Papillary carcinoma associated with black thyroid gland

Black thyroid associated with thyroid carcinoma

Objective. Black thyroid is a rare pigmented change seen almost exclusively in patients upon minocycline ingestion, and the process has previously been thought to be generally benign. There have been 61 reported cases of black thyroid. We are aware of 13 cases previously reported in association with thyroid carcinoma. This paper reports six patients with black thyroid pigmentation in association with thyroid carcinoma. Design. The medical records of six patients who were diagnosed with black thyroid syndrome, all of whom underwent thyroid surgery, were reviewed. Data on age, gender, race, preoperative fine needle aspiration biopsy (FNA), thyroid function levels, and pathology reports were collected. Main Outcome. The mean age was 60 years. There were 5 females, 4 of whom were African American. All patients were clinically and biochemically euthyroid. Black pigmentation was not diagnosed in preoperative FNA, and only one patient had a preoperative diagnosis of papillary thyroid carcinoma. The other patients underwent surgery and were found to have black pigmentation of the thyroid associated with carcinoma. Conclusions. FNA does not diagnose black thyroid, which is associated with thyroid carcinoma. Thyroid glands with black pigmentation deserve thorough pathologic examination, including several sections of each specimen.

A case of black thyroid associated with hyalinizing trabecular tumor

Black thyroid is an uncommon phenomenon of black pigmentation of thyroid parenchyma induced by chronic minocycline therapy. Thyroid tumors associated with black pigmented thyroid are rare. We describe here a 42-year-old woman with a black thyroid associated with hyalinizing trabecular tumor (HTT). The patient presented with a palpable left-sided thyroid nodule. She had taken minocycline for aphthous stomatitis and an oral ulcer for 9 years. The findings of fine needle aspiration biopsy and BRAF mutation analysis suggested a papillary carcinoma. The patient underwent a near-total thyroidectomy with central compartment node dissection. The surgical specimen showed a diffuse black thyroid and a 2-cm non-pigmented, well-circumscribed nodule in the left thyroid. Histopathologically, numerous black pigmented follicular epithelial cells and colloid were seen throughout the thyroid parenchyma, and the nodule was composed of elongated, polygonal cells in trabecular arrangement and dense hyaline stromas. The tumor cells showed a strong positive cytoplasmic reaction to Ki 67. All of these findings suggested a HTT, or a hyalinizing trabecular variant of papillary carcinoma, arising in a black thyroid. To our knowledge, this is the first case of black thyroid associated with HTT.

Black thyroid revisited: cytologic diagnosis in fine-needle aspirates is unlikely

We report four patients diagnosed with black discoloration of the thyroid gland at surgery and a fifth patient in which the "black thyroid" was an incidental finding at autopsy. The four patients diagnosed at surgery had prior fine-needle aspirations (FNA), which did not reveal any characteristic pigmentation. One patient presented with cervical lymph node metastases from a papillary microcarcinoma of thyroid. The second patient was diagnosed as a cellular adenomatoid nodule, and suppressive therapy was recommended. She elected to have surgery instead. The third patient underwent surgery because of an oxyphilic cell nodule, in a background of lymphocytic thyroiditis, in which a Hürthle cell neoplasm could not be ruled out. His aspirates were reviewed at two other institutions, and no diagnosis of black thyroid was entertained. The fourth patient had an adenomatoid nodule with cystic change and slightly atypical squamous metaplasia. She decided to have surgery, which revealed a black thyroid. Later, it was discovered that the patients had received minocycline for the treatment of acne. FNA does not seem to be a reliable method to diagnose black thyroid preoperatively. Although this is a striking operative finding, diagnosing it on FNA seems to be unlikely and also inconsequential.

Minocycline-induced black thyroid gland: Medical curiosity or a marker for papillary cancer?

PURPOSE

Black pigmentation of the thyroid gland is a rare side effect of minocycline.

METHODS

Only 26 cases, in addition to the 2 we present, have been reported in the literature. Eleven cases of thyroid carcinoma associated with black thyroid syndrome have been reported.

CONCLUSIONS

The incidence of papillary cancer may be increased in thyroid glands stained by the minocycline pigment, which warrants an increased index of suspicion in patients who develop thyroid nodules and have previously been treated with minocycline.