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Shi P, Zhang L, Shi H, Wu Y. Inflammatory Myofibroblastic Tumor in the Thyroid Gland: A Retrospective Case Series Study and Literature Review. Oncol Res Treat 2022; 45:353-365. [DOI: 10.1159/000524489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/02/2022] [Indexed: 11/19/2022]
Abstract
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.
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Patil PA, DeLellis RA. Plasma Cell Granuloma of the Thyroid: Review of an Uncommon Entity. Arch Pathol Lab Med 2019; 142:998-1005. [PMID: 30040458 DOI: 10.5858/arpa.2017-0068-rs] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Plasma cell granuloma (PCG) is characterized by proliferation of polyclonal plasma cells with associated fibrosis and is often considered part of the heterogeneous group of inflammatory myofibroblastic tumors (IMTs). The thyroid is rarely affected by PCG. A patient having PCG associated with Hashimoto thyroiditis (HT) prompted our literature search that revealed 18 cases of PCG, 55% (n = 10) of which occurred together with HT. The etiopathogenesis of PCG is unknown and there is no specific treatment except surgical excision for compressive symptoms. This entity has an excellent prognosis with no evidence of recurrence or metastasis. Lesions of the thyroid with infiltrating plasma cells include HT, fibrous variant of HT, plasmacytoma, plasma cell myeloma, Riedel thyroiditis, IgG4 (immunoglobulin G4)-related disease, IMT, and PCG. Inflammatory myofibroblastic tumor has ALK gene rearrangements and is considered a neoplasm as opposed to PCG, which is a reactive polyclonal plasma cell proliferation. We believe IMT and PCG are distinct entities and consensus definitions are required for avoiding confusion in the literature.
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Affiliation(s)
| | - Ronald A DeLellis
- From the Department of Pathology, Warren Alpert Medical School of Brown University, Lifespan Academic Medical Center, Providence, Rhode Island
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Abstract
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.
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Affiliation(s)
- Jiajia Duan
- Department of Interventional Radiology, China Meitan General Hospital
| | - Ying Wang
- Department of Pathology, Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
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Marylilly S, Subachitra T, Ramya V. Inflammatory Myofibroblastic Tumour of Thyroid with its Prominent Spindle Cell Pattern: A Rare Case Report. J Clin Diagn Res 2016; 10:ED05-7. [PMID: 27190815 DOI: 10.7860/jcdr/2016/15159.7558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 01/31/2016] [Indexed: 12/26/2022]
Abstract
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.
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Affiliation(s)
- S Marylilly
- Professor, Department of Pathology, Stanley Medical College , Chennai, Tamil Nadu, India
| | - T Subachitra
- Assistant Professor, Department of Pathology, Stanley Medical College , Chennai, Tamil Nadu, India
| | - V Ramya
- Postgraduate, Department of Pathology, Stanley Medical College , Chennai, Tamil Nadu, India
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Modesto J, Gardeazabal I, Santos AM, Galofré JC. (18)F-FDG PET discovered an elusive cervical inflammatory pseudotumor associated with a papillary thyroid cancer. ACTA ACUST UNITED AC 2014; 61:338-40. [PMID: 24721020 DOI: 10.1016/j.endonu.2014.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/19/2014] [Accepted: 02/23/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Juan Modesto
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Itziar Gardeazabal
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Ana-María Santos
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Juan C Galofré
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain.
