皮膚瘻孔を伴った腺腫様甲状腺腫の1例

A case of adenomatous goiter with skin sinus formation healed spontaneously

Ⅰ　はじめに

　甲状腺疾患において，前頸部の皮膚瘻孔をきたしうるものとして，悪性腫瘍や結核^1,2）によるものがあるが，通常，皮膚瘻孔は治療することなく改善することはない。今回，われわれは前頸部皮膚の発赤・瘻孔を主訴に来院し，甲状腺癌が疑われた症例で，本人の強い希望で経過観察したところ，自然経過により皮膚の発赤・瘻孔が改善した稀な症例を経験したので報告する。

　A 90-year-old female patient presented with a thyroid swelling for 2 weeks and a discharge from neck sinus with ulceration. CT showed an irregular low density mass in the thyroid left lobe. We suspected undifferentiated carcinoma of thyroid or thyroid tuberculosis. Two open biopsies of the anterior neck mass resulted in granulation tissue with inflammatory cells and negative for tuberculosis. The subtotal thyroidectomy with skin excision for diagnosis and therapy was recommended. However,the patient refused surgery strongly. Her neck lesion was spontaneously disappeared after several months without treatment. Echogram revealed adenomatous goiter in the neck lesion. The reason for improvement without therapy was not clear.