Shear wave elastography diagnosis of the diffuse sclerosing variant of papillary thyroid carcinoma: A case report

Xue,Nianyu; Xu,Youfeng; Huang,Pintong; Zhang,Shengmin; Wang,Hongwei; Yu,Fei

doi:10.3892/mco.2016.932

Shear wave elastography diagnosis of the diffuse sclerosing variant of papillary thyroid carcinoma: A case report

Authors:
- Nianyu Xue
- Youfeng Xu
- Pintong Huang
- Shengmin Zhang
- Hongwei Wang
- Fei Yu
View Affiliations

Affiliations: Department of Ultrasonography, The Ningbo First Hospital, Ningbo, Zhejiang 315010, P.R. China, Department of Ultrasonography, The Second Affiliated Hospital of Zhejiang University Medical College, Hangzhou, Zhejiang 310000, P.R. China, Department of Pathology, The Ningbo First Hospital, Ningbo, Zhejiang 315010, P.R. China
Published online on: June 13, 2016 https://doi.org/10.3892/mco.2016.932
Pages: 333-336

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The present study aimed to report the shear wave elastography (SWE) findings in a patient with the diffuse sclerosing variant of papillary thyroid carcinoma (DSVPTC). Since patients with DSVPTC may present with typical clinicopathological features and initially appear to have Hashimoto's thyroiditis, a thorough clinical evaluation and an early diagnosis are important. A 20-year-old female patient presented with a 1‑month history of a neck mass and sore throat. Conventional ultrasound and SWE were performed using an AIXPLORER system with 14‑5 MHz linear transducer. The patient had undergone total thyroidectomy and bilateral neck lymph node dissection, and an intraoperative pathology consultation to confirm the malignancy of lymph node metastasis. Pathological diagnosis was DSVPTC in both lobes, with lymph node metastases in the bilateral neck. The clinical presentation and serological findings were all indicative of Hashimoto's thyroiditis. Thyroid ultrasonography revealed diffuse enlargement of the both lobes, heterogenous echogenicity without mass formation, diffuse scattered microcalcifications and poor vascularization. SWE revealed stiff values of the thyroid: The mean stiffness was 99.7 kpa, the minimum stiffness was 59.1 kpa and the maximum stiffness was 180.1 kpa. The maximum stiffness of the DSVPTC (180.1 kpa) was higher compared with the diagnostic criteria of malignant thyroid nodules (65 kPa). SWE may be considered as a novel and valuable method to diagnose DSVPC.

