European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2026
Riedel thyroiditis mimicking malignancy: a fatal surgical outcome.
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Gündoğdu Yavuz, Çavlan Celal Emre, Tereci Oran Badel, Asya Orhan, Çeşmecioğlu Karavin Emine, Türköz Kemal, Yumuşakhuylu Ali Cemal
Аннотация
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.
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.