{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T14:18:35Z","timestamp":1774534715313,"version":"3.50.1"},"reference-count":42,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Riedel\u2019s thyroiditis is a rare fibrosing thyroid disorder that remains one of the most difficult to diagnose, often being initially interpreted as malignant due to its clinical, radiological, and histopathological similarities with anaplastic carcinoma or other infiltrative thyroid diseases. Preoperative investigations, including fine-needle aspiration cytology (FNAC), may be misleading and contribute to an erroneous diagnosis of cancer. Methods: We report the case of a 44-year-old woman presenting with a rapidly enlarging, hard goiter associated with compressive symptoms and cytological findings suspicious for papillary thyroid carcinoma (Bethesda V). Based on these findings and the multidisciplinary team\u2019s assessment, surgical intervention was undertaken. Intraoperatively, the thyroid gland was densely fibrotic and adherent to adjacent structures, prompting frozen-section analysis that revealed a benign fibroinflammatory process consistent with Riedel\u2019s thyroiditis. This intraoperative finding guided the surgical team toward a near-total thyroidectomy, preventing unnecessary radical excision. Results: The paraffin-embedded section confirmed the diagnosis. Postoperative recovery was favorable, with complete resolution of compressive symptoms. Conclusions: This case highlights the persistent diagnostic challenges of Riedel\u2019s thyroiditis and illustrates how intraoperative frozen-section examination can contribute to differentiating it from malignancy when preoperative findings remain inconclusive. A multidisciplinary approach and surgical expertise are essential in tailoring the extent of resection, preventing complications, and achieving both diagnostic confirmation and symptom relief.<\/jats:p>","DOI":"10.3390\/jcm15072529","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T13:37:15Z","timestamp":1774532235000},"page":"2529","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["From Cytology to Frozen Section: Diagnostic Challenges in Riedel\u2019s Thyroiditis\u2014A Case Report and Brief Literature Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5118-2989","authenticated-orcid":false,"given":"Diana-Raluca","family":"Streinu","sequence":"first","affiliation":[{"name":"Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6046-9191","authenticated-orcid":false,"given":"Andreea","family":"Bena","sequence":"additional","affiliation":[{"name":"Discipline of Endocrinology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ion","family":"Icma","sequence":"additional","affiliation":[{"name":"First Surgery Clinic, \u201cPius Brinzeu\u201d Clinical Emergency Hospital, 300723 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivan","family":"Codrut","sequence":"additional","affiliation":[{"name":"First Surgery Clinic, \u201cPius Brinzeu\u201d Clinical Emergency Hospital, 300723 Timisoara, Romania"},{"name":"Abdominal Surgery and Phlebology Research Center, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Department X of Surgery, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0497-0405","authenticated-orcid":false,"given":"C\u0103lin","family":"Muntean","sequence":"additional","affiliation":[{"name":"Medical Informatics and Biostatistics, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2617-0470","authenticated-orcid":false,"given":"Iuliana-Anamaria","family":"Tr\u0103il\u0103","sequence":"additional","affiliation":[{"name":"Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Department of Microscopic Morphology Genetics Discipline, Center of Genomic Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0926-9511","authenticated-orcid":false,"given":"Dana Liana","family":"Stoian","sequence":"additional","affiliation":[{"name":"Discipline of Endocrinology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Dr. D Medical Center, Center for Advanced Ultrasound Evaluation, 300029 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1093\/ajcp\/90.6.715","article-title":"Riedel\u2019s thyroiditis","volume":"6","author":"Schwaegerle","year":"1988","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1016\/S0025-6196(12)64789-2","article-title":"Thyroiditis: A clinical update","volume":"60","author":"Hay","year":"1985","journal-title":"Mayo Clin. Proc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1089\/thy.2010.0453","article-title":"Invasive fibrous thyroiditis (Riedel thyroiditis): The Mayo Clinic experience, 1976\u20132008","volume":"21","author":"Fatourechi","year":"2011","journal-title":"Thyroid"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Musta\u021b\u0103, D.-M., Bisorca, D., Ionel, I., Adjal, A., and Balogh, R.-M. (2025). Real-Time Insights into Indoor Air Quality in University Environments: PM and CO2 Monitoring. Atmosphere, 16.","DOI":"10.3390\/atmos16080972"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Popa, R.