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Nazerani-Zemann T, Pernthaler B, Abete L, Wienerroither VF, Gstettner C. A Rare Case of Thyroid Sarcoidosis. Clin Nucl Med 2024; 49:169-170. [PMID: 38109040 DOI: 10.1097/rlu.0000000000005008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
ABSTRACT Thyroid sarcoidosis is a rare manifestation of sarcoidosis, an inflammatory disease characterized by the formation of noncaseating granulomas in various organs. The diagnosis of thyroid sarcoidosis is challenging because of its nonspecific symptoms and the absence of specific biomarkers. Here, we report the case of a 43-year-old woman who presented with a 2-year history of neck swelling, dysphonia, and dysphagia, and suspected nodule in her left thyroid.
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Affiliation(s)
| | | | - Luca Abete
- Diagnostic and Research Institute of Pathology
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Katsamakas M, Tzitzili E, Boudina M, Kiziridou A, Valeri R, Zafeiriou G, Chrisoulidou A. Thyroid sarcoidosis: a rare entity in the differential diagnosis of thyroid cancer. Endocrinol Diabetes Metab Case Rep 2021; 2021:EDM210095. [PMID: 34515660 PMCID: PMC8495726 DOI: 10.1530/edm-21-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022] Open
Abstract
SUMMARY We present two cases of thyroid sarcoidosis that were misdiagnosed as thyroid cancer. In the first patient, fine needle aspiration cytology (FNAc) of a suspicious thyroid nodule indicated the presence of papillary thyroid cancer, and the patient underwent thyroid surgery. However, histopathology identified a sarcoid granuloma, without any sign of malignancy. The second patient had a history of papillary microcarcinoma with suspicious lymph nodes diagnosed years after the initial diagnosis and was referred for assessment of cervical lymphadenopathy. Fine needle aspiration cytology (FNAc) of the suspicious lymph nodes erroneously indicated metastasis from thyroid cancer, and lateral modified lymph node dissection was performed, based on FNAc and ultrasonographic features. Histopathology excluded malignancy and identified non-caseating granulomas. Sarcoidosis of the thyroid may have a clinical presentation similar to well-differentiated thyroid carcinoma and, although rare, should be considered in the differential diagnosis, especially when other signs of the disease are already present. In these cases, FNAc provided a false diagnosis of papillary thyroid carcinoma and lymph node metastases that led to unnecessary surgery. LEARNING POINTS Sarcoidosis may share clinical and ultrasonographic features with papillary thyroid carcinoma. Fine needle aspiration cytology is helpful in the diagnosis of both conditions; however, the overlapping cytological characteristics may lead to erroneous diagnosis. The present cases illustrate the importance of cytological identification of these difficult cases. Every piece of information provided by the clinician is essential to the cytologist.
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Affiliation(s)
| | | | | | | | - Rosalia Valeri
- Cytology Department, Theageneio Cancer Hospital, Thessaloniki, Greece
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Wenter V, Albert NL, Ahmaddy F, Unterrainer M, Hornung J, Ilhan H, Bartenstein P, Spitzweg C, Kneidinger N, Todica A. The diagnostic challenge of coexistent sarcoidosis and thyroid cancer - a retrospective study. BMC Cancer 2021; 21:139. [PMID: 33550991 PMCID: PMC7868024 DOI: 10.1186/s12885-020-07745-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 12/16/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Sarcoid lesions may mimic metastatic disease or recurrence in thyroid cancer (TC) patients as both diseases may affect the lungs and lymph nodes. We present the first study to systematically evaluate the clinical course of patients with (TC) after adjuvant radioactive iodine therapy (RIT) and concomitant sarcoidosis of the lung or the lymph nodes. METHODS We screened 3285 patients and retrospectively identified 16 patients with TC (11 papillary thyroid cancer (PTC), 3 follicular thyroid cancer (FTC), 1 oncocytic PTC, 1 oncocytic FTC) and coexisting sarcoidosis of the lung and/or the lymph nodes treated at our institute. All patients had undergone thyroidectomy and initial adjuvant RIT. Challenges in diagnosing and the management of these patients were evaluated during long term follow-up (median 4.9 years (0.8-15.0 years)). RESULTS Median age at first diagnosis of TC was 50.1 years (33.0-71.5 years) and of sarcoidosis 39.4 years (18.0-63.9 years). During follow-up, physicians were able to differentiate between SA and persistent or recurrent TC in 10 of 16 patients (63%). Diagnosis was complicated by initial negative thyroglobulin (Tg), positive Tg antibodies and non-specific imaging findings. Histopathology can reliably distinguish between SA and TC in patients with one suspicious lesion. CONCLUSION Physicians should be aware of the rare coexistence of sarcoidosis and TC. Lymphadenopathy and pulmonary lesions could be metastases, sarcoidosis or even a mix of both. Therefore, this rare patient group should receive a thorough work up including histopathological clarification and, if necessary, separately for each lesion.
