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CC BY-NC-ND 4.0 · Ultrasound Int Open 2025; 11: a27414863
DOI: 10.1055/a-2741-4863
Case Report

Newly developed diffuse sclerosing papillary thyroid carcinoma during follow-up of benign thyroid nodules: a case report of two cases with ultrasound findings

Authors

  • Rie Goryo

    1   Department of Clinical Laboratory, Kuma Hospital, Kobe, Japan (Ringgold ID: RIN157722)

  • Mitsuyoshi Hirokawa

    2   Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan (Ringgold ID: RIN157722)

  • Ayana Suzuki

    2   Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan (Ringgold ID: RIN157722)

  • Minoru Kihara

    3   Department of Surgery, Kuma Hospital, Kobe, Japan (Ringgold ID: RIN157722)

  • Sayo Nishikawa

    1   Department of Clinical Laboratory, Kuma Hospital, Kobe, Japan (Ringgold ID: RIN157722)

  • Maki Oshita

    1   Department of Clinical Laboratory, Kuma Hospital, Kobe, Japan (Ringgold ID: RIN157722)

  • Hiroyuki Yamaoka

    4   Department of Internal Medicine, Kuma Hospital, Kobe, Japan (Ringgold ID: RIN157722)

  • Eijun Nishihara

    4   Department of Internal Medicine, Kuma Hospital, Kobe, Japan (Ringgold ID: RIN157722)

  • Makoto Fujishima

    3   Department of Surgery, Kuma Hospital, Kobe, Japan (Ringgold ID: RIN157722)

  • Akira Miyauchi

    3   Department of Surgery, Kuma Hospital, Kobe, Japan (Ringgold ID: RIN157722)

  • Takashi Akamizu

    4   Department of Internal Medicine, Kuma Hospital, Kobe, Japan (Ringgold ID: RIN157722)
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Introduction

Diffuse sclerosing papillary thyroid carcinoma (DS-PTC) is characterized by diffuse unilateral or bilateral involvement of PTC with extensive lymphatic invasion, dense stromal fibrosis, squamous metaplasia, numerous psammoma bodies, and background chronic lymphocytic thyroiditis. This subtype typically affects younger individuals, accounts for 0.7–6.6% of all PTCs and exhibits more aggressive behavior than classic PTC (S Pillai, et al. Crit Rev Oncol Hematol. 2015; 94:64–73).

Despite its distinct histopathological features, the sonographic diagnosis of DS-PTC remains challenging, with a reported accuracy of only 32.4% (B Kang, et al. Ann Surg Treat Res. 2025; 109:35–43). Most previously documented cases have been diagnosed at advanced stages, and limited information is available regarding the chronological progression of DS-PTC or its early imaging characteristics.

In this report, we present two rare cases of DS-PTC that emerged during long-term follow-up of patients initially diagnosed with benign thyroid tumors. We aimed to explore the ultrasonographic (US) features that preceded the pathological diagnosis, with particular emphasis on the appearance of multiple punctate echogenic foci (MPEF). We propose that MPEF may serve as a potential early sonographic indicator of DS-PTC development, offering insight into its preclinical evolution and aiding earlier detection.



Publication History

Received: 26 February 2025

Accepted after revision: 05 November 2025

Article published online:
12 December 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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Bibliographical Record
Rie Goryo, Mitsuyoshi Hirokawa, Ayana Suzuki, Minoru Kihara, Sayo Nishikawa, Maki Oshita, Hiroyuki Yamaoka, Eijun Nishihara, Makoto Fujishima, Akira Miyauchi, Takashi Akamizu. Newly developed diffuse sclerosing papillary thyroid carcinoma during follow-up of benign thyroid nodules: a case report of two cases with ultrasound findings. Ultrasound Int Open 2025; 11: a27414863.
DOI: 10.1055/a-2741-4863