2024年 · 第39卷第12期

A 36-year-old female was admitted to hospital mainly because of "parathyroid cyst found in physical examination for more than 2 months". Physical examination: A mass about 3 cm ×2 cm in size was palpable at the lower pole of the left thyroid gland, with good mobility and no tenderness, and no swollen lymph nodes were palpable in the neck. Laboratory tests: serum parathyroid hormone 47.7 pg/ml, serum calcium 2.30 mmol/L, serum phosphorus 0.97 mmol/L. Ultrasound examination showed that a cystic anechoic with a size of about 31 mm ×19 mm was seen on the dorsal side of the left lobe of the thyroid gland, with clear boundary, thin wall and good internal sound transmission. CDFI: No obvious blood flow signal was seen. Left parathyroid cyst suggested (Figure 1). Ultrasound-guided cyst puncture was performed, and the measurement of parathyroid hormone in cystic fluid was 179 pg/ml (normal reference value: 15-65 pg/ml). A non-functional parathyroid cyst was diagnosed. Ultrasound-guided sclerotherapy of parathyroid cyst was performed. After local infiltration anesthesia, 18G disposable puncture needle was punctured into the cyst under ultrasound guidance, and 6 ml of colorless and clear liquid was withdrawn (Figure 2), followed by injection of normal saline to rinse the cyst cavity, and 10 ml of laurosterol injection was injected to rinse the sclerotherapy multiple times. The patients had no complications such as bleeding, choking and coughing after drinking water, hoarseness and dyspnea. After 1 year follow-up, no obvious abnormalities were found in laboratory examination, and ultrasound examination showed that the cyst cavity gradually shrank to disappear without recurrence.

A 53-year-old female was seen "due to neck discomfort for 1 week". Specialist physical examination: A mass can be palpable in the left lobe of the thyroid gland, about 2 cm ×1 cm in size, with good mobility with swallowing. Thyroid ultrasonography showed that a solid hypoechoic nodule with a size of about 2.0 cm ×1.2 cm could be detected in the left lobe of the thyroid gland, with patchy strong echoes (Figure 1), which was classified as Class 4b by TI-RADS; Several nodular isoechoes can be seen at the edge, the larger one is about 0.5 cm ×0.4 cm in size. Radical thyroidectomy was performed, and one nodule in the left lobe of the thyroid was explored during the operation, with a size of about 1.5 cm ×2.0 cm. Intraoperative rapid pathological examination showed that follicular epithelial cells proliferated in some fibrous tissues (left lobe of thyroid gland), the cytoplasm was eosinophilic, showing multinodular growth, and peripheral Hashimoto's disease. Left thyroid lobe and isthmus resection + prelaryngeal and pretracheal lymph node dissection were performed. Postoperative pathological examination showed that the tumor showed multi-nodular growth, diffuse infiltration of thyroid parenchyma, and wide collagen fiber tissue was interspersed between the nodules; The boundaries between tumor cells are clear, arranged into follicular structures of different sizes, and varying amounts of glia can be seen in some follicular cavities; Tumor cells are rich in cytoplasm, which is filled with strongly eosinophilic particles, and the nuclei vary in size (Figure 2); The nucleus of focal tumor cells is enlarged and groundglass-like, with nuclear grooves and intranuclear inclusions, which are arranged in a papillary shape (Figure 3); Lymphocyte infiltration in the surrounding thyroid parenchyma shows lymphoid follicular structure, and thyroid follicular epithelial cells are rich in cytoplasm, eosinophilic, and arranged in follicles (Figure 4). Pathological diagnosis: Eosinophilic carcinoma of the left lobe of the thyroid gland, approx. 3 cm ×2 cm ×2 cm; papillary carcinoma, approximately 0.2 cm in diameter; Hashimoto's disease. Immunohistochemical examination of papillary carcinoma revealed: CK19 (+), CyclinD1 (+) (FIG. 5), CD56 (−); Immunohistochemical examination of eosinophilic carcinoma revealed: CD56 (+), CyclinD1 (+), CD34 (-), D2-40 (-), p53 (small amount +) (Figure 6). At present, the patient was followed up for 6 months, and there was no adverse prognosis.

A 68-year-old male was seen for "abdominal pain for 1 year, frequent urination and urgency for 20 days". Routine blood test showed: white blood cell count 8.37×10⁹/L, neutrophil percentage 77.5%; Routine urine examination showed: white blood cell count 5 455.4/μ L, red blood cell count 61/μ L; erythrocyte sedimentation rate 96 mm/h; Serum CEA 4.99 ng/ml, CA199 8.97 U/ml. Color ultrasound examination showed: right kidney cyst, bladder wall locally thickened, less smooth, and prostate enlargement. Enhanced CT examination showed localized thickening of the wall of sigmoid colon, which was considered to be a high possibility of colon cancer. A patchy abnormal density shadow in the front and upper part of the bladder, considering the possibility of urachal infection. The bladder wall is unevenly thickened and blurred (Figure 1). Colonoscopy results: colonic mass 20 cm from anus, endoscopic failure, biopsy pathology results: moderately differentiated adenocarcinoma. Cystoscopy after admission: bilateral ureteral orifices were normal, the triangular area was congested and red, and multiple follicular-like changes were seen in the bubble area, ranging from about 3 to 4 cm. Preoperative considerations for diagnosis: (1) sigmoid colon cancer involving bladder? (2) The nature of urachal tumor is to be investigated. Laparoscopic exploration revealed a huge mass of about 12 cm ×9 cm in the lower segment of sigmoid colon and urachus, involving the appendix and the top of the bladder (Figure 2). Laparoscopic expanded radical resection of sigmoid colon cancer, partial resection of urachus mass and bladder, and appendectomy were performed (part of the bladder wall was removed along the mass during the operation, and the bladder wall was obviously thickened; the bladder wall margin was sent to freeze for pathological examination: fibroadipose and smooth muscle tissue showed chronic inflammation, accompanied by lymphoid tissue hyperplasia, and some cells had mild atypical) (Figure 3). The postoperative pathological results showed that the differentiated adenocarcinoma of the colon (non-special type), with a maximum diameter of 6 cm, penetrated the whole thickness of the intestinal wall, with low budding, no vascular invasion and no nerve invasion. The muscular layer of the bladder wall was involved, the wall of the appendix was involved, and the urachus was not involved. There was no invasive carcinoma involvement (no adenoma) in the proximal and distal margin, and no invasive carcinoma accumulation in the circumferential margin. There was no cancer involvement in the broken end of urachus, bladder and appendix. Metastatic lymph node carcinoma (1/18 peri-intestinal, 0/2 lymph nodes in group 252, 0/3 lymph nodes in group 253), with one tumor nodule. Tumor stage: pT4bN1aM1a.