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MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/diagnostic imaging
- Adenocarcinoma, Follicular/metabolism
- Adenocarcinoma, Follicular/surgery
- Adolescent
- Adult
- Aged
- Biomarkers, Tumor/metabolism
- Diagnosis, Differential
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Prognosis
- Retrospective Studies
- Sarcoidosis/diagnosis
- Sarcoidosis/diagnostic imaging
- Sarcoidosis/metabolism
- Sarcoidosis/surgery
- Thyroid Cancer, Papillary/diagnosis
- Thyroid Cancer, Papillary/diagnostic imaging
- Thyroid Cancer, Papillary/metabolism
- Thyroid Cancer, Papillary/surgery
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/diagnostic imaging
- Thyroid Neoplasms/metabolism
- Thyroid Neoplasms/surgery
- Young Adult
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Affiliation(s)
- Vera Wenter
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Nathalie L Albert
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Freba Ahmaddy
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Marcus Unterrainer
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Julia Hornung
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Harun Ilhan
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Comprehensive Cancer Center (CCC LMU) and Interdisciplinary Center for Thyroid Carcinoma (ISKUM), University Hospital, LMU Munich, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Comprehensive Cancer Center (CCC LMU) and Interdisciplinary Center for Thyroid Carcinoma (ISKUM), University Hospital, LMU Munich, Munich, Germany
| | - Christine Spitzweg
- Comprehensive Cancer Center (CCC LMU) and Interdisciplinary Center for Thyroid Carcinoma (ISKUM), University Hospital, LMU Munich, Munich, Germany
- Department of Internal Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center (CPC-M), Helmholtz Zentrum München, Member of the German Centre for Lung Research (DZL), Munich, Germany
| | - Andrei Todica
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Comprehensive Cancer Center (CCC LMU) and Interdisciplinary Center for Thyroid Carcinoma (ISKUM), University Hospital, LMU Munich, Munich, Germany
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Kmieć P, Lewandowska M, Dubaniewicz A, Mizan-Gross K, Antolak A, Wołyniak B, Sworczak K. Two cases of thyroid sarcoidosis presentation as painful, recurrent goiter in patients with Graves' disease. ACTA ACUST UNITED AC 2013; 56:209-14. [PMID: 22666738 DOI: 10.1590/s0004-27302012000300010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 03/18/2012] [Indexed: 11/22/2022]
Abstract
Sarcoidosis rarely involves the thyroid gland. Pain in the thyroid gland area was only sporadically reported in patients suffering from this disease. The aim of this paper is to report and discuss the cases of two female patients with Graves' disease who presented painful, rapidly growing, recurrent goiters (after strumectomy in their early adult lives). Invasive treatment was applied and sarcoidosis was revealed histologically. The first patient suffered from dysphagia and dyspnoea due to large goiter; skin lesions were present as well. Sarcoidosis was diagnosed in histological examination of the thyroid tissue specimens. Steroid treatment was ineffective; thus, the thyroid was removed. Two years later thyroid sarcoidosis recurred as a painful goiter and surgical treatment was applied once again. In the second case, thyroid ultrasound findings suggesting malignancy, and prompted the decision to perform thyroidectomy despite the fact that FNAB (fine needle aspiration biopsy) revealed cells indicative of a "granulomatous disease in the post-resection scar" and results of the thorax high-resolution computed tomography scan suggested pulmonary sarcoidosis. Pathological examination confirmed sarcoidosis. However, a papillary cancer focus was also found.
