Diffuse sclerosing variant of papillary thyroid carcinoma (DSVPTC) is a rare variant, and the clinical characteristics were continuously debated. Here we described the clinical and sonographic characteristics of two cases.
The 17-year-old girl presented with neck swelling for one month, which was associated with mild dysphagia. Ultrasound showed bilateral multinodular goiter (MNG) and multiple cervical lymphadenopathies (LAPs). Blood test showed euthyroid with high anti-thyroid autoantibodies (ATA). The fine needle aspiration cytology (FNAC) showed positive for malignant cells. She received radical thyroidectomy and neck lymph node dissection (LND), and the pathology showed DSVPTC with multiple LN metastases, pT3N1b/cM0, stage I. 150mCi radioactive iodine (RAI) therapy was given, and the whole body scan (WBS) showed no residual functioning thyroid tissue and probably treatment response with minimal residual RAI-avid nodal metastasis at right thoracic inlet. There was no local recurrence or distant metastasis till 3-year follow-up.
Left neck mass was noted in health checkup in a 22-year-old male student. Blood test showed euthyroid and negative ATA. Ultrasound showed bilateral MNG and multiple cervical LAPs. The FNAC confirmed positive for malignant cells. He received radical thyroidectomy and neck LND, and the pathology showed DSVPTC with lymph node metastases, pT3N1b/cM0, stage I. He received 150mCi RAI therapy, and WBS showed probable RAI-avid malignancies at left cervical and upper mediastinal nodes. Local recurrent at left neck lymph nodes was noted one year later. He received neck LND again, and received another 150mCi RAI therapy. There was no local recurrence or distant metastasis till 4-year follow-up.
Both cases are diagnosed at young age. Both ultrasonography were characterized with diffusely involvement with scattered micro-calcification and multiple neck LAPs. Both pathology were characterized by diffusely involvement of bilateral thyroid with extensive squamous metaplasia, diffuse fibrosis, abundant lymphocytic infiltration and psammoma bodies, and positive extrathyroid extension and extranodal extension.