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Kuba K, Kawasaki T, Enoki Y, Inoue H, Matsumura S, Yamazaki T, Ebihara Y, Nakahira M, Sugasawa M. Follicular adenoma with a papillary architecture originating from an ectopic thyroid gland: a case report. BMC Endocr Disord 2024; 24:16. [PMID: 38287285 PMCID: PMC10826198 DOI: 10.1186/s12902-024-01547-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/24/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Follicular adenomas with papillary architecture are rare tumors of thyroid origin and are composed of completely encapsulated follicular cells with a papillary architecture lacking the nuclear characteristics of papillary carcinoma. Herein, we present a case of follicular adenoma with papillary architecture originating from an ectopic thyroid gland, diagnosed from a mass in the submandibular region. CASE PRESENTATION A 70-year-old woman was referred to our hospital with the chief complaint of a painless left submandibular mass that had been present for one year. The patient underwent left submandibular dissection for therapy and diagnosis. Microscopically, papillary lesions with fibrovascular cores were observed in the interior, and the epithelial cells were cylindrical in shape with eosinophilic cytoplasm, round or oval nuclei, with no pathological features, leading to a diagnosis of papillary carcinoma or follicular carcinoma. The mass was diagnosed as a follicular thyroid adenoma with papillary architecture. This is the first report of a follicular adenoma with a papillary architecture originating from an ectopic thyroid gland. CONCLUSION This experience suggests that follicular adenoma should be included in the differential diagnosis of ectopic thyroid tumors.
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Affiliation(s)
- Kiyomi Kuba
- Department of Head and Neck Surgery, Ageo Central General Hospital, Ageo, Saitama, Japan.
| | - Tomonori Kawasaki
- Department of Diagnostic Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Yuichiro Enoki
- Department of Head and Neck Surgery and Otolaryngology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hitoshi Inoue
- Department of Head and Neck Surgery and Otolaryngology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Satoko Matsumura
- Department of Head and Neck Surgery and Otolaryngology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Tomoko Yamazaki
- Department of Head and Neck Surgery and Otolaryngology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Yasuhiro Ebihara
- Department of Head and Neck Surgery and Otolaryngology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Mitsuhiko Nakahira
- Department of Head and Neck Surgery and Otolaryngology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Masashi Sugasawa
- Department of Head and Neck Surgery, Kameda Medical Center, Kamogawa, Chiba, Japan
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Fu G, Guo F, Zhang W, Ruan X, Zheng X, Wang Z, Gao M. Diagnosis and treatment of ectopic thyroid carcinoma: A case report and literature review. Front Oncol 2022; 12:1072607. [PMID: 36465404 PMCID: PMC9716014 DOI: 10.3389/fonc.2022.1072607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/07/2022] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Ectopic thyroid cancer (ETC) is primary thyroid cancer occurring in ectopic thyroid tissue, and its incidence rate is approximately 0.3%-0.5% of thyroid cancer. Only approximately 132 cases of ETC have been diagnosed and treated worldwide in the past 110 years, with most of them being adults. Of note, patients with ETC are prone to misdiagnosis and mistreatment. CASE REPORT This was a 13-year-old adolescent female who reported having a sensation of swallowing obstruction when eating blocky foods. Color Doppler Ultrasound (CDU) found a 2.3 cm ×1.7 cm × 2.1 cm hypoechoic nodule slightly to the right of the deep surface of the tongue base, with a honeycomb shape. Meanwhile, a mixed echogenic nodule of approximately 2.0 cm × 1.9 cm × 2.3 cm was seen deep in the mouth floor, and a very low echogenic region of 1.4 cm × 1.1 cm × 1.8 cm was observed in the nodule. We then performed a fine needle aspiration biopsy (FNAB) of the thyroid nodules guided by CDU, and the results showed papillary thyroid carcinoma (PTC). Then, a local extended resection of the thyroid carcinoma was performed. Bilateral cervical IA and adjacent subhyoid lymph node dissection was performed through a small anterior cervical incision. The patient recovered well, and was discharged on the fifth day after surgery. The patient only took levothyroxine tablets for replacement therapy after surgery. The patient was followed up for 36 months, and the thyroid function remained in the normal range. Reexamination by CDU showed no tumor recurrence, lymph node enlargement, or obvious change in the tongue base ectopic thyroid. CONCLUSIONS ETC is an extremely rare type of thyroid cancer, which is easy to be misdiagnosed. Preoperative use of CDU, nuclide scanning, computed tomography (CT)/Magnetic resonance imaging (MRI), and FNAB can significantly reduce the misdiagnosis rate of this disease. Surgery is currently the main treatment for ETC. Complete resection still has a high cure rate. For patients with advanced ETC who cannot be completely resected, external radiotherapy and targeted therapy can be tried, but the prognosis needs to be verified with more cases in the future.
