Inflammatory pseudotumor of the thyroid gland showing prominent fibrohistiocytic proliferation. A case report

Inflammatory Myofibroblastic Tumor in the Thyroid Gland: A Retrospective Case Series Study and Literature Review

Background: The objective of this study was to investigate the clinical characteristics, diagnosis and treatment of inflammatory myofibroblastoma tumor (IMT) in the thyroid gland. Methods: A total of 17 patients with IMT by pathology from 2010 to 2020 were included in this study. Clinical features, imaging features, treatment and prognosis were analyzed in this retrospective study. Results: The case series comprised 5 males and 12 females, with an average age of 49.6±15.36 years. The patients were divided into two cohorts: with IMT without further pathological changes and with further pathological changes of the thyroid gland (for example nodular goiter or autoimmune thyroid disease). No significant differences were detected in tumor size and extrathyroid extension between the two groups. Fine needle aspiration biopsy examination before the operation was performed in 2 cases, and rapid freezing pathology examination during the operation was performed in 7 cases. Ultrasound images of 5 cases with only one type of pathology, IMT presented a high and intermediate risk of malignancy. In the other 11 cases with further pathological changes of the thyroid gland, the image could be very low risk of malignancy or benign feature. Only 2 cases showed a high risk of malignancy ultrasound features. 5/17 patients underwent preventive cervical lymph node dissection additional to thyroid surgery. None of the lymph nodes were confirmed positive by postoperative pathology. Thyroid ultrasound, computed tomography scan of the lungs, abdomen ultrasound and thyroid function tests were routine follow-up tests. During the follow-up period of 26-141 months, 2 cases were lost, and remaining 15 cases had no recurrence or metastasis and were considered cured. Conclusion: IMT in the thyroid gland is a rare disease with a good prognosis and surgical resection is the preferred treatment.

Riedel Thyroiditis

CONTEXT

Riedel thyroiditis (RT) is a rare inflammatory autoimmune disease that is often a clinically diagnostic dilemma because of its insidious presentation and nonspecific symptoms.

OBJECTIVE

The aim of the present systematic review and meta-analysis is to clarify the presentation, management, and outcomes of RT.

STUDY SELECTION

A systematic search of PubMed/MEDLINE and Web of Science was conducted to identify relevant reports published up to September 2019.

DATA EXTRACTION

First author, country, patient sex, ethnicity, presentation, biochemical status, duration of symptoms, histology, treatment, follow-up duration, and short- and long-term outcomes.

DATA SYNTHESIS

Data from 212 RT patients were retrieved. The mean age was 47 years with a predominantly female population (81%). Neck swelling (89%), dyspnea (50%), and neck pain (41%) were the most common presenting symptoms. Inflammatory markers were elevated in 70% to 97% and thyroid antibody positivity was present in less than 50%. Up to 82% underwent surgical intervention, with the most common being total thyroidectomy in 34% of individuals. Glucocorticoids were used in 70% of individuals with median duration 3 months. Prognosis was reasonable with 90% having resolution or improvement of symptoms.

CONCLUSIONS

This analysis is the largest and most comprehensive to date of RT and provides clinicians with vital information on the common presentation features that may alert to the diagnosis and highlight management options.

ALK-1-positive inflammatory myofibroblastic tumor of the thyroid complicated by Hashimoto's thyroiditis: report of a rare case and a literature review

BACKGROUND

Inflammatory myofibroblastic tumors (IMTs) of the thyroid are extremely rare soft-tissue tumors. In the literature, IMTs are sometimes called plasma cell granulomas (PCGs) or inflammatory pseudotumors, which often causes ambiguity. To date, 17 cases of PCGs and five cases of thyroid IMTs have been reported. These cases reveal that IMTs of the thyroid are often negative for the anaplastic lymphoma kinase (ALK-1) gene. To provide further information on this rare lesion, we present a case of an ALK-1-positive thyroid IMT and a review of IMTs of the thyroid.

