ZNAČAJ PREVENTIVNE ULTRAZVUČNE DIJAGNOSTIKE U PRAVOVREMENOJ DETEKCIJI RETKIH I AGRESIVNIH TIREOIDNIH KARCINOMA – PRIKAZ SLUČAJA
Sažetak
Uvod: Medularni karcinom štitaste žlezde (MKŠ) je agresivan tumor udružen sa značajno lošijom prognozom u odnosu na druge tipove tireoidnog karcinoma. Dopler ultrazvučni pregled i adekvatna dijagnostika zasnovana na TIRADS (Thyroid Imaging Reporting and Data System) klasifikaciji suspektnih nodusa su neophodni.
Cilj: Ovaj prikaz slučaja naglašava značaj precizne ultrazvučne dijagnostike, presudne u ranoj detekciji i primeni adekvatnih hirurških postupaka u zbrinjavanju ovako agresivnih formi bolesti.
Prikaz slučaja: Prikazujemo pacijentkinju staru 31 godinu koja je ultrazvučno dijagnostikovana rutinskim sistematskim pregledom. Ultrazvučnim pregledom uočen je hipoehogeni, nejasno ograničen mikronodus dimenzija 5 mm x 4 mm x 3 mm, sa ehogenim fokusima lokalizovanim u centralnim zonama levog režnja štitaste žlezde (TIRADS 4, score 6). S obzirom na suspektno maligne ultrazvučne karakteristike, lokalizaciju mirkonodusa i sledstveno rađen povišen serumski nivo kalcitonina, postavljena je sumnja na mikromedularni karcinom. Nakon urađene kompletne tiroidektomije, dijagnoza je potvrđena histopatološkim pregledom. Histopatološka analiza pokazuje manji, beličast nodus (5 mm) u levom režnju, bez upadljive nekroze i bez amiloidnog sadržaja. Limfovaskularna invazija nije utvrđena, dok su mitoze retke. Stadijum tumorske bolesti je T1 (pTNM), bez udaljenih metastaza. Hiperplazija C ćelija je prisutna u okolini tumora. Imunohistohemijska analiza je pokazala pozitivnu reakciju na kalcitonin, hromogranin i mCEA. Proliferativni indeks je nizak (4%). Nakon hirurške intervencije nivo kalcitonina se normalizovano. Tri godine nakon operacije pacijentkinja je dobrog opšteg stanja, na redovnom praćenju. U međuvremenu se pacijentkinja ostvarila kao majka.
Zaključak: Rana detekcija i pravovremeni terapijski pristup u lečenju mikromedularnog karcinoma štitaste žlezde su vrlo značajni, s obzirom na vrlo agresivno biološko ponašanje ovih tumora. Adekvatan ultrazvučni pregled može značajno promeniti terapijski ishod i prognozu bolesti kod ovakvih pacijenata.
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