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Affiliation(s)
- Guiming Fu
- Department of Thyroid and Neck Tumor, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Thyroid-otolaryngology Department, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center · School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Fengli Guo
- Department of Thyroid and Neck Tumor, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Department of Thyroid and Breast Surgery, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Wei Zhang
- Department of Thyroid and Neck Tumor, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
- School of Medicine, Nankai University, Tianjin, China
- Department of Thyroid and Breast Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Xianhui Ruan
- Department of Thyroid and Neck Tumor, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Xiangqian Zheng
- Department of Thyroid and Neck Tumor, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Zhaohui Wang
- Thyroid-otolaryngology Department, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center · School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ming Gao
- Department of Thyroid and Neck Tumor, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Department of Thyroid and Breast Surgery, Tianjin Union Medical Center, Tianjin, China
- Tianjin Key Laboratory of General Surgery in Construction, Tianjin Union Medical Center, Tianjin, China
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Rangankar V, Uz Zaman S, Muralinath K, Shah VP, Yadav P. Case of Colloid Nodular Goitre in a Rare Submandibular Location. Cureus 2021; 13:e18035. [PMID: 34671523 PMCID: PMC8520570 DOI: 10.7759/cureus.18035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 12/01/2022] Open
Abstract
Ectopic thyroid gland occurs due to aberrant descent of primitive thyroid gland to the final pre-tracheal position and failure of fusion of thyroid anlages. Submandibular ectopic thyroid is a rare thyroid anomaly that can present with or without an orthotopic thyroid gland. We present a case of a young female with hypothyroidism and left submandibular swelling demonstrated to be an ectopic thyroid with the colloid nodular goitre on imaging and cytology.
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Affiliation(s)
- Varsha Rangankar
- Radiology, Dr. D.Y. Patil Medical College, Hospital and Research Center, Pune, IND
| | - Sameeh Uz Zaman
- Radiology, Dr. D.Y. Patil Medical College, Hospital and Research Center, Pune, IND
| | | | - Viraj P Shah
- Radiology, Dr. D.Y. Patil Medical College, Hospital and Research Center, Pune, IND
| | - Pratiksha Yadav
- Radiology, Dr. D.Y. Patil Medical College, Hospital and Research Center, Pune, IND
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Iorio CB, Atkins KA, Nass RM, Shonka DC. Ectopic Thyroid Tissue Masquerading as a Functional Carotid Body Paraganglioma. AACE Clin Case Rep 2020; 6:e189-e192. [DOI: 10.4158/accr-2019-0553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/22/2020] [Indexed: 11/15/2022] Open
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Aliyev A, Ismayilov R, Seyidov N. Lateral ectopic thyroid with orthotopic multinodular goitre: A case report. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.jecr.2020.100058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Batchala PP, Dyer A, Mukherjee S, Rehm PK. Lateral ectopic thyroid mimics carotid body tumor on Indium-111 pentetreotide scintigraphy. Clin Imaging 2019; 58:46-49. [PMID: 31238185 DOI: 10.1016/j.clinimag.2019.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 12/29/2022]
Abstract
A 34-year old woman with past history of anxiety, depression, and hypothyroidism resulting from prior total thyroidectomy for multinodular goiter presented with complaints of palpitations, sweating, and tachycardia. Clinical examination revealed a painless right lateral neck mass. USG/CT of the neck revealed the soft tissue mass located at the right carotid bifurcation. A subsequent Indium-111 pentetreotide somatostatin receptor scintigraphy (SRS) demonstrated tracer uptake in the mass. Hence, secretory carotid body tumor/paraganglioma was strongly suspected. However, post-surgical histopathological specimen revealed only benign thyroid follicles indicative of lateral ectopic thyroid with no evidence of neuroendocrine cells or malignancy. This case highlights the importance of considering lateral ectopic thyroid, a very rare entity, in the differential diagnosis for carotid bifurcation masses. Also highlighted is the false positivity from normal but ectopic thyroid tissue on Indium-111 pentetreotide SRS mimicking a paraganglioma.