CASE PRESENTATION

A 34-year-old Chinese woman presented with a painless neck mass that had persisted for over a month. Ultrasonography revealed a 4.28 × 2.53 cm² hypoechoic mass, in the left lobe of the thyroid gland. Serum levels of thyroglobulin and anti-thyroglobulin antibodies were high. Subsequently, left lobectomy was performed. Macroscopically, the lesion was a gray-brown nodular mass with a partial envelope. Histologically, two different lesion types were observed. The first lesion showed classic spindle cell proliferation, with spindle cells arranged in fascicles, accompanied by mature inflammatory cells. The other lesion showed a large number of infiltrating lymphocytes, with lymphoid follicles in the remaining thyroid gland, which was atrophic. Immunohistochemical staining showed that the spindle cells were negative for CK19, CyclinD1, Gelectin-3, EMA, CD34, S100, Bcl-2, and STAT-6, but strongly positive for ALK-1, vimentin, and TTF1. CK was focally expressed, and the Ki-67 index was 5%. A diagnosis of IMT was proposed according to immunohistochemical findings and morphology. Hashimoto's thyroiditis was confirmed according to serum levels of thyroglobulin and anti-thyroglobulin antibodies and morphology. The patient did not receive adjuvant therapy. She remained alive without disease recurrence for 10 months after lobectomy.

CONCLUSIONS

IMTs should be considered in the diagnosis when spindle cell proliferation accompanied by mature inflammatory cells is observed, spindle cells are mildly atypical, and myofibroblast differentiation is present in the thyroid. A uniform diagnostic term is crucial to avoid ambiguity. Clinicians and pathologists should be aware of the necessity for long-term follow-up, especially in ALK-positive cases. The therapeutic potential of ALK-1 positivity should be explored further.

A case report of recurrent thyroid inflammatory myofibroblastic tumor and its metastasis in soft tissue

RATIONALE

Inflammatory myofibroblastic tumor (IMT) is a neoplasm of low malignant potential. The most frequent site of IMT is in the lung, whereas recurrent and metastasis of thyroid IMT has been seldom reported.

PATIENT CONCERNS

A 57-year-old male presented with a 3-year history of painless thyroid mass. The physical examination revealed a diffusely enlarged thyroid which was firm. The thyroid function and antibodies were normal. Thyroid ultrasound revealed a hypoechoic mass in the left lobe and heterogeneous echo in the right lobe. Neck computed tomography showed a diffused enlargement of thyroid with the homogeneously low intensity and the moderate enhancement.

DIAGNOSES

A diagnosis of thyroid IMT was made according the postoperative histological and immunohistochemical analysis.

INTERVENTIONS

The patient underwent subtotal thyroidectomy. Seventeen months after the surgery, the patients presented with a firm nodule of right adductor magnus and a relapsing mass of thyroid. Needle core biopsy of the thyroid mass suggested the relapsing of thyroid IMT. The mass excision of the right adductor magnus was performed and an IMT was confirmed by histopathology. The patient underwent thyroid radiation therapy and steroid therapy.

OUTCOMES

The size of the tumor was smaller than the preradiation size and the patient is now under follow-up.

LESSONS

This is the seldom reported patient with recurrent thyroid IMT with metastasis. IMT of the thyroid is an unusual but distinct disease entity. The clinical and radiological features are not specific and its diagnosis is based on the histological features. Although tumor resection and radiation seem to be effective, no standard treatment for such disease has been established.

Inflammatory myofibroblastic tumor of the lumbar spinal canal: A Case Report With Literature Review

RATIONALE

Inflammatory myofibroblastic tumor (IMT) is a rare type of mesenchymal tumor. IMT can arise in multiple anatomic locations. IMT of the lumbar spinal canal is exceptionally rare.

PATIENT CONCERNS

Here, we report the case of a 56-year-old male patient with an IMT who was in good health until 1 year prior to admission, when he began experiencing pain in both lower extremities and the lower back.

INTERVENTIONS

A space-occupying lesion in the lumbar canal was identified by magnetic resonance imaging and then surgically resected.

DIAGNOSES

Histopathological analysis of the lesion revealed a composition of mucous edema, inflammatory cells, collagenous fibers, and spindle cells that were diffuse and positive for smooth muscle actin and CD68; focal positive for vimentin and desmin; and negative for CD34 (marker of vascular endothelial cells), CD21, CD23, CD35, S-100, Epstein-Barr virus infection, Ki-67, and anaplastic lymphoma kinase. Thus, the diagnosis was an IMT of the lumbar canal.

OUTCOMES

In the spinal canal, IMT should be considered in the evaluation of tumors although it is a very rare diagnosis. It is a benign lesion, but it has potential for invasion and recurrence.

LESSONS

There are no characteristic imaging features of these tumors, but they can be addressed by complete surgical excision. Patients with these lesions should undergo frequent long-term follow-up to detect and address recurrence.

