润生长,肉芽肿性炎,结节病型。程序意图:肿瘤委员会咨询后,在5周的时间间隔内完成甲状腺切除术(pT2pN0[0/1]V1L0G3R0),随后进行放射性碘消融治疗;18F-FDG-PET-CT(右肺上叶内若干非典型浸润)和支气管镜检查,未发现结节病的进一步表现.
结论:结节病被认为是一种罕见的多房性肉芽肿,尚未完全知道病因的全身性疾病,具有实质性异质性。在大多数情况下,它与肺有关,但可以在各种器官中表现出来。经常,肺外表现通常是偶然发现的组织学发现,需要进一步研究以找出其他表现,并排除肺部感染或其他肉芽肿过程(明确鉴别诊断)。治疗仅适用于有症状的器官表现,考虑到自发愈合率高和可能的副作用。
OBJECTIVE: By means of the scientific description of two uncommon cases who underwent. surgical resection of multinodous goiter and following histopathological investigation revealing isolated extrapulmonary manifestation of sarcoidosis, this uncommon diagnosis including symptomatology, clinical findings, diagnostic and therapeutic management is to be illustrated.
METHODS: Diagnostics: Scintigraphy of the thyroid gland with a left-thyroid cold node; ultrasound-guided puncture (cytological investigation, non-suspicious).
METHODS: Elective thyroidectomy with no macroscopic anomalies und no abnormal aspects with regard to surgical tactic and technique. Histopathological investigation: Complete resection specimen of the thyroid gland with granulomatous inflammation consistent with sarcoidosis.
METHODS: Uneventful with no further manifestations of sarcoidosis in the following diagnostics.
METHODS: Ultrasound, inhomogeneous node (37×30×35 mm) of the right thyroideal gland with echo-poor parts and peripheral vascularization; scintigraphy showing marginally compensated unifocal autonomy of the thyroid gland (laboratory parameters, increased serum level of thyroglobulin [632 ng/mL]).
METHODS: Planned right hemithyroidectomy with confirmed nodous structure of thyroid parenchyma, without suspicious lymph nodes. Histopathological investigation: 33-mm follicular, nodular, encapsulated structure of thyroid parenchyma (diagnosed as follicular adenoma); 2nd opinion: low-grade differentiated carcinoma of thyroid gland with angioinfiltrating growth and granulomatous inflammation of sarcoidosis type. Procedural intent: After tumor-board consultation, completing thyroidectomy was performed within a 5-weeks interval (pT2 pN0[0/1] V1 L0 G3 R0) with subsequent ablating radio\'active iodine therapy; 18 F-FDG-PET-CT (several atypical infiltrates within the right upper lobe of the lung) and bronchoscopy with no detection of further manifestation of sarcoidosis.
CONCLUSIONS: Sarcoidosis is considered a rare granulomatous multi-locular, systemic disease of not completely known etiopathogenesis with substantial heterogeneity. In most cases, it is associated with the lung, but which can become manifest in various organs. Frequently, extrapulmonary manifestations are usually detected as histological findings by coincidence, which require further investigation to find out additional manifestations as well as to exclude florid infection or other granulomatous processes (clarifying competently differential diagnosis). Therapy is only indicated in symptomatic organ manifestations, taking into account the high rate of spontaneous healing and possible side effects.