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Affiliation(s)
- Prem P Batchala
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Anthony Dyer
- School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Sugoto Mukherjee
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Patrice K Rehm
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA.
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7
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Affiliation(s)
- Don K. Nakayama
- Department of Surgery Florida International University School of Medicine Sacred Heart Medical Group, Pediatric Surgery Pensacola, Florida
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8
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Consalvo V, Barbieri G, Rossetti ARR, Romano M, Contieri R, Tramontano S, Rescigno C, Infranzi M, Lombardi D. Follicular adenoma in ectopic thyroid. A case-report. Int J Surg Case Rep 2017; 40:94-96. [PMID: 28946030 PMCID: PMC5614748 DOI: 10.1016/j.ijscr.2017.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 11/25/2022] Open
Abstract
Ectopic thyroid is thyroidal tissue located far from its anatomic place. A patient under our observation displayed left submandibular swelling. The FNAC test report described a follicular adenoma. Based on the FNAC diagnosis, we surgically removed the mass. The post-operative follow-up was uneventful.
Introduction The term ectopic thyroid refers to the presence of thyroid tissue located far from its usual anatomic placement and with no vascular connection to the main gland. The presence of swelling in atypical locations is diagnostically differentiated from other pathologies like pleomorphic adenoma or carcinoma, inflammatory lesions like sialadenitis, neurogenic tumors, paraganglioma, fibrolipoma and lymphadenopaties of diverse etiologies. Presentation of case Here we present the case of a submandibular ectopic thyroid in a 67 year old woman. She came to our attention for a left submandibular swelling. The anamnesis did not show related pathologies, as well as blood tests. Diagnostic image studies and a FNAC were performed. The mass was surgically removed and histopatology showed a follicular adenoma in the contest of the capsulated lesion. Discussion It is important to not underestimate these types of lesions and procede with hematochemical, instrumental tests and above all surgery that can eliminate any diagnostic uncertainty and on the whole be therapeutic. Conclusion It should not be forgotten that ectopic thyroid tissue can be a site for adenoma or papillary carcinoma and thus any watch and wait strategy should be avoided.
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Affiliation(s)
- Vincenzo Consalvo
- Università degli Studi di Salerno, Italy; Collaborator of Clinique du Parc Montpellier, France.
| | | | | | | | | | | | | | | | - Domenico Lombardi
- Hospital of Cava de' Tirreni, Università degli studi di Salerno, Italy.
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Chahed H, Kharrat G, Bechraoui R, Marrakchi J, Mediouni A, Amor MB, Zainine R, Beltaief N, Besbes G. Ectopic thyroid tissue: unusual differential diagnosis of cervical paraganglioma. Pan Afr Med J 2017; 27:43. [PMID: 28761619 PMCID: PMC5516674 DOI: 10.11604/pamj.2017.27.43.11495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 04/16/2017] [Indexed: 11/13/2022] Open
Abstract
Ectopic thyroid tissue (ETT) lateral to the midline is rare. Its occurrence in the carotid bifurcation is exceptional. We present a 45 years woman who consulted with a slow growing right cervical swelling. Clinical examination Ultrasonography, contrast enhanced CT and cervical MRI concluded to a paraganglioma. Intra-operatively, the tumor didn’t have the characteristic aspect of a paraganglioma. Complete excision was performed. Histology concluded to an ectopic micro-vesicular thyroid adenoma.Previous literature was reviewed to summarize clinical and radiologic characteristics of such rare entity. Despite its rarity, ETT must be included in the differential diagnosis of cervical paraganglioma.