Inflammatory Myofibroblastic Tumour of Thyroid with its Prominent Spindle Cell Pattern: A Rare Case Report

Inflammatory myofibroblastic tumour of thyroid is very rare. Only 18 cases reported so far. Here we report a case of Inflammatory myofibroblastic tumour with its prominent spindle cell (fibrohistiocytic) pattern in a 61-year-old male patient. The dominant histological pattern in our case was myofibroblastic in contrast to prominent lymphoplasmocytic pattern in other previously reported cases. The tumour was strongly positive for vimentin, Anaplastic lymphoma kinase and showed focal positivity for Smooth Muscle Actin. The patient was treated with total thyroidectomy and he is comfortable after surgery.

Recurrent inflammatory myofibroblastic tumor of the inguinal region: A case report and review of the literature

Inflammatory myofibroblastic tumors (IMTs) of the inguinal region are exceptionally rare. The current study reported the case of a 49 year-old male patient with IMT, who presented with a fever, night sweats, anorexia, loss of weight and frequent urination. Computed tomography (CT) revealed a lesion occupying the soft tissue of the right inguinal region and surgery was performed to resect the lesion. Histopathological analysis of the lesion revealed a composition of spindle and inflammatory cells, including plasma cells and lymphocytes. In addition, immunohistochemical analysis demonstrated that the tumor cells were positive for CD34, vimentin, actin, Ki-67, B cell lymphoma-2, CD99, epithelial membrane antigen and CD38; however, tumor cells were negative for CD117, desmin, anaplastic lymphoma kinase and creatine kinase. Thus, the patient was diagnosed with IMT and was advised to return for regular follow-up appointments. Subsequently, the patient developed a local recurrence 12 months following the initial surgery. Of note, the histopathological characteristics of the recurrent lesions were consistent with those of the initial specimen. Thus, a second surgery was performed, followed by fractionated radiotherapy (FRT). At 3 and 6 months following the FRT, magnetic resonance imaging scans did not indicate tumor recurrence or metastasis. In conclusion, surgical excision is the current recommended treatment for IMT; however, for cases similar to that of the current study, which are not successfully controlled by surgical excision, radiotherapy should be considered and long-term follow-up is essential.

Plasma Cell Granuloma of the Thyroid Gland

This study reports a case of plasma cell granuloma of the thyroid gland in a 47-year-old woman, presenting with a right subhyoid mass and a previous diagnosis of Hashimoto thyroiditis dating back to 1988, which was made on a subtotal thyroidectomy. Plasma cell granuloma preferentially involves the lung, with only 18 cases of thyroid gland involvement having been reported to date in the English literature. Thyroid plasma cell granuloma preferentially affects women and classically shows a prominent plasma cell infiltrate embedded in a variable degree of fibrous stroma: only 2 of the reported cases exhibited the morphologic features of inflammatory myofibroblastic tumor. These morphologic features may raise problems in the differential diagnosis with other plasma cell–rich disorders, including infectious diseases and auto(dys)immune conditions, including the recently described “IgG4-related sclerosing disease.” In view of these considerations, a contemporary diagnostic approach to thyroid plasma cell granuloma is therefore discussed here.

Postaural inflammatory pseudotumor: an extremely unusual complication of trauma in a child

We report the case of a 12-year-old boy who presented with a rapidly enlarging, painless mass behind the ear following trauma to the area. The mass was excised, and histopathologic and immunohistochemical evaluations revealed it to be an inflammatory pseudotumor. At 1 year postoperatively, the child exhibited no evidence of recurrence.

Plasma cell granuloma of the thyroid: a conservative approach to a rare condition and review of the literature

Introduction. We present a case of an 89-year-old female who attended our surgical endocrine clinic with a 3-month history of a left-sided neck lump. There was no past medical history of thyroid disease. Methods. Following examination and further investigation, including core biopsy, a diagnosis of plasma cell granuloma of the thyroid was made. Biochemical testing of thyroid function and Thyroid Peroxidase Antibody was in-keeping with an associated Hashimoto's thyroiditis. Results. The patient was treated conservatively with thyroxine and regularly seen in clinic. TSH levels improved and the lump showed signs of regression. Conclusion. Plasma cell granuloma of the thyroid is rare with only 16 previously reported cases. We present a new approach to management without the use of surgery or steroids. The literature is reviewed comparing clinico-pathological features and management of other reported cases.