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Affiliation(s)
- Piotr Kmieć
- Department of Endocrinology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland.
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Kini U. Role of fine needle aspiration cytology in thyroiditis. Expert Rev Clin Immunol 2007; 3:85-99. [PMID: 20476954 DOI: 10.1586/1744666x.3.1.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fine needle aspiration (FNA) of thyroid is a cost-effective, simple, diagnostic tool in the initial screening of patients with thyroid lesions. Its role in a minimally enlarged thyroid in a symptomatic patient suspected of thyroid dysfunction is now well known. It plays an important role in the medical management of all nonpalpable/minimally enlarged thyroid (goiter) in patients suspect for thyroid pathology and/or in combination with thyroid-stimulating hormone, T3 and T4 levels by diagnosing early cases of thyroiditis. FNA may be of assistance in the early detection of subclinical hypothyroidism, which is of utmost importance in pregnant women, and further makes possible the availability of baseline values for future reference. With the implementation of this protocol of FNA thyroid with/without imaging, we affirm that the practice of cytology has differed in different geographic areas and from country to country, depending on economy and availability of infrastructure.
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Affiliation(s)
- Usha Kini
- Department of Pathology, St John's Medical College, Bangalore 560034, India.
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Abstract
Sarcoidosis is a systemic disorder characterized by granulomatous lesions, principally affecting the lungs. There are numerous reports in the literature of an associated involvement of the thyroid, much more frequently in hypothyroid than in hyperthyroid subjects. The present case report refers to a woman presenting with thyroid nodules and normal biochemical levels and thyroid function parameters, while histology revealed sarcoid-type lesions. Subsequent investigations and a long follow-up showed no evidence of involvement of other sites, including the lungs. Consequently, after a long period of normal health associated with the negative results of the examinations, a diagnosis of sarcoidosis limited to the thyroid was proposed, which was cured by thyroidectomy.
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Sheu SY, Schmid KW. [Inflammatory diseases of the thyroid gland. Epidemiology, symptoms and morphology]. DER PATHOLOGE 2003; 24:339-47. [PMID: 12961022 DOI: 10.1007/s00292-003-0628-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Inflammation of the thyroid gland makes up approximately 20% of all thyroid diseases. According to the clinical course, thyroiditis has been subdivided into acute, subacute, and chronic forms. Recent classifications are based on the fact that the majority of thyroiditis cases have an autoimmune background. The most common form of this disease is autoimmune thyroiditis (AIT), with or without subclinical/manifest hypothyroidism; less common forms of autoimmune thyroiditis comprise subacute granulomatous (de Quervain's) thyroiditis, postpartum thyroiditis, silent ("painless") thyroiditis, and invasive-sclerosing thyroiditis (Riedel's thyroiditis). Non-autoimmune thyroiditis is very rare (acute suppurative thyroiditis, radiation thyroiditis). Thyroiditis is both clinically and morphologically an important differential diagnosis of thyroid tumours. The present paper deals with the epidemiology, clinical course, and morphology of thyroiditis, knowledge of which is essential for the examination of cytological and histological thyroid specimens.
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Affiliation(s)
- S-Y Sheu
- Institut für Pathologie, Universitätsklinikum Essen, Germany
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Saydam L, Bozkurt MK, Kutluay L, Ozçelik T. Sarcoidosis of the thyroid gland initially diagnosed as malignancy. Otolaryngol Head Neck Surg 2003; 129:154-6. [PMID: 12869935 DOI: 10.1016/s0194-59980300484-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Levent Saydam
- Department of Otolaryngology--Head and Neck Surgery, Bayindir Medical Center, Bayindir Hospital.
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Ludvíková M, Ryska A, Dvoráková E. Focal sarcoid-like change of the thyroid gland. A possible consequence of aspiration cytology? Pathol Res Pract 2003; 198:479-82; discussion 483. [PMID: 12234067 DOI: 10.1078/0344-0338-00285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
An unusual case of focal accumulation of sarcoid-like granulomas occurring within the thyroid gland of a 43-year-old female patient is reported. The granulomas were found solely at the site of previous fine needle aspiration biopsy. The follow-up did not show any symptoms of systemic granulomatous disease. The pathogenesis of this lesion is discussed.