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Affiliation(s)
- Houda Chahed
- Department of Oto-Rhino-Laryngology and Cervico-Facial Surgery of 'Rabta' Hospital Tunisia, Medecine Faculty, El ManarUniversity, Tunisia
| | - Ghada Kharrat
- Department of Oto-Rhino-Laryngology and Cervico-Facial Surgery of 'Rabta' Hospital Tunisia, Medecine Faculty, El ManarUniversity, Tunisia
| | - Rim Bechraoui
- Department of Oto-Rhino-Laryngology and Cervico-Facial Surgery of 'Rabta' Hospital Tunisia, Medecine Faculty, El ManarUniversity, Tunisia
| | - Jihene Marrakchi
- Department of Oto-Rhino-Laryngology and Cervico-Facial Surgery of 'Rabta' Hospital Tunisia, Medecine Faculty, El ManarUniversity, Tunisia
| | - Azza Mediouni
- Department of Oto-Rhino-Laryngology and Cervico-Facial Surgery of 'Rabta' Hospital Tunisia, Medecine Faculty, El ManarUniversity, Tunisia
| | - Mohamed Ben Amor
- Department of Oto-Rhino-Laryngology and Cervico-Facial Surgery of 'Rabta' Hospital Tunisia, Medecine Faculty, El ManarUniversity, Tunisia
| | - Rim Zainine
- Department of Oto-Rhino-Laryngology and Cervico-Facial Surgery of 'Rabta' Hospital Tunisia, Medecine Faculty, El ManarUniversity, Tunisia
| | - Nejeh Beltaief
- Department of Oto-Rhino-Laryngology and Cervico-Facial Surgery of 'Rabta' Hospital Tunisia, Medecine Faculty, El ManarUniversity, Tunisia
| | - Ghazi Besbes
- Department of Oto-Rhino-Laryngology and Cervico-Facial Surgery of 'Rabta' Hospital Tunisia, Medecine Faculty, El ManarUniversity, Tunisia
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A Rare Case of a Postoperative Submandibular Exophytic Goiter in a Patient With a Recurrent Normotopic Nodular Goiter. Clin Nucl Med 2016; 41:485-7. [PMID: 27055140 DOI: 10.1097/rlu.0000000000001226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 50-year-old woman presented a painless left submandibular mass. She had history of partial thyroidectomy for nodular goiter. A radioiodine whole-body scan showed tracer accumulation in the mass, which connected with the thyroid remnant. The left submandibular mass was resected, and the pathological examination demonstrated exophytic and normotopic nodular goiter.
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11
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Bhardwaj AK, Mani V, Dixit R, Garg A. Ectopic goitrous submandibular thyroid with goitrous orthotopic thyroid gland. Indian J Radiol Imaging 2016; 26:245-8. [PMID: 27413274 PMCID: PMC4931786 DOI: 10.4103/0971-3026.184420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Ectopic thyroid is a rare developmental anomaly with lingual thyroid accounting for majority of the cases. The presence of ectopic thyroid tissue lateral to the midline is very rare, and very few cases located in the submandibular region have been reported. The simultaneous finding of submandibular ectopic thyroid tissue and a functional orthotopic thyroid gland is even rarer. In the differential diagnosis of an ectopic submandibular thyroid, it is fundamental to exclude a metastasis from well-differentiated thyroid cancer, even when primary thyroid carcinoma is not demonstrable.
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Affiliation(s)
- Avinash Kumar Bhardwaj
- Department of Radiodiagnosis, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Vinayaga Mani
- Department of Radiodiagnosis, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Rashmi Dixit
- Department of Radiodiagnosis, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Anju Garg
- Department of Radiodiagnosis, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
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12
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Submandibular Lateral Ectopic Thyroid Tissue: Ultrasonography, Computed Tomography, and Scintigraphic Findings. Case Rep Otolaryngol 2015; 2015:769604. [PMID: 26634164 PMCID: PMC4655019 DOI: 10.1155/2015/769604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/01/2015] [Indexed: 12/04/2022] Open
Abstract
Ectopic thyroid can be encountered anywhere between the base of tongue and pretracheal region. The most common form is euthyroid neck mass. Herein, we aimed to present the findings of a female case with ectopic thyroid tissue localized in the left submandibular region. A 44-year-old female patient, who underwent bilateral subtotal thyroidectomy four years ago with the diagnosis of multinodular goiter, was admitted to our hospital due to a mass localized in the left submandibular area that gradually increased in the last six months. Neck ultrasonography, contrast-enhanced computed tomography, and scintigraphic examination were performed on the patient. On thyroid scintigraphy with Tc-99m pertechnetate, thyroid tissue activity uptake showing massive radioactivity was observed in the normal localization of the thyroid gland and in the submandibular localization. The focus in the submandibular region was excised. Pathological examination of the specimen showed normal thyroid follicle cells with no signs of malignancy. The submandibular mass is a rarely encountered lateral ectopic thyroid tissue. Accordingly, ectopic thyroid tissue should also be considered in the differential diagnosis of masses in the submandibular region.