-M., Musta\u021b\u0103, D.-M., Ionel, I., and Balogh, R.-M. (2023). Metal Element Traces Sampled from Peri-Urban Road Verge Particulate Matter. Appl. Sci., 13.","DOI":"10.20944\/preprints202309.0275.v1"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Huang, Y., Cai, L., Zheng, Y., Pan, J., Li, L., Zong, L., Lin, W., Liang, J., Huang, H., and Wen, J. (2019). Association between lifestyle and thyroid dysfunction: A cross-sectional epidemiologic study in the She ethnic minority group of Fujian Province in China. BMC Endocr. Disord., 19.","DOI":"10.1186\/s12902-019-0414-z"},{"key":"ref_7","unstructured":"Chiru, A., and Covaciu, D. (2025). Roof up or Down: Exploring Particulate Matter and Noise Pollution Dynamics in Convertible Vehicles. Proceedings of the CONAT 2024 International Congress of Automotive and Transport Engineering, Springer. Proceedings in Automotive Engineering."},{"key":"ref_8","first-page":"4101323","article-title":"Does the Intensity of IGG4 Immunostaining have a correlation with the Clinical Presentation of Riedel\u2019s Thyroiditis?","volume":"2018","author":"Tavares","year":"2018","journal-title":"Case Rep. Endocrinol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"R175","DOI":"10.1530\/EJE-18-1024","article-title":"DIAGNOSIS OF ENDOCRINE DISEASE: IgG4-related thyroid autoimmune disease","volume":"180","author":"Rotondi","year":"2019","journal-title":"Eur. J. Endocrinol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1007\/s13193-016-0513-5","article-title":"Riedel\u2019s Thyroiditis Mimicking as Anaplastic Thyroid Carcinoma: Unusual Presentation","volume":"7","author":"Hakeem","year":"2016","journal-title":"Indian J. Surg. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.radcr.2016.05.017","article-title":"Riedel\u2019s thyroiditis","volume":"11","author":"Darouichi","year":"2016","journal-title":"Radiol. Case Rep."},{"key":"ref_12","unstructured":"(2025, December 20). La Nuova Frontiera Della Citologia. Available online: https:\/\/Cytomatrix.It\/."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.amsu.2020.02.006","article-title":"Riedel\u2019s thyroiditis as a diagnostic dilemma\u2014A case report and review of the literature","volume":"52","author":"Shafi","year":"2020","journal-title":"Ann. Med. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"66","DOI":"10.21614\/chirurgia.116.1.66","article-title":"Presurgical Stratification of Thyroid Nodules\u2014Is it really Needed? Current Guidelines versus Real Life","volume":"116","author":"Borlea","year":"2021","journal-title":"Chirurgia"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Feier, C.V.I., Muntean, C., Faur, A.M., Blidari, A., Contes, O.E., Streinu, D.R., and Olariu, S. (2023). The Changing Landscape of Thyroid Surgery during the COVID-19 Pandemic: A Four-Year Analysis in a University Hospital in Romania. Cancers, 15.","DOI":"10.3390\/cancers15113032"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Bible, K.C., Kebebew, E., Brierley, J., Brito, J.P., Cabanillas, M.E., Clark, T.J., Di Cristofano, A., Foote, R., Giordano, T., and Kasperbauer, J. (2023, July 10). 2021 American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer American Thyroid Association Anaplastic Thyroid Cancer Guidelines Task Force. Available online: www.liebertpub.com.","DOI":"10.1089\/thy.2020.0944"},{"key":"ref_17","first-page":"460","article-title":"Anaplastic thyroid carcinoma: Case report","volume":"29","author":"Rangel","year":"2012","journal-title":"Endocr. Abstr."},{"key":"ref_18","first-page":"69","article-title":"Anaplastic thyroid carcinoma: A case of a young women that reports a survival exceeding 6 years","volume":"11","author":"Batori","year":"2007","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_19","first-page":"e051860","article-title":"Anaplastic Thyroid Carcinoma in a Young Woman: Case Report","volume":"68","author":"Boscoli","year":"2022","journal-title":"Rev. Bras. Cancerol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1159\/000452623","article-title":"Immunoglobulin G4-Related Thyroid Diseases","volume":"5","author":"Kottahachchia","year":"2016","journal-title":"Eur. Thyroid J."},{"key":"ref_21","first-page":"599","article-title":"The consequences of the COVID-19 pandemic on elective surgery for colon cancer","volume":"93","author":"Feier","year":"2022","journal-title":"Ann. Ital. Chir."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/1752-1947-4-15","article-title":"Riedel\u2019s Thyroiditis masquerading as anaplastic thyroid carcinoma: A case report","volume":"4","author":"Shahi","year":"2010","journal-title":"J. Med. Case Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"317","DOI":"10.4174\/jkss.2012.82.5.317","article-title":"A case of Riedel\u2019s thyroiditis","volume":"82","author":"Pi","year":"2012","journal-title":"J. Korean Surg. Soc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1002\/dc.24130","article-title":"Difficulties in diagnosis of Riedel\u2019s thyroiditis on aspiration cytology: A case report and brief review of the literature","volume":"47","author":"Kumar","year":"2019","journal-title":"Diagn. Cytopathol."