DOI QR코드

DOI QR Code

Concurrent Medullary Carcinoma and Hashimoto's Thyroiditis: A Case Report with an Emphasis on US Features

하시모토 갑상선염과 동반된 갑상선 수질암의 증례 보고: 초음파 소견을 중심으로

  • Hyoung Yeob Kim (Department of Radiology, Myongji Hospital, Hanyang University, College of Medicine) ;
  • Noh Hyuck Park (Department of Radiology, Myongji Hospital, Hanyang University, College of Medicine)
  • 김형엽 (한양대학교 의과대학 명지병원 영상의학과) ;
  • 박노혁 (한양대학교 의과대학 명지병원 영상의학과)
  • Received : 2022.07.29
  • Accepted : 2023.02.08
  • Published : 2023.09.01

Abstract

Medullary thyroid carcinoma (MTC) is a rare malignancy that originates from the parafollicular cells of the thyroid gland. Hashimoto's thyroiditis (HT) is an autoimmune thyroid disease and is the most common cause of hypothyroidism. Previous studies have frequently discussed the association among HT, papillary thyroid carcinoma, and thyroid lymphoma. However, there have been few reports on the ultrasonographic findings of concomitant HT and MTC. In the present case, a heterogeneous hypoechoic background parenchymal echogenicity, with intraglandular echogenic strands, and increased vascularity were observed. A concurrent, ill-defined, parallel-oriented, heterogeneous hypoechoic mass with central microcalcifications was located at the left thyroid gland, consistent with reported US findings of medullary thyroid carcinoma except for an ill-defined margin in our case.

갑상선 수질암은 갑상선의 소포곁세포에서 기원하는 드문 악성 종양이다. 하시모토 갑상선염은 자가면역성 갑상선 질환의 일종으로, 갑상선 기능 저하증의 가장 흔한 원인이다. 하시모토 갑상선염과 갑상선 유두암 및 갑상선 림프종 사이의 연관성은 이전 연구에서 자주 논의되었다. 하지만 하시모토 갑상선염과 동반된 갑상선 수질암의 초음파 소견에 대한 보고는 거의 없었다. 증례에서 갑상선 실질은 미만성의 비균질 저에코 소견 및 내부에 에코발생 가닥이 관찰되었으며, 색 도플러 영상에서 증가된 혈관분포를 보였다. 이와 동시에 불분명한 경계의 평행한 방향성의 저에코성 종괴가 좌측 갑상선의 중간에서 하부 극에 관찰되었으며, 내부에는 중심 미세석회화를 보였고, 이는 불분명한 경계를 보인다는것을 제외하면 이전의 보고된 갑상선 수질암의 초음파 소견과 같았다.

Keywords

References

  1. Resende de Paiva C, Gronhoj C, Feldt-Rasmussen U, von Buchwald C. Association between Hashimoto's thyroiditis and thyroid cancer in 64,628 patients. Front Oncol 2017;7:53
  2. Saller B, Moeller L, Gorges R, Janssen OE, Mann K. Role of conventional ultrasound and color Doppler sonography in the diagnosis of medullary thyroid carcinoma. Exp Clin Endocrinol Diabetes 2002;110:403-407 https://doi.org/10.1055/s-2002-36546
  3. Liu MJ, Liu ZF, Hou YY, Men YM, Zhang YX, Gao LY, et al. Ultrasonographic characteristics of medullary thyroid carcinoma: a comparison with papillary thyroid carcinoma. Oncotarget 2017;8:27520-27528 https://doi.org/10.18632/oncotarget.15897
  4. Lee S, Shin JH, Han BK, Ko EY. Medullary thyroid carcinoma: comparison with papillary thyroid carcinoma and application of current sonographic criteria. AJR Am J Roentgenol 2010;194:1090-1094 https://doi.org/10.2214/AJR.09.3276
  5. Gul K, Dirikoc A, Kiyak G, Ersoy PE, Ugras NS, Ersoy R, et al. The association between thyroid carcinoma and Hashimoto's thyroiditis: the ultrasonographic and histopathologic characteristics of malignant nodules. Thyroid 2010;20:873-878 https://doi.org/10.1089/thy.2009.0118
  6. Ohmori N, Miyakawa M, Ohmori K, Takano K. Ultrasonographic findings of papillary thyroid carcinoma with Hashimoto's thyroiditis. Intern Med 2007;46:547-550 https://doi.org/10.2169/internalmedicine.46.1901
  7. Yang L, Zhao H, He Y, Zhu X, Yue C, Luo Y, et al. Contrast-enhanced ultrasound in the differential diagnosis of primary thyroid lymphoma and nodular Hashimoto's thyroiditis in a background of heterogeneous parenchyma. Front Oncol 2021;10:597975
  8. Mousa U, Gursoy A, Ozdemir H, Moray G. Medullary thyroid carcinoma in a patient with Hashimoto's thyroiditis diagnosed by calcitonin washout from a thyroid nodule. Diagn Cytopathol 2013;41:644-646 https://doi.org/10.1002/dc.21850
  9. Turiano G. Sporadic micromedullary thyroid carcinoma and Hashimoto's thyroiditis: a case report and review of the literature. APMB 2018;106:A9
  10. Choi MR, Yoo SB, Kim JH. Sporadic medullary microcarcinoma in a male patient with concurrent Hashimoto's hypothyroidism and Kikuchi disease. Korean J Intern Med 2016;31:1184-1186 https://doi.org/10.3904/kjim.2014.395