Ultrasounographic finding of thyroid nodule with squamous metaplasia: report of a case and review of literature

doi:10.16150/j.1671-2870.2019.04.008

Abstract

Abstract:

Objective: To investigate the ultrasounographic appearance of thyroid nodule with squamous metaplasia in conventional ultrasounography and contrast-enhanced ultrasounography (CEUS), so as to improve the understanding and diagnosis of the disease. Methods: The features on conventional ultrasounography and CEUS of thyroid nodule with squamous metaplasia in a patient were analyzed. The results in combination with pathological findings and relevant literatures were discussed. Results: The nodule was in the lower aspect of the right thyroid, contacting with the capsule. On conventional ultrasounographic examination, it appeared as an inhomogeneous hypoechoic, irregular and ill-defined nodule with microcalcification. CEUS showed slow wash-in and fast wash-out, obviously heterogeneous low enhancement. The final pathological result was nodular goiter with fibrous nodule forming squamous metaplasia. Conclusions: The ultrasounographic appearance of thyroid nodule with squamous metaplasia is not specific, and is similar to the features of papillary thyroid carcinoma. The final diagnosis depends on pathological examination of postoperative specimen.

Key words: Thyroid Nodule, Squamous metaplasia, Ultrasounography

CLC Number:

R736.1

KUANG Lijun, WANG Yi, LU Caifeng, FAN Jinfang, WU Min, ZHOU Wei. Ultrasounographic finding of thyroid nodule with squamous metaplasia: report of a case and review of literature[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(04): 423-427.

Figures/Tables 7

References 24

[1]	Pellicer DL, Sadow PM, Stephen A, et al. Atypical squamous metaplasia in a benign cystic thyroid nodule mimi-cking high-grade carcinoma[J]. Diagn Cytopathol, 2013, 41(8):706-709. doi: 10.1002/dc.22803 pmid: 22144088
[2]	Gage H, Hubbard E, Nodit L. Multiple squamous cells in thyroid fine needle aspiration: Friends or foes?[J]. Diagn Cytopathol, 2016, 44(8):676-681. doi: 10.1002/dc.23512 URL
[3]	Noh SJ, Cha EJ, Choi KH, et al. Papillary carcinoma of the thyroid with massive squamous metaplasia after fine needle aspiration: a potential diagnostic pitfall[J]. Acta Cytol, 2009, 53(5):605-607. doi: 10.1159/000325395 URL
[4]	Ryska A, Ludvíková M, Rydlová M, et al. Massive squamous metaplasia of the thyroid gland-- report of three cases[J]. Pathol Res Pract, 2006, 202(2):99-106. pmid: 16376021
[5]	Musso-Lassalle S, Butori C, Bailleux S, et al. A diagnostic pitfall: nodular tumor-like squamous metaplasia with Hashimoto's thyroiditis mimicking a sclerosing mucoepidermoid carcinoma with eosinophilia[J]. Pathol Res Pract, 2006, 202(5):379-383. pmid: 16488086
[6]	Niveditha SR, Geethamani V, Suguna BV, et al. Squamous metaplasia in a multinodular goiter: a case report[J]. Indian J Pathol Microbiol, 2003, 46(1):100-101.
[7]	Kobayashi T, Okamoto S, Maruyama H, et al. Squamous metaplasia with Hashimoto's thyroiditis presenting as a thyroid nodule[J]. J Surg Oncol, 1989, 40(2):139-142. pmid: 2915541
[8]	周萍, 周伟, 周建桥, 等. 甲状腺乳头状癌的灰阶超声造影特征与颈部淋巴结转移的关系[J]. 诊断学理论与实践, 2011, 10(1):45-49.
[9]	周伟, 倪晓枫, 叶廷军, 等. 超声引导下小于5 mm甲状腺结节细针穿刺细胞学检查与超声评估的应用价值[J]. 中国超声医学杂志, 2014, 30(1):7-10.
[10]	刘颖, 林僖, 李安华, 等. 甲状腺乳头状微小癌与非微小癌超声特征的对比研究[J]. 中国超声医学杂志, 2016, 32(9):769-772.
[11]	Leung AH, Kort KC, Khurana KK. Reparative change with extensive squamous metaplasia: a potential diagnostic pitfall on thyroid aspiration[J]. South Med J, 2010, 103(3):268-271. doi: 10.1097/SMJ.0b013e3181ce0e62 URL
[12]	Hirokawa M, Kuma S, Miyauchi A, et al. Morules in cribriform-morular variant of papillary thyroid carcinoma: Immunohistochemical characteristics and distinction from squamous metaplasia[J]. APMIS, 2004, 112(4-5):275-282. doi: 10.1111/j.1600-0463.2004.apm11204-0508.x URL
[13]	Goldberg HM, Harvey P. Squamous-cell cysts of the thyroid with special reference to the aetiology of squamous epithelium in the human thyroid[J]. Br J Surg, 1956, 43(182):565-569. doi: 10.1002/bjs.18004318203 URL
[14]	Goldman RL. Primary squamous cell carcinoma of the thyroid gland: Report of a case and review of the literature[J]. Am Surg, 1964, 30:247-252.
[15]	Nayak SK, Pai PK, Naik R, et al. Extensive squamous metaplasia in nodular goiter--a diagnostic dilemma in the fine needle aspiration (FNA) cytology--a case report[J]. Indian J Pathol Microbiol, 2002, 45(1):111-113.
[16]	Haugen BR, Alexander EK, Bible KC, et al. 2015 Ame-rican Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer[J]. Thyroid, 2016, 26(1):1-133. doi: 10.1089/thy.2015.0020 pmid: 26462967
[17]	Zhang B, Jiang YX, Liu JB, et al. Utility of contrast-enhanced ultrasound for evaluation of thyroid nodules[J]. Thyroid, 2010, 20(1):51-57. doi: 10.1089/thy.2009.0045 pmid: 20067379
[18]	周琦, 姜珏, 杜晓鹏, 等. 超声造影在甲状腺乳头状癌中的诊断价值[J]. 中国超声医学杂志, 2011, 27(7):595-597.
[19]	Bartolotta TV, Midiri M, Galia M, et al. Qualitative and quantitative evaluation of solitary thyroid nodules with contrast-enhanced ultrasound: initial results[J]. Eur Radiol, 2006, 16(10):2234-2241. doi: 10.1007/s00330-006-0229-y pmid: 16670868
[20]	付燕飚, 李百周, 王平. 甲状腺内的鳞状上皮结节一例[J]. 中华病理学杂志, 2013, 42(1):53-54.
[21]	Sahoo M, Bal CS, Bhatnagar D. Primary squamous-cell carcinoma of the thyroid gland: new evidence in support of follicular epithelial cell origin[J]. Diagn Cytopathol, 2002, 27(4):227-231. doi: 10.1002/dc.10178 URL
[22]	韦力, 梁前晖, 周军, 等. 原发性甲状腺鳞状细胞癌的超声表现和临床特点[J]. 中华超声影像学杂志, 2013, 22(10):869-872.
[23]	Shimaoka K, Tsukada Y. Squamous cell carcinomas and adenosquamous carcinomas originating from the thyroid gland[J]. Cancer, 1980, 46(8):1833-1842. pmid: 7427886
[24]	张红丽, 王华, 姜珏, 等. 结节性甲状腺肿的超声造影表现[J]. 中国超声医学杂志, 2013, 29(6):481-484.