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Zander DA, Smoker WRK. Imaging of ectopic thyroid tissue and thyroglossal duct cysts. Radiographics 2015; 34:37-50. [PMID: 24428281 DOI: 10.1148/rg.341135055] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
When a child or young adult presents with a mass in the anterior portion of the neck, diagnostic considerations include a thyroglossal duct cyst and ectopic thyroid tissue. These entities are often suspected clinically, and imaging provides an opportunity to evaluate the extent, confirm the diagnosis, and evaluate for complications. Imaging characteristics of a thyroglossal duct cyst as a simple cyst and of ectopic thyroid tissue as a hyperattenuating soft-tissue mass can help identify these lesions at computed tomography (CT); however, intrinsic magnetic resonance, CT, and ultrasonographic imaging characteristics alone cannot be used to confirm the diagnosis. Rather, knowledge of the typical course of the thyroid primordium during embryologic development is essential to understand the variant locations along this path where thyroid tissue can be found. The migration of thyroid primordium begins at the foramen cecum at the base of the tongue and then loops around the hyoid bone anteriorly and inferiorly and descends anteriorly to the thyrohyoid membrane into the orthotopic location in the infrahyoid portion of the neck. Thyroid ectopia is categorized into one of four typical locations with respect to this embryologic course: (a) the base of the tongue, (b) adjacent to the hyoid bone, (c) the midline infrahyoid portion of the neck, and, rarely, (d) the lateral part of the neck. The differential diagnosis includes metastatic thyroid carcinoma, branchial cleft cyst, lymphatic malformation, abscess, saccular cyst, epidermoid cyst, and squamous cell carcinoma. The relationship of a mass to landmarks such as the foramen cecum, hyoid bone, strap muscles, thyrohyoid membrane, and thyroid cartilage can help differentiate a thyroglossal duct cyst and ectopic thyroid tissue from other anterior neck masses when the embryologic thyroid course is considered.
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Affiliation(s)
- David A Zander
- From the Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242
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Peterson ME, Broome MR. THYROID SCINTIGRAPHY FINDINGS IN 2096 CATS WITH HYPERTHYROIDISM. Vet Radiol Ultrasound 2014; 56:84-95. [DOI: 10.1111/vru.12165] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 03/06/2014] [Indexed: 11/28/2022] Open
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Takemoto N, Koyanagi A, Koike J, Yamamoto H. An accessory thyroid gland that presented tumor-like images. J Med Ultrason (2001) 2013; 40:163-8. [PMID: 27277107 DOI: 10.1007/s10396-012-0402-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 08/16/2012] [Indexed: 11/25/2022]
Abstract
A 26-year-old woman presented with right breast pain and itching. Incidentally, a firm, non-tender, movable mass (3 cm in diameter) located in the lower right part of the neck was identified by palpation. Ultrasonography revealed a clearly demarcated dumbbell-shaped mass with homogenous hypo- (cranial side) and hyper-echogenicity (caudal side) compared with the thyroid gland. Computed tomography scan and magnetic resonance imaging presented images that were different from thyroid gland substance. The right thyroid lobe was strongly compressed by the mass. Hyperparathyroidism was ruled out by laboratory testing. The patient solicited resection of the mass despite recommendations for core needle biopsy, and it was removed surgically. The mass was surrounded by a thin capsule and was not connected with the thyroid gland. Pathological examinations revealed normal thyroid gland tissue. The final diagnosis was an accessory thyroid gland. Accessory thyroid glands should be considered as a possible diagnosis when nodules around the main thyroid gland are encountered.