},{"key":"ref_25","first-page":"351","article-title":"A difficult diagnosis: A case report of combined Riedel\u2019s disease and fibrosing Hashimoto\u2019s thyroiditis","volume":"62","author":"Junik","year":"2011","journal-title":"Endokrynol. Pol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/s00428-023-03561-2","article-title":"IgG4-related sclerosing thyroiditis (Riedel-Struma): A review of clinicopathological features and management","volume":"483","author":"Czarnywojtek","year":"2023","journal-title":"Virchows Arch."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"S50","DOI":"10.1309\/NUU88VAFR9YEHKNA","article-title":"Current Concepts on Riedel Thyroiditis","volume":"121","author":"Papi","year":"2004","journal-title":"Pathol. Patterns Rev."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Streinu, D.R., Stoian, D.L., Neagoe, O.C., Derban, M., Ciordas, P.D., and Marian, C. (2025). Inside the Matrix: Integrated Cytology and Molecular Testing of Thyroid FNAC Samples Using a Commercial Synthetic 3D Scaffold. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms262211100"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3031","DOI":"10.1210\/jc.2011-0617","article-title":"Riedel\u2019s Thyroiditis: A Clinical Review","volume":"96","author":"Hennessey","year":"2011","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_30","first-page":"9989953","article-title":"Riedel\u2019s Thyroiditis: Pitfalls in Diagnosis and Subsequent Complications","volume":"2023","author":"Pandev","year":"2023","journal-title":"Case Rep. Endocrinol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s12020-018-1526-3","article-title":"Riedel\u2019s thyroiditis: Clinical presentation, treatment and outcomes","volume":"60","author":"Falhammar","year":"2018","journal-title":"Endocrine"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e3469","DOI":"10.1210\/clinem\/dgaa468","article-title":"Riedel Thyroiditis","volume":"105","author":"Zala","year":"2020","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/j.jfma.2012.07.012","article-title":"A misdiagnosed Riedel\u2019s thyroiditis successfully treated by thyroidectomy and tamoxifen","volume":"111","author":"Wang","year":"2012","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1002\/dc.10420","article-title":"Fine-needle aspiration of Riedel\u2019s disease: Report of a case and review of the literature","volume":"30","author":"Harigopal","year":"2004","journal-title":"Diagn. Cytopathol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1111\/cen.13238","article-title":"Riedel\u2019s thyroiditis association with IgG4-related disease","volume":"86","author":"Stan","year":"2017","journal-title":"Clin. Endocrinol."},{"key":"ref_36","first-page":"5130106","article-title":"Riedel\u2019s Thyroiditis: Report of Two Cases and Literature Review","volume":"2019","author":"Blanco","year":"2019","journal-title":"Case Rep. Endocrinol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1111\/j.1365-2796.1994.tb01071.x","article-title":"Riedel\u2019s thyroiditis: An autoimmune or primary fibrotic disease?","volume":"235","year":"1994","journal-title":"J. Intern. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1136\/pgmj.73.866.817","article-title":"Corticosteroid therapy in Riedel\u2019s thyroiditis","volume":"73","author":"Vaidya","year":"1997","journal-title":"Postgrad. Med. J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1007\/BF03347818","article-title":"Fibrous invasive (Riedel\u2019s) thyroiditis with critical response to steroid treatment","volume":"18","author":"Bagnasco","year":"1995","journal-title":"J. Endocrinol. Investig."},{"key":"ref_40","first-page":"3543","article-title":"Riedel\u2019s Thyroiditis: Report of a Case Complicated by Spontaneous Hypoparathyroidism, Recurrent Laryngeal Nerve Injury, and Horner\u2019s Syndrome","volume":"87","author":"Yasmeen","year":"2002","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1177\/003693306801300103","article-title":"The effect of steroid therapy on Riedel\u2019s thyroiditis","volume":"13","author":"Thomson","year":"1968","journal-title":"Scott. Med. J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1016\/S0039-6060(96)80045-6","article-title":"Riedel\u2019s thyroiditis: Treatment with tamoxifen","volume":"120","author":"Few","year":"1996","journal-title":"Surgery"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2529\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T13:41:58Z","timestamp":1774532518000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2529"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,26]]},"references-count":42,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcm15072529"],"URL":"https:\/\/doi.org\/10.3390\/jcm15072529","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,26]]}}}