Pідкісна нейрофіброма поворотного гортанного нерва з клінічною картиною злоякісного ураження щитоподібної залози. Клінічний випадок та огляд літератури

Objective — to describe a rare clinical case of laryngeal recurrence nerve neurofibroma that clinically and on ultrasound mimicked a malignant thyroid tumor, and to discuss differential diagnostic and therapeutic aspects. Clinical case. A 43-year-old female patient presented with a single complaint of hoarseness. Thyroid ultrasound revealed a 30×25 mm formation in the left lobe, classified as TIRADS 5. Fine-needle aspiration biopsy was non-informative (Bethesda I). Laryngoscopy revealed left vocal cord palsy. History included combined treatment (surgery and radiation therapy) for astrocytoma 4 years prior. Left-sided hemithyroidectomy with lymph node dissection was performed. Intraoperatively, a tumor tightly fused with the laryngeal recurrence nerve was found. Intraoperative frozen section examination indicated a spindle cell tumor without signs of malignancy. Final histopathological examination verified the diagnosis: neurofibroma. The postoperative period was uneventful, but vocal cord palsy persisted, for which the patient was referred to a phoniatrist. Conclusions. Neurofibromas of the peripheral nerves of the neck, particularly the laryngeal nerve, are rare tumors that can mimic thyroid tumors. A patient’s history of radiation therapy is an important predictor for the development of such tumors. Diagnosis is challenging, and fine-needle aspiration biopsy is often non-diagnostic. Diagnosis verification is only possible intraoperatively using frozen section examination, which determines the extent of surgery. A comprehensive multidisciplinary approach is mandatory for the effective management of such patients.