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Affiliation(s)
- Marie Ludvíková
- Department of Pathology, Charles University Medical Faculty, Plzen, Czech Republic.
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Zimmermann-Belsing T, Christensen L, Hansen HS, Kirkegaard J, Blichert-Toft M, Feldt-Rasmussen U. A case of sarcoidosis and sarcoid granuloma, papillary carcinoma, and Graves' disease in the thyroid gland. Thyroid 2000; 10:275-8. [PMID: 10779143 DOI: 10.1089/thy.2000.10.275] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Sarcoidosis is a systemic chronic granulomatous disease of unknown etiology most commonly affecting young females. The disease was first described in the thyroid gland in 1938. Our patient, a 27-year-old male with known sarcoidosis, was referred to the National University Hospital for acute symptoms of thyrotoxicosis (weight loss of 6 kg, tremor, thyroid enlargement, and tachycardia). Laboratory findings showed suppressed serum thyrotropin (TSH, <0.03 mU/L [0.5-4.20]), increased total thyroxine (T4) (223 nmol/L, [60-140]), and triiodothyronine (T3) (8.5 nmol/L, [1.5-2.7]). Furthermore, Tc-99m pertechnetate scintigraphy disclosed diffuse accumulation of the isotope confirming the diagnosis of Graves' disease. During the next 18 months of antithyroid treatment (thiamazole, Thycapzol) hyperthyroidism was difficult to control, the thyroid gland gradually enlarged, and surgery was recommended. Initially, the patient declined surgery but after an additional 18 months, he accepted surgery. During the 36-month period of antithyroid drug treatment TSH was suppressed (<0.01 mU/L) and T3 often elevated despite high doses of thiamazole. Total thyroidectomy was performed, and histologic examination of the removed thyroid tissue confirmed the diagnosis of Graves' disease and also the presence of sarcoid granuloma and metastatic papillary adenocarcinoma with spread to neck lymph nodes. Four months later, a modified radical neck dissection was performed with removal of neck lymph nodes followed by external radiation therapy (2 Gy x 32 fractions to the neck). The concomitant presence of sarcoidosis, papillary carcinoma, and Graves' disease in a thyroid gland, to our knowledge, has not previously been described in the literature.
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Affiliation(s)
- T Zimmermann-Belsing
- Department of Endocrinology, National University Hospital, Rigshospitalet, Copenhagen.
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Mombaerts I, Schlingemann RO, Goldschmeding R, Koornneef L. Idiopathic granulomatous orbital inflammation. Ophthalmology 1996; 103:2135-41. [PMID: 9003349 DOI: 10.1016/s0161-6420(96)30378-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Granulomatous orbital inflammation may occur as an isolated condition of unknown origin. These idiopathic granulomatous lesions are believed to belong to the orbital pseudotumor group by some authors, whereas others consider them sarcoidosis limited to the orbit. The aim of this study is to define the clinicotherapeutic aspects of these lesions. METHODS The records of all patients with diagnosis of orbital pseudotumor and orbital sarcoidosis from the Orbital Center Amsterdam in the period between 1976 and 1994 were reviewed to define those with idiopathic granulomatous orbital inflammation. The authors studied the clinicotherapeutic aspects and histopathology of idiopathic granulomatous orbital inflammation by analysis of their own series and the literature. RESULTS Their study group encompassed seven patients with idiopathic granulomatous orbital inflammation. The mean follow-up was 9.5 years (range, 3.5-16.0 years). All had unilateral orbital presentation, with localization in the lacrimal gland in three patients. The lesions clinically presented with signs of mass effect or inflammation or both and were treated successfully with surgery, systemic corticosteroids, a combination of surgery and systemic corticosteroids, or systemic corticosteroids followed by irradiation. Histopathologic analysis showed a spectrum of granulomatous inflammation, admixed with nongranulomatous inflammation and fibrosis. There have been 30 similar cases described in the literature with comparable clinicotherapeutic characteristics. CONCLUSIONS Based on this study and the literature, it appears that idiopathic granulomatous orbital inflammation is more related to orbital pseudotumor than to orbital sarcoidosis.
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Affiliation(s)
- I Mombaerts
- Department of Ophthalmology, Academic Medical Center, University of Amsterdam, The Netherlands
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