臨床サルコイドーシスを合併した甲状腺乳頭癌例

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A rare case of papillary carcinoma of the thyroid with systemic sarcoidosis is reported. A 63-year-old woman who had had operations for recurrent papillary carcinoma of the thyroid four times visited our department complaining of a lump in the right neck. Further examination revealed enlarged lymph nodes in the bilateral neck, the upper mediastinum and the bilateral hilum of the lung. Fine needle aspiration biopsy of the right cervical lymph node yielded papillary carcinoma. Serum lysozyme and ACE levels were beyond normal limits. She underwent bilateral neck dissection, and histopathological examination revealed papillary carcinoma in the right cervical lymph node and sarcoidosis in the left. Gallium scintigram performed after the operation showed uptakes in the upper mediastinum and the bilateral hilum of the lung. A tuberculin test was negative. We finally diagnosed her illness as recurrent papillary carcinoma of the thyroid in the right cervical lymph node, and systemic sarcoidosis in the left cervical, upper mediastinal and bilateral hilar lymph nodes. It seems very difficult to preoperatively differentiate thyroid carcinoma and sarcoidosis co-existing in the cervical lymph nodes. The management of cervical lymphadenopathy in thyroid carcinoma should not be changed because of the presence of sarcoidosis, and a neck dissection should be performed.
耳鼻咽喉科臨床学会の論文