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Cremonini A, Ponzoni M, Beretta E, Mari G, Cangi MG, Arrigoni G, Doglioni C. Plasma Cell Granuloma of the Thyroid Gland. Int J Surg Pathol 2011; 20:500-6. [DOI: 10.1177/1066896911431453] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Barber WA, Fernando M, Chadwick DR. Plasma cell granuloma of the thyroid: a conservative approach to a rare condition and review of the literature. J Thyroid Res 2010; 2010:840469. [PMID: 21048843 PMCID: PMC2957798 DOI: 10.4061/2010/840469] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 12/18/2009] [Accepted: 12/28/2009] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- W A Barber
- Department of General Surgery, Chesterfield Royal Hospital, Calow, Chesterfield S44 5BL, UK
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Kaba S, Hirokawa M, Kuma S, Maekawa M, Yanase Y, Kojima M, Miyauchi A. Cytologic findings of primary thyroid MALT lymphoma with extreme plasma cell differentiation: FNA cytology of two cases. Diagn Cytopathol 2009; 37:815-9. [DOI: 10.1002/dc.21106] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Kojima M, Suzuki M, Shimizu K, Masawa N. Inflammatory pseudotumor of the thyroid gland showing prominent fibrohistiocytic proliferation. A case report. Endocr Pathol 2009; 20:186-90. [PMID: 19444653 DOI: 10.1007/s12022-009-9080-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Inflammatory pseudotumor of the thyroid gland (IPT) appears to be exceedingly rare. Histologically, 14 previously reported cases demonstrated plasma cell granuloma variant. We report here an IPT showing a predominantly fibrohistiocytic proliferation that occurred in a 75-year-old Japanese woman. Histologically, the lesion was characterized by haphazardly arranged spindle cells, histiocytes having foamy cytoplasm containing intracytoplasmic brown pigments, and small lymphocytes. Immunohistochemical study demonstrated that the spindle cells were vimentin+, desmin-, muscle-specific actin+, cytokeratin-, endomysial antibody-, anaplastic lymphoma kinase-, CD34-- CD68+/-, CD99-, cyclin D1-, bcl-2-, and antifollicular dendritic cell antibody-. IPT showing a predominant fibrohistiocytic proliferation should be differentiated from various nonneoplastic or neoplastic disorders showing spindle cell proliferation and/or exuberant fibrosis. They include Riedel's thyroiditis, fibrous variant of chronic thyroiditis, papillary carcinoma with exuberant nodular fasciitis-like stroma, paucicellular variant of anaplastic thyroid carcinoma, and solitary fibrous tumor.
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Affiliation(s)
- Masaru Kojima
- Department of Anatomic and Diagnostic Pathology, Dokkyo University School of Medicine, 880, Ooaza Kitakobayashi, Mibu, 321-0293, Japan.
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Kojima M, Nakamura N, Shimizu K, Segawa A, Kaba S, Masawa N. MALT Type Lymphoma Demonstrating Prominent Plasma Cell Differentiation Resembling Fibrous Variant of Hashimoto’s Thyroiditis: a Three Case Report. Pathol Oncol Res 2008; 15:285-9. [DOI: 10.1007/s12253-008-9108-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 09/30/2008] [Indexed: 01/23/2023]
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Kojima M, Shimizu K, Shimizu K, Masawa N. Incidental MALT type lymphoma exhibiting prominent plasma cell differentiation associated with Hashimoto's thyroiditis. A two case report. Head Neck Pathol 2008; 3:27-30. [PMID: 20596985 PMCID: PMC2807536 DOI: 10.1007/s12105-008-0087-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Accepted: 09/05/2008] [Indexed: 12/12/2022]
Abstract
We present here two cases of incidental extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) showing prominent plasma cell differentiation associated with Hashimoto's thyroiditis (HT). Histological examination demonstrated that both lesions exhibited HT including lymphoplasmacytic infiltration with the formation of germinal centers, destruction of the normal thyroid follicular architecture, Hürthle cell changes, and squamous metaplasia. The dominant tumor nodules of both cases contained large, well-circumscribed but unencapsulated aggregation of mature plasma cells and scattered centrocyte-like cells (CCL-cells). Both lesions contained a few lymphoepithelial lesions. Moreover, immunohistochemical study demonstrated that plasma cells and CCL-cells of these two lesions contained monotypic intracytoplasmic kappa light chain. Other small B-cell lymphomas, plasmacytoma and plasmablastic lymphoma were excluded using stains for CD5, CD10, CD23, CD43, CD56. Cyclin D1, human herpes virus type-8.
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Affiliation(s)
- Masaru Kojima
- Department of Pathology and Clinical Laboratories, Gunma Cancer Center Hospital, 617-1, Takabayashinishi-cho, Ohta, 373-8550 Japan
| | - Ken Shimizu
- Department of Pathology and Clinical Laboratories, Ashikaga Red Cross Hospital, Ashikaga, Japan
| | - Kazuhiko Shimizu
- Department of Pathology, Saitama Social Insurance Hospital, Saitama, Japan
| | - Nobuhide Masawa
- Department of Anatomic and Diagnostic Pathology, Dokkyo University School of Medicine, Mibu, Japan
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