Dezmoidni tumor u ležištu štitnjače: prikaz bolesnika

Ana Mijatović Karačić, Sanja Kusačić Kuna, Juraj Lukinović, Marina Šeronja Kuhar, Ivana Brnadić, Dražen Huić

Dezmoidni tumori su rijetke benigne tvorbe podrijetla vezivnog tkiva koje sporo rastu, ne metastaziraju, ali mogu invadirati okolna tkiva. Cilj izvješća je prikaz bolesnice s dezmoidnim tumorom razvijenim u ležištu lijevog režnja štitnjače nakon prethodnoga operacijskog zahvata totalne tireoidektomije zbog multinodularne guše s ekstirpacijom adenoma paratireoidne žlijezde u istom aktu. Zbog promuklosti i osjećaja bolnosti u ležištu štitnjače dvije godine nakon inicijalnog zahvata kod bolesnice je učinjen kontrolni ultrazvuk vrata koji verificira slabo ograničen, nehomogen, pretežno izoehogen čvor tvrde konzistencije u ležištu lijevog režnja štitnjače koji je po svojim ehografskim karakteristikama bio suspektan na malignu promjenu. Ciljana citološka punkcija opisuje rijetke vretenaste stanice, ali bez drugih elemenata za pobližu diferencijaciju. Stoga je ultrazvučni pregled dopunjen drugim slikovnim radiološkim metodama (kompjutorizirana tomografija i magnetska rezonancija) koje postavljaju sumnju na paragangliom ili adenom paratireoidne žlijezde, ali se nije mogla sa sigurnošću isključiti ni promjena druge etiologije. Zbog navedenog kod bolesnice je preporučena kirurška ekscizija koja je bila zahtjevna zbog tvrdoće navedene tvorbe. Patohistološki nalaz je odgovarao ekstraabdominalnoj fibromatozi, odnosno dezmoidnom tumoru s mogućom pojavom recidiva. Iako je dezmoidni tumor općenito benigna bolest, ponekad može biti lokalno invazivan s infiltracijom okolnih struktura oponašajući sliku malignog procesa uz otežanu potpunu kiruršku eksciziju koja je terapija izbora. Štoviše, unatoč potpunom uklanjanju čest je recidiv bolesti pa bolesnike s dezmoidnim tumorom treba povremeno kontrolirati.

Desmoid tumors are rare formations of fibroblastic origin thought benign and slow growing, but could be aggressive in behaviour invading the surrounding areas. The aim of this report is to present a case of a patient with desmoid tumor located in anterior cervical region mimicking malignant formation. A 69-year-old female patient with previous history of surgery due to multinodular goiter as well as primary hyperparathyroidism caused by parathyroid adenoma was scheduled to ultrasound of the neck due to hoarseness. Ultrasound revealed extremely hard, isoechoic, poorly defined nodule with calcification in thyroid bed suggestive of malignant tissue. The finding of fine needle aspiration cytology report showed rare spindle cells but was inconclusive. Other
imaging techniques like computed tomography and magnetic resonance imaging were suggestive for paraganglioma or parathyroid adenoma, but another etiology could not be ruled out with certainty and complete surgical resection was recommended. Pathology report was consistent with fibromatosis, leading to the final diagnosis of extra-abdominal desmoid tumor. Although desmoid tumor is generally a benign disease, it can sometimes be locally aggressive invading the surrounding tissue and mimicking the picture of a malignant process with difficulties to remove surgically, as in our case. Moreover, even after complete excision, recurrence of the disease often occurs that should be kept in mind and such patients should be monitored periodically.