View Figures

View References

1	Vickery AL Jr, Carcangiu ML, Johannessen JV and Sobrinho-Simoes M: Papillary carcinoma. Semin Diagn Pathol. 2:90–100. 1985.PubMed/NCBI
2	Lam AK, Lo CY and Lam KS: Papillary carcinoma of thyroid: A 30-yr clinicopathological review of the histological variants. Endocr Pathol. 16:323–330. 2005. View Article : Google Scholar : PubMed/NCBI
3	Thompson LD, Wieneke JA and Heffess CS: Diffuse sclerosing variant of papillary thyroid carcinoma: A clinicopathologic and immunophenotypic analysis of 22 cases. Endocr Pathol. 16:331–348. 2005. View Article : Google Scholar : PubMed/NCBI
4	Chow SM, Chan JK, Law SC, Tang DL, Ho CM, Cheung WY, Wong IS and Lau WH: Diffuse sclerosing variant of papillary thyroid carcinoma-clinical features and outcome. Eur J Surg Oncol. 29:446–449. 2003. View Article : Google Scholar : PubMed/NCBI
5	Carcangiu ML and Bianchi S: Diffuse sclerosing variant of papillary thyroid carcinoma. Clinicopathologic study of 15 cases. Am J Surg Pathol. 13:1041–1049. 1989. View Article : Google Scholar : PubMed/NCBI
6	Imamura Y, Kasahara Y and Fukuda M: Multiple brain metastases from a diffuse sclerosing variant of papillary carcinoma of the thyroid. Endocr Pathol. 11:97–108. 2000. View Article : Google Scholar : PubMed/NCBI
7	Akaishi J, Sugino K, Kameyama K, Masaki C, Matsuzu K, Suzuki A, Uruno T, Ohkuwa K, Shibuya H, Kitagawa W, et al: Clinicopathologic features and outcomes in patients with diffuse sclerosing variant of papillary thyroid carcinoma. World J Surg. 39:1728–1735. 2015. View Article : Google Scholar : PubMed/NCBI
8	Falvo L, Giacomelli L, D'Andrea V, Marzullo A, Guerriero G and de Antoni E: Prognostic importance of sclerosing variant in papillary thyroid carcinoma. Am Surg. 72:438–444. 2006.PubMed/NCBI
9	Chen CC, Chen WC, Peng SL and Huang SM: Diffuse sclerosing variant of thyroid papillary carcinoma: Diagnostic challenges occur with Hashimoto's thyroiditis. J Formos Med Assoc. 112:358–362. 2013. View Article : Google Scholar : PubMed/NCBI
10	Fukushima M, Ito Y, Hirokawa M, Akasu H, Shimizu K and Miyauchi A: Clinicopathologic characteristics and prognosis of diffuse sclerosing variant of papillary thyroid carcinoma in Japan: An 18-year experience at a single institution. World J Surg. 33:958–962. 2009. View Article : Google Scholar : PubMed/NCBI
11	Regalbuto C, Malandrino P, Tumminia A, Le Moli R, Vigneri R and Pezzino V: A diffuse sclerosing variant of papillary thyroid carcinoma: Clinical and pathologic features and outcomes of 34 consecutive cases. Thyroid. 21:383–389. 2011. View Article : Google Scholar : PubMed/NCBI
12	Marshall CB: Diffuse sclerosing variant of papillary thyroid carcinoma preoperative diagnosis through imaging and cytology allows for optimal patient care. Pathology Case Reviews. 20:125–128. 2015. View Article : Google Scholar
13	Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JW and Wiersinga W: European Thyroid Cancer Taskforce: European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol. 154:787–803. 2006. View Article : Google Scholar : PubMed/NCBI
14	Kim HS, Han BK, Shin JH, Ko EY, Sung CO, Oh YL and Song SY: Papillary thyroid carcinoma of a diffuse sclerosing variant: Ultrasonographic monitoring from a normal thyroid gland to mass formation. Korean J Radiol. 11:579–582. 2010. View Article : Google Scholar : PubMed/NCBI
15	Martín-Pérez E, Larrañaga E and Serrano P: Diffuse sclerosing variant of papillary carcinoma of the thyroid. Eur J Surg. 164:713–715. 1998. View Article : Google Scholar : PubMed/NCBI
16	Sheu SY, Schwertheim S, Worm K, Grabellus F and Schmid KW: Diffuse sclerosing variant of papillary thyroid carcinoma: Lack of BRAF mutation but occurrence of RET/PTC rearrangements. Mod Pathol. 20:779–787. 2007. View Article : Google Scholar : PubMed/NCBI
17	Zhang Y, Xia D, Lin P, Gao L, Li G and Zhang W: Sonographic findings of the diffuse sclerosing variant of papillary carcinoma of the thyroid. J Ultrasound Med. 29:1223–1226. 2010.PubMed/NCBI
18	Shuzhen C: Comparison analysis between conventional ultrasonography and ultrasound elastography of thyroid nodules. Eur J Radiol. 81:1806–1811. 2012. View Article : Google Scholar : PubMed/NCBI
19	Wang Y, Dan HJ, Dan HY, Li T and Hu B: Differential diagnosis of small single solid thyroid nodules using real-time ultrasound elastography. J Int Med Res. 38:466–472. 2010. View Article : Google Scholar : PubMed/NCBI
20	Liu BX, Xie XY, Liang JY, Zheng YL, Huang GL, Zhou LY, Wang Z, Xu M and Lu MD: Shear wave elastography versus real-time elastography on evaluation thyroid nodules: A preliminary study. Eur J Radiol. 83:1135–1143. 2014. View Article : Google Scholar : PubMed/NCBI
21	Magri F, Chytiris S, Capelli V, Alessi S, Nalon E, Rotondi M, Cassibba S, Calliada F and Chiovato L: Shear wave elastography in the diagnosis of thyroid nodules: Feasibility in the case of coexistent chronic autoimmune Hashimoto's thyroiditis. Clin Endocrinol (Oxf). 76:137–141. 2012. View Article : Google Scholar : PubMed/NCBI
22	Lee EJ, Jung HK, Ko KH, Lee JT and Yoon JH: Diagnostic performances of shear wave elastography: Which parameter to use in differential diagnosis of solid breast masses? Eur Radiol. 23:1803–1811. 2013. View Article : Google Scholar : PubMed/NCBI
23	Liu B, Liang J, Zheng Y, Xie X, Huang G, Zhou L, Wang W and Lu M: Two-dimensional shear wave elastography as promising diagnostic tool for predicting malignant thyroid nodules: A prospective single-centre experience. Eur Radiol. 25:624–634. 2015. View Article : Google Scholar : PubMed/NCBI
24	Veyrieres JB, Albarel F, Lombard JV, Berbis J, Sebag F, Oliver C and Petit P: A threshold value in Shear Wave elastography to rule out malignant thyroid nodules: A reality? Eur J Radiol. 81:3965–3972. 2012. View Article : Google Scholar : PubMed/NCBI
25	Sebag F, Vaillant-Lombard J, Berbis J, Griset V, Henry JF, Petit P and Oliver C: Shear wave elastography: A new ultrasound imaging mode for the differential diagnosis of benign and malignant thyroid nodules. J Clin Endocrinol Metab. 95:5281–5288. 2010. View Article : Google Scholar : PubMed/NCBI