Sclerosing Mucoepidermoid Carcinoma With Eosinophilia of the Thyroid: A Rare Case From Georgia and a Comprehensive Literature Review.

Sclerosing mucoepidermoid carcinoma with eosinophilia (SMECE) is a rare thyroid malignancy typically linked to chronic lymphocytic thyroiditis. We present the first documented case of SMECE in Georgia, involving a 41-year-old woman with Hashimoto's thyroiditis. A 16 mm hypoechoic thyroid nodule was detected on routine ultrasound, and fine needle aspiration categorized it as Bethesda V. The patient underwent total thyroidectomy with central neck dissection, confirming SMECE confined to the thyroid without lymph node involvement (0/22 nodes). She recovered well postoperatively on hormone replacement therapy, with no recurrence during follow-up. This case emphasizes the importance of considering SMECE in patients with thyroid nodules, especially with autoimmune thyroiditis. Key diagnostic features include eosinophilic infiltration in a sclerotic stroma and mucinous and squamous differentiation. Immunohistochemistry, showing positivity for CK7, p63, and CEA, was critical for diagnosis. Given the absence of extrathyroidal spread, the patient did not receive radioactive iodine (RAI) therapy. This report adds to the limited literature, underscoring the need for careful histopathological and immunohistochemical evaluation in rare thyroid malignancies.