How to treat diffuse sclerosing thyroid cancer? What are the characteristics of diffuse sclerosing thyroid cancer?

Diffuse thyroid disease is a disease of the thyroid gland. Common types of diffuse thyroid disease in clinic are nodular goiter (hereinafter referred to as nodular goiter), thyroid cancer (hereinafter referred to as thyroid cancer), Hashimoto's thyroiditis (hereinafter referred to as Hashimoto's disease), Graves' disease, etc. Since the treatment plans for each disease are different, it is necessary to make a qualitative diagnosis of such diseases before treatment. So, how to treat diffuse sclerosing thyroid cancer?

The morphological characteristics of diffuse sclerosing thyroid cancer are:

1. The tumor diffusely involves one or both thyroid glands;

2. Numerous irregular and short micropapillaries are formed, located in the small slits of lymphatic vessels, and there may also be solid cell nests;

3. A large number of squamous metaplastic foci;

4. A large amount of sand body calcification;

5. Obvious lymphocyte infiltration;

6. Obvious fibrosis.

DSV is most likely to be misdiagnosed as a benign diffuse thyroid disease, such as lymphocytic thyroiditis or subacute granulomatous thyroiditis.

How to treat diffuse sclerosing thyroid cancer

Papillary thyroid carcinoma: Classical papillary thyroid carcinoma often presents nodular changes, often accompanied by sand-like calcification, and has a clear boundary with the normal thyroid gland, while DSV erodes the entire thyroid lobe, with almost no remaining normal thyroid tissue structure.

Subacute thyroiditis: Subacute thyroiditis is a diffuse lesion in the thyroid gland. The lesion area is uneven, flake-like, or cloud-like with extremely low echoes. It can involve one lobe, but usually bilaterally, and is very easy to confuse. However, there is no sand-like calcification in the lesion area of ​​subacute thyroiditis.

Hashimoto's thyroiditis: Hashimoto's thyroiditis is a bilateral, symmetrical, diffuse change of the thyroid gland. The bilateral thyroid glands are diffuse and uneven, the parenchyma is rough and has low echogenicity, but is not accompanied by psammoma bodies. It may be accompanied by hyperthyroidism in the acute phase. The blood flow signal in the thyroid gland is extremely rich, while the DSV blood flow signal is sparse.

Nodular goiter: DSV is the least likely to be confused with nodular goiter, but those with cysts as the main manifestation are easily mistaken for benign, because cystic changes in thyroid cancer are rare, and cystic changes in DSV are rare. The distinguishing points are microcalcifications in the thyroid parenchyma and metastatic lymph nodes in the neck. Once DSV becomes cystic, it indicates a long course of disease and a high degree of malignancy, and almost all of them have metastasis to the cervical lymph nodes.

Cervical lymph nodes: Thyroid inflammation is often accompanied by hyperplastic changes in the central zone (zone VI). The lymph nodes are hypoechoic, located around the thyroid gland and trachea, about 5-7 mm, with parenchymal thickening and blood flow signal level 1. DSV lymph node metastasis is relatively standard, and there may be metastasis in zones VI, III, IV and the contralateral side. The metastatic lymph nodes range from 5 mm to 30 mm, are isoechoic, sand-like calcification and cystic changes, and the blood flow signal is rich at about level 2.

Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy and can be divided into multiple subtypes, of which diffuse sclerosing variant papillary carcinoma of thyroid (DSVPC) is one of them. This subtype mostly occurs in young people around 20 years old (5-35 years old), accounting for about 5% of PTC.