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A21-year-oldwomanpresentswithlarge,asymmetric,left-sidedneckswelling.21岁女性患者，表现为左侧颈部不对称肿大。
A
B
(A,B)Irregularnonenhancinghypodensenodulesareseenwithintheleftlobeofthethyroidglandwithirregularlateralmargins(whitearrow).Thereispresenceoflargecysticleftlevel3andlevel4lymphnodes(whitearrow)withsmallerlymphnodeswithringandnodularcontrastenhancementseensuperiorly(smallwhitearrow).Thereismasseffectonthetracheawithcontralateraldisplacement.Thereismedialdisplacementofleftinternalcarotidartery(blackarrow).
(A，B)甲状腺左叶内可见不规则无强化低密度结节，边缘不规则(白色箭头)。左侧3区和4区可见大囊性淋巴结(白色箭头)，较小的淋巴结呈环状和结节状强化(白色小箭头)。占位效应导致气管向对侧移位。左侧颈内动脉向内侧移位(黑色箭头)。
DifferentialDiagnosis
?Differentiatedthyroidcarcinoma:Focal,unilateral,irregularleftthyroidlobenodulewithirregularlateralmargins,largeleftcarotidspace,andcysticlevel3andlevel4lymphnodes.
?Follicularadenomaathyroidgland:Solitary,lowattenuating,unilateralthyroidglandmasswithoutpericapsularspreadorlymphnodeenlargement.
?Hemorrhagiccolloidcyst:Alarge,unilateralcysticmassisseenwithinthyroidglandwithsurroundingnormalthyroidtissue.Noevidenceforpericapsularspreadorlymphnodeenlargementisseen.
鉴别诊断
?分化型甲状腺癌：局灶性、单侧、不规则的左侧甲状腺叶结节，边缘不规则，左侧颈动脉间隙大，3区和4区淋巴结囊性改变。
?滤泡性腺瘤甲状腺：孤立、低密度、单侧甲状腺肿块，无薄膜周围扩散或淋巴结肿大。
?出血性胶体囊肿：甲状腺内可见一个巨大的单侧囊性肿块，周围甲状腺组织正常。无包膜周围扩散或淋巴结增大征象。
EssentialFacts
?Allthemalignantneoplasmsofthethyroidglandwithawell-definedhistologyarecalleddifferentiatedthyroidcarcinoma.Itmainlyincludespapillary(90%)andfolliculartypes.
?Itisthemost
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