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Affiliation(s)
- Nobuyuki Takemoto
- Department of Breast and Endocrine Surgery, Japan Medical Alliance Higashi Saitama General Hospital, 5-517 Yoshino, Satte, Saitama, 340-0153, Japan.
| | - Ai Koyanagi
- Department of Global Health Policy, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Junko Koike
- Clinical Laboratory Medicine, Japan Medical Alliance Higashi Saitama General Hospital, 5-517 Yoshino, Satte, Saitama, 340-0153, Japan
| | - Hiroshi Yamamoto
- Geriatric Health Service Facility (COSMOS), Japan Medical Alliance Yokohama Stroke and Brain Center, 1-2-1 Takigashira, Isogoku, Yokohama, Kanagawa, 235-0012, Japan
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Rossi ED, Martini M, Straccia P, Larocca LM, Fadda G. Detection of ectopic thyroid remnants: a serious diagnostic dilemma. When molecular biology and immunohistochemistry can solve the problem. Pathol Res Pract 2012. [PMID: 23200790 DOI: 10.1016/j.prp.2012.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The presence of ectopic thyroid tissue is a frequent diagnostic feedback related to a possible histogenetic abnormality or a result of post-surgical seeding. The important challenge is the diagnostic definition of its nature, which could lead to a different therapeutic approach. We describe a case with all the possible implications and differential diagnoses supported by the application of immunohistochemistry and BRAF-V600E molecular detection. A 36-year-old girl with a left thyroid nodule underwent surgery with a diagnosis of angio-invasive tall cell variant of papillary carcinoma without lymph-node metastases. The patient history revealed a previous right lobectomy in another institution ten years before. The right neck dissection was histologically characterized by the presence of thymic residual and evidence of microfollicular microfoci (less than 1mm) of thyroid tissue. Thyroid tumor cells were positive for thyroglobulin, TTF-1, HBME-1 and Galectin-3, while the residual ectopic thyroid tissue showed positivity only for TTF-1 and thyroglobulin. The molecular tests on the thyroid nodule revealed the presence of BRAF-V600E mutation, but wild type BRAF in the ectopic tissue. The histo-morphological definition of these remnants plays the most important role, but the application of immunohistochemistry and molecular biology may help to reach a conclusive diagnosis.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, Agostino Gemelli School of Medicine and Hospital, Largo Francesco Vito 1, Rome, Italy.
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Collins AM, Bodenner D, Chen C, Stone P, Stack BC. Delayed treatment of papillary thyroid carcinoma arising from struma ovarii in a patient with history of bilateral salpingo-oophorectomy: a case report. Endocr Pract 2012; 18:e1-4. [PMID: 22068256 DOI: 10.4158/ep11253.cr] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE We present a case of papillary thyroid carcinoma arising from struma ovarii treated erroneously as ovarian adenocarcinoma for more than 3 years. METHODS We report clinical, surgical, laboratory, and imaging findings of the study patient and review the relevant literature. RESULTS A 64-year-old woman was treated for ovarian adenocarcinoma for more than 3 years before it was determined that she likely had papillary thyroid carcinoma arising from struma ovarii. This is the first reported case of thyroid carcinoma arising from struma ovarii in a patient with a history of bilateral salpingo-oophorectomy. Possible etiologies include residual ovarian tissue after oophorectomy, ectopic thyroid, or metastatic thyroid cancer. CONCLUSIONS It is important to include struma ovarii and thyroid carcinoma arising from struma ovarii in the differential diagnosis, even with a history of bilateral salpingo-oophorectomy. This case emphasizes the importance of effective communication among the pathologist, oncologist, and surgeon to ensure timely initiation of appropriate therapy and reduced patient morbidity.
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Affiliation(s)
- Alissa M Collins
- College of Medicine, Winthrop Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
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Maki AC, Foster MB, Bond SJ. Lateral pediatric ectopic thyroid. Laryngoscope 2012; 123:524-7. [DOI: 10.1002/lary.23359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 03/15/2012] [Accepted: 03/26/2012] [Indexed: 11/08/2022]
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Prado H, Prado A, Castillo B. Lateral Ectopic Thyroid: A Case Diagnosed Preoperatively. EAR, NOSE & THROAT JOURNAL 2012; 91:E14-8. [DOI: 10.1177/014556131209100417] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Ectopic thyroid is an uncommon condition defined as the presence of thyroid tissue at a site other than the pretracheal area. When the process of embryologic migration is disturbed, aberrant thyroid tissue may appear. In most cases, ectopic thyroid is located along the embryologic descent path of migration as either a lingual thyroid or a thyroglossal duct cyst. In rare cases, aberrant migration can result in lateral ectopic thyroid tissue. Approximately 1 to 3% of all ectopic thyroids are located in the lateral neck. Ectopic tissue frequently represents the only presence of thyroid tissue; a second site of orthotopic or ectopic thyroid tissue is found in other cases. The presentation of ectopic thyroid as a lateral mass should be differentiated from metastatic thyroid cancer; other differential diagnoses include a submandibular tumor, branchial cleft cyst, carotid body tumor, and lymphadenopathy of various etiologies. In addition to the history and physical examination, the workup for a patient with a submandibular mass suspicious for ectopic thyroid should include (1) technetium-99m or iodine-131 scintigraphy, (2) ultrasonography and either computed tomography or magnetic resonance imaging, (3) fine-needle aspiration biopsy, and (4) thyroid function testing. No treatment is required for asymptomatic patients with normal thyroid function and cytology, but hypothyroid patients should be placed on thyroid hormone replacement therapy. Most cases are diagnosed postoperatively. Surgical treatment of ectopic thyroid should be considered when a malignancy is suspected or diagnosed, when the patient is symptomatic, or when thyroid suppression therapy fails.
