ROBERT S. DINSMORE, M.D.
Division of Surgery
JOHN B. HAZARD, M.D.
Department of Pathology
THE differential diagnosis between Riedel’s struma and carcinoma of the thyroid gland is often difficult because of their common features of mass, pressure, and infiltration of structures adjoining the thyroid gland. The occurrence of the combined lesion is a rarity despite the fact that adenomas are not uncommon in struma fibrosa. A case was recently encountered which presented clinical features consistent with either diagnosis and the unusual pathologic findings of a sclerosing lesion of the thyroid gland and an undifferentiated carcinoma.
A married white woman, aged 38, was first admitted to the Cleveland Clinic on August 13, 1930, complaining of enlargement of the neck. She had first noticed slight enlargement seven years previously, and six years before admission a nodular enlargement of the thyroid gland, greater on the left, had been noted by her physician. The enlargement was described as the size of a goose egg. The thyroid mass was believed to resemble carcinoma, and removal was advised. However, operation was not performed, and the mass gradually increased in size. There had been no nervousness, palpitation, or tenderness.
Temperature was 98.2 F., pulse rate 72, blood pressure 110 systolic, 80 diastolic. Physical examination revealed the left lobe of the thyroid gland to be enlarged, firm, nodular, and freely movable. Otherwise the physical examination did not reveal abnormalities. T he red cell count was 4,400,000, hemoglobin 80 per cent, white cell count 6700.
The diagnosis was adenomatous goiter without hyperthyroidism. Thyroidectomy was advised but was not performed.
The patient. . .