三种不同病理亚型的甲状腺癌共存并发原发性甲状腺结核：病例报道

Coexistence of Three Distinct Pathological Subtypes of Thyroid Carcinoma with Primary Thyroid Tuberculosis: A Case Report

摘要:

本文报道一例极为罕见的甲状腺病例：甲状腺乳头状癌 (Papillary Thyroid Carcinoma, PTC)、甲状腺未分化癌 (Anaplastic Thyroid Carcinoma, ATC)、甲状腺低分化癌 (Poorly Differentiated Thyroid Carcinoma, PDTC)三种病理亚型共存，并同时合并原发性甲状腺结核感染。患者为54岁男性，因双侧甲状腺结节入院。行甲状腺全切及双侧中央区+右侧颈淋巴结清扫术，术后病理证实三种恶性肿瘤并存，且右侧甲状腺内见干酪样坏死性肉芽肿，结核分枝杆菌PCR阳性。胸部CT、痰培养及T-SPOT检查排除其他部位结核。术后给予抗结核治疗（2HRZE/4HR）、辅助放化疗、靶向治疗（多纳非尼）及放射性碘-131治疗。术后随访1年余，患者无肿瘤复发及结核播散。该病例提示，对于复杂性甲状腺占位，需警惕多亚型肿瘤及合并感染可能；早期根治性手术联合个体化综合治疗是改善预后的关键。

Abstract:

This report presents an extremely rare case of the thyroid with coexistence of three distinct pathological subtypes—papillary thyroid carcinoma (PTC), anaplastic thyroid carcinoma (ATC), and poorly differentiated thyroid carcinoma (PDTC)—alongside primary thyroid tuberculosis. A 54-year-old male presented with bilateral thyroid nodules. He underwent total thyroidectomy with central and right lateral neck dissection. Postoperative pathology confirmed the three malignancies coexisting with caseating granulomatous inflammation; PCR for Mycobacterium tuberculosis was positive. Extrathyroidal tuberculosis was excluded by chest CT, sputum culture, and T-SPOT. Postoperatively, the patient received anti-tuberculosis therapy (2HRZE/4HR), adjuvant chemoradiotherapy, targeted therapy (donafenib), and radioactive iodine-131 therapy. At over one year of follow-up, the patient remains disease-free without tuberculosis reactivation. This case highlights the importance of considering multiple tumor subtypes and concurrent infection in complex thyroid lesions. Early radical surgery combined with individualized multimodal treatment is crucial for improving outcomes.