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Affiliation(s)
- Héctor Prado
- Department of Otolaryngology–Head and Neck Surgery Hospital General Dr. Manuel Gea González, Distrito Federal, México
| | - Alejandro Prado
- Department of Otolaryngology–Head and Neck Surgery Hospital General Dr. Manuel Gea González, Distrito Federal, México
| | - Bertha Castillo
- Department of Otolaryngology–Head and Neck Surgery Hospital General Dr. Manuel Gea González, Distrito Federal, México
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Ectopic, submandibular thyroid causing hyperthyroidism. The Journal of Laryngology & Otology 2011; 125:1091-3. [PMID: 21774845 DOI: 10.1017/s0022215111000855] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Ectopic thyroid tissue in the submandibular region is exceptionally rare. Nevertheless, the treating physician should consider this condition within the differential diagnosis of a submandibular mass. METHOD Case report of ectopic thyroid tissue presenting as a submandibular mass in a patient with hyperthyroidism, together with a review of the English-literature concerning ectopic thyroid tissue. CONCLUSION To our knowledge, this is the first report of ectopic thyroid tissue presenting as a submandibular mass and causing hyperthyroidism. Removal of the submandibular mass resulted in normalisation of thyroid function, and subsequent reduction in the patient's antithyroid medication dosage. Ectopic thyroid tissue should be suspected in any patient with a submandibular mass. Prior to resection of such a lesion, it is essential to ensure that normal, functioning thyroid tissue is present elsewhere. Ectopic thyroid tissue can also present with pathology similar to that affecting the normal thyroid gland.
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Bersaneti JA, Silva RDP, Ramos RRN, de Medeiros Matsushita M, Souto LRM. Ectopic thyroid presenting as a submandibular mass. Head Neck Pathol 2010; 5:63-6. [PMID: 20857245 PMCID: PMC3037464 DOI: 10.1007/s12105-010-0209-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 08/30/2010] [Indexed: 02/05/2023]
Abstract
Although extremely rare, the presence of ectopic thyroid tissue in the submandibular region should be considered in the differential diagnosis of tissue masses in the cervical region. Diagnosis is confirmed by fine-needle aspiration biopsy and exclusion of malignancy should be confirmed by histopathologic analysis of the lesion. In general, surgery is the treatment of choice. A rare case of ectopic thyroid in the right submandibular region is reported; it was diagnosed after total thyroidectomy and successfully treated through surgery.
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Affiliation(s)
- Joseli Assem Bersaneti
- Department of Surgery, School of Medical Sciences, Universidade de Marília (UNIMAR), Av. Rio Branco, 1132–Cj. 41, Marília, São Paulo CEP 17502-000 Brazil
| | - Rafael Denadai Pigozzi Silva
- Department of Surgery, School of Medical Sciences, Universidade de Marília (UNIMAR), Av. Rio Branco, 1132–Cj. 41, Marília, São Paulo CEP 17502-000 Brazil
| | | | - Marcus de Medeiros Matsushita
- Department of Anatomic Pathology, School of Medical Sciences, Universidade de Marília (UNIMAR), Marília, São Paulo Brazil
| | - Luís Ricardo Martinhão Souto
- Department of Surgery, School of Medical Sciences, Universidade de Marília (UNIMAR), Av. Rio Branco, 1132–Cj. 41, Marília, São Paulo CEP 17502-000 Brazil
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