以颅眶区转移为首发表现的隐匿性甲状腺滤泡癌一例

Occult Follicular Thyroid Carcinoma Initially Presenting as Cranio-orbital Metastasis: A Case Report

摘要:

目的 探讨以颅眶区转移为首发表现的隐匿性甲状腺滤泡癌（FTC）的临床特点、诊断及治疗策略。方法 回顾性分析1例以右眼外突伴视物不清为首发症状的FTC患者临床资料，并结合文献进行讨论。结果 患者为61岁女性，影像学提示右侧眼眶外上方占位伴骨质破坏。患者先后接受颅眶病损切除术、残余甲状腺切除术及3次放射性碘（131I）治疗。术后病理证实颅眶病变为转移性FTC，而甲状腺原发灶未见明确恶性证据。治疗后，患者血清甲状腺球蛋白（Tg）水平显著下降，残余病灶及骨转移灶明显缩小，突眼症状好转，随访期间未见肿瘤进展。结论 以颅眶区转移为首发的FTC极为罕见，且原发灶可呈良性表观，诊断困难。对于伴有骨质破坏的颅眶区甲状腺来源病变，应警惕隐匿性FTC转移。综合运用病理、免疫组化、血清Tg监测及核医学显像有助于明确诊断与制定治疗方案。

Abstract:

Objective To investigate the clinical characteristics, diagnostic approaches, and therapeutic strategies for occult follicular thyroid carcinoma (FTC) presenting initially as cranio-orbital metastasis.Methods The clinical data of a patient with FTC who presented with right-sided exophthalmos and blurred vision as the initial symptoms were retrospectively analyzed, and a review of relevant literature was conducted.Results The patient was a 61-year-old female. Imaging revealed a space-occupying lesion in the superolateral aspect of the right orbit accompanied by bone destruction. The patient sequentially underwent cranio-orbital lesion resection, completion thyroidectomy, and three sessions of radioactive iodine (131I) therapy. Postoperative pathological examination confirmed the cranio-orbital lesion as metastatic FTC, whereas multiple examinations of the primary thyroid lesion showed no definitive evidence of malignancy. Following treatment, the patient"s serum thyroglobulin (Tg) levels decreased significantly. Both the residual cranio-orbital lesion and bone metastases exhibited marked shrinkage, and the exophthalmos improved. No tumor progression was observed during the follow-up period.Conclusion FTC presenting initially as cranio-orbital metastasis is exceedingly rare, and the primary tumor may exhibit benign morphological features, posing significant diagnostic challenges. For cranio-orbital lesions of thyroid origin accompanied by bone destruction, clinicians should maintain a high index of suspicion for occult FTC metastasis. A comprehensive approach integrating histopathology, immunohistochemistry, serum Tg monitoring, and nuclear medicine imaging is essential for establishing a definitive diagnosis and formulating an effective treatment regimen.