title: A Case Report Demonstrating How the Clinical Presentation of the Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma Can Mimic Benign Riedel's Thyroiditis.
abstract: A 44-year-old female presented with a two-month history of a neck mass, sore throat, hoarseness, and intermittent dysphagia. Examination revealed a "woody" hard swelling arising from the right lobe of the thyroid. Clinically this was felt to be classical Riedel's thyroiditis (RT). Thyroid ultrasound showed a diffusely enlarged, low echogenicity thyroid with a multinodular goitre. An abnormal nodule extending across the isthmus was noted. Following a nondiagnostic fine needle aspiration, an open core biopsy was performed. This showed dense sclerotic fibrosis punctuated by nodular mononuclear inflammatory cells, which obscured follicular epithelial cells consistent with a fibrosing thyroiditis (Riedel's thyroiditis). A biopsy of pretracheal lymph nodes showed a sclerotic process throughout the lymph nodes and nests of epithelium bands with squamous differentiation obscured by a fibrous process. These findings raised the differential diagnosis of diffuse sclerosing variant of papillary thyroid carcinoma (DSV-PTC) with metastasis to lymph nodes. A total thyroidectomy and pretracheal lymph node dissection were performed. The final histological diagnosis was DSV-PTC. When managing a patient with presumed RT it is important to consider malignancy in the differential. DSV-PTC is one of the more aggressive forms of thyroid cancer but with early diagnosis and appropriate treatment patients may have excellent outcomes.
authors.affiliation: Department of Endocrinology, South Infirmary Victoria University Hospital, Cork, Ireland.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Walsh
authors.affiliation: Department of Endocrinology, South Infirmary Victoria University Hospital, Cork, Ireland.
authors.forename: Tomas P
authors.initials: TP
authors.lastname: Griffin
authors.affiliation: Department of Pathology, Cork University Hospital, Cork, Ireland.
authors.forename: Carmel B
authors.initials: CB
authors.lastname: Ryan
authors.affiliation: Department of Pathology, Cork University Hospital, Cork, Ireland.
authors.forename: James
authors.initials: J
authors.lastname: Fitzgibbon
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Sheahan
authors.affiliation: Department of Endocrinology, South Infirmary Victoria University Hospital, Cork, Ireland.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Murphy