Thyroid-like low grade nasopharyngeal papillary adenocarcinoma例

抄録

Thyroid-like low grade nasopharyngeal papillary adenocarcinoma (TL-LGNPPA) is an extremely rare adenocarcinoma that arises in the posterior nasal septum or the nasopharynx, with histological findings similar to those of papillary thyroid carcinoma; the tumor shows positive immunohistochemistry for thyroid transcription factor-1 (TTF-1) but negative results for thyroglobulin. We performed endoscopic removal of a nasal tumor under general anesthesia in a pregnant woman, and the histopathological diagnosis was TL-LGNPPA.

A 33-year-old woman presented with epistaxis, otorrhea, nasal obstruction, and facial pain during pregnancy. She was referred to our department at 16 weeks of pregnancy for closer examination and treatment of a stalked mass originating from the posterior nasal septum. Biopsy revealed the diagnosis of adenocarcinoma, and we performed endoscopic endonasal surgery while she continued her pregnancy. The tumor showed papillary growth of atypical epithelium, and the tumor cells were positive for TTF-1 and negative for thyroglobulin. Based on the findings, the postoperative histopathological diagnosis was TL-LGNPPA. Both mother and child are healthy, and the patient has shown neither local recurrence nor distant metastasis until now, 8 years since the operation.

This case was extremely rare in the following two respects: endoscopic surgery for a malignant nasal tumor was performed during pregnancy, and the histopathological diagnosis was TL-LGNPPA. By working together with obstetricians and anesthesiologists, we were able to safely accomplish complete removal of the tumor while the patient could continue her pregnancy to term.