An Intriguing Case of Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma: A Case Report

Abstract

Aims: Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, representing approximately 80% of all thyroid malignancies. Diffuse sclerosing variant (DSV) accounts for only 2% of all PTC. We present a case of this rare variant in an old lady and subsequently delve into the current understanding of DSV of PTC, drawing insights from various scholarly articles to illuminate its clinical significance, diagnostic challenges, and therapeutic implications. Presentation of Case:  A 55-year-old lady presented with swelling in the right side of her neck. On examination, the swelling measured 2.5 x 2.5 cm, firm and moving with deglutition. Ultrasonography confirmed that the bulky right lobe of the thyroid replaced with cysts and nodules, leading to right hemithyroidectomy. Histomorphology confirmed DSV of PTC, following which underwent completion thyroidectomy with node dissection and adjuvant chemotherapy. Discussion: DSV of PTC usually presents in middle-aged to older adults, with a slight female predominance. Being a rare variant, the diagnosis remains a major challenge. It is generally associated with a favourable prognosis, with low lymph node metastasis rates and distant spread. Surgical resection remains the main cornerstone of treatment, with adjuvant therapy reserved for high-risk cases. Conclusion: DSV of PTC represents a rare and distinct variant of thyroid cancer with unique features. A multimodal approach is required for accurate diagnosis and treatment. More research in this field is required to explain the molecular mechanisms driving DSV and also novel therapeutic targets for this rare variant.