Gland surgery · 2026
Primary adenoid cystic carcinoma of the thyroid gland: a case report and literature review.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Zhao Yueyao, Zhao Lina, Wei Zhihong, Huang Quanfeng, Zhang Bei
Аннотация
BACKGROUND: Primary thyroid adenoid cystic carcinoma (PT-ACC) is an extremely rare malignant tumor, accounting for a negligible proportion of thyroid malignancies. It predominantly affects men and lacks unified clinical diagnostic criteria, resulting in a high rate of misdiagnosis. Owing to the scarcity of reported cases in female patients, we present this case with detailed ultrasonographic findings, pathological features, and 18-month follow-up data to supplement clinical evidence in this underrepresented population and to aid differential diagnosis and treatment strategies.
CASE DESCRIPTION: A 39-year-old woman with a 2-year history of hypertension, well controlled with oral medication, was found to have a thyroid nodule [Thyroid Imaging Reporting and Data System (TI-RADS) category 4B] during a routine physical examination in May 2021. Ultrasonography revealed a hypoechoic nodule measuring 20 mm × 16 mm × 24 mm located in the right thyroid lobe and isthmus, with an irregular shape and increased intranodular vascularity. Preoperative differential diagnoses included follicular carcinoma, atypical adenoma, and medullary carcinoma; the latter was excluded based on normal serum calcitonin levels. The patient underwent total thyroidectomy with central lymph node dissection and bilateral recurrent laryngeal nerve exploration, followed by postoperative radiotherapy (total dose of 60 Gy delivered in 30 fractions, 5 fractions per week). Chemotherapy was not administered. Postoperative pathological examination and immunohistochemical analysis confirmed the diagnosis of PT-ACC. During an 18-month follow-up period (up to December 2022), no evidence of local recurrence, distant metastasis, or treatment-related adverse events was observed, and the patient reported a normal quality of life.
CONCLUSIONS: Ultrasonography combined with TI-RADS classification is valuable for the preliminary screening of PT-ACC. In female patients presenting with thyroid nodules characterized by irregular morphology and abnormal vascularity, ACC should be considered in the differential diagnosis. Early radical surgical resection combined with postoperative radiotherapy may improve prognosis. This case adds to the limited clinical data on thyroid ACC in female patients and provides a useful reference for clinical diagnosis and management.
CASE DESCRIPTION: A 39-year-old woman with a 2-year history of hypertension, well controlled with oral medication, was found to have a thyroid nodule [Thyroid Imaging Reporting and Data System (TI-RADS) category 4B] during a routine physical examination in May 2021. Ultrasonography revealed a hypoechoic nodule measuring 20 mm × 16 mm × 24 mm located in the right thyroid lobe and isthmus, with an irregular shape and increased intranodular vascularity. Preoperative differential diagnoses included follicular carcinoma, atypical adenoma, and medullary carcinoma; the latter was excluded based on normal serum calcitonin levels. The patient underwent total thyroidectomy with central lymph node dissection and bilateral recurrent laryngeal nerve exploration, followed by postoperative radiotherapy (total dose of 60 Gy delivered in 30 fractions, 5 fractions per week). Chemotherapy was not administered. Postoperative pathological examination and immunohistochemical analysis confirmed the diagnosis of PT-ACC. During an 18-month follow-up period (up to December 2022), no evidence of local recurrence, distant metastasis, or treatment-related adverse events was observed, and the patient reported a normal quality of life.
CONCLUSIONS: Ultrasonography combined with TI-RADS classification is valuable for the preliminary screening of PT-ACC. In female patients presenting with thyroid nodules characterized by irregular morphology and abnormal vascularity, ACC should be considered in the differential diagnosis. Early radical surgical resection combined with postoperative radiotherapy may improve prognosis. This case adds to the limited clinical data on thyroid ACC in female patients and provides a useful reference for clinical diagnosis and management.