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Carsote M, Ciobica ML, Sima OC, Ciuche A, Popa-Velea O, Stanciu M, Popa FL, Nistor C. Personalized Management of Malignant and Non-Malignant Ectopic Mediastinal Thyroid: A Proposed 10-Item Algorithm Approach. Cancers (Basel) 2024; 16:1868. [PMID: 38791947 PMCID: PMC11120123 DOI: 10.3390/cancers16101868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
We aimed to analyze the management of the ectopic mediastinal thyroid (EMT) with respect to EMT-related cancer and non-malignant findings related to the pathological report, clinical presentation, imaging traits, endocrine profile, connective tissue to the cervical (eutopic) thyroid gland, biopsy or fine needle aspiration (FNA) results, surgical techniques and post-operatory outcome. This was a comprehensive review based on revising any type of freely PubMed-accessible English, full-length original papers including the keywords "ectopic thyroid" and "mediastinum" from inception until March 2024. We included 89 original articles that specified EMTs data. We classified them into four main groups: (I) studies/case series (n = 10; N = 36 EMT patients); (II) malignant EMTs (N = 22 subjects; except for one newborn with immature teratoma in the EMT, only adults were reported; mean age of 62.94 years; ranges: 34 to 90 years; female to male ratio of 0.9). Histological analysis in adults showed the following: papillary (N = 11/21); follicular variant of the papillary type (N = 2/21); Hürthle cell thyroid follicular malignancy (N = 1/21); poorly differentiated (N = 1/21); anaplastic (N = 2/21); medullary (N = 1/21); lymphoma (N = 2/21); and MALT (mucosa-associated lymphoid tissue) (N = 1/21); (III) benign EMTs with no thyroid anomalies (N = 37 subjects; mean age of 56.32 years; ranges: 30 to 80 years; female to male ratio of 1.8); (IV) benign EMTs with thyroid anomalies (N = 23; female to male ratio of 5.6; average age of 52.1 years). This panel involved clinical/subclinical hypothyroidism (iatrogenic, congenital, thyroiditis-induced, and transitory type upon EMT removal); thyrotoxicosis (including autonomous activity in EMTs that suppressed eutopic gland); autoimmune thyroiditis/Graves's disease; nodules/multinodular goiter and cancer in eutopic thyroid or prior thyroidectomy (before EMT detection). We propose a 10-item algorithm that might help navigate through the EMT domain. To conclude, across this focused-sample analysis (to our knowledge, the largest of its kind) of EMTs, the EMT clinical index of suspicion remains low; a higher rate of cancer is reported than prior data (18.8%), incident imagery-based detection was found in 10-14% of the EMTs; surgery offered an overall good outcome. A wide range of imagery, biopsy/FNA and surgical procedures is part of an otherwise complex personalized management.
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Affiliation(s)
- Mara Carsote
- Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Clinical Endocrinology V, “C.I. Parhon” National Institute of Endocrinology, 011863 Bucharest, Romania
| | - Mihai-Lucian Ciobica
- Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Internal Medicine I and Rheumatology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania
| | - Oana-Claudia Sima
- PhD Doctoral School, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Adrian Ciuche
- Department 4-Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Thoracic Surgery Department, “Dr. Carol Davila” Central Military University Emergency Hospital, 010242 Bucharest, Romania
| | - Ovidiu Popa-Velea
- Department of Medical Psychology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Mihaela Stanciu
- Department of Endocrinology, Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania;
| | - Florina Ligia Popa
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550024 Sibiu, Romania;
| | - Claudiu Nistor
- Department 4-Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Thoracic Surgery Department, “Dr. Carol Davila” Central Military University Emergency Hospital, 010242 Bucharest, Romania
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Jakowczuk TE, Ren S. Ectopic mediastinal thyroid tissue: an indelible imitator. J Thorac Dis 2024; 16:1745-1749. [PMID: 38617772 PMCID: PMC11009603 DOI: 10.21037/jtd-24-200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 02/22/2024] [Indexed: 04/16/2024]
Affiliation(s)
| | - Shuyue Ren
- Department of Pathology and Laboratory Medicine, Cooper University Hospital, Camden, NJ, USA
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Motlaghzadeh Y, Nesbit S, Guo HH, Yang E, Desai K, Lui NS. Surgical resection of mediastinal ectopic thyroid tissue: a case series. J Thorac Dis 2023; 15:1473-1481. [PMID: 37065554 PMCID: PMC10089840 DOI: 10.21037/jtd-22-479] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 01/30/2023] [Indexed: 03/05/2023]
Abstract
Background Ectopic thyroid tissue (ETT) is characterized by the presence of thyroid tissue in any location other than its normal anatomic position. Mediastinal ectopic thyroid gland is a rare entity, accounting for 1% of all ETT cases. In this article, we present seven cases with mediastinal ETT over the last 26 years admitted to Stanford hospital. Case Description Searching Stanford pathology database for specimens that contained term "ectopic thyroid" between 1996 and 2021, a total of 202 patients were collected. Among those seven were classified as mediastinal ETT. Patients' electronic medical records were reviewed for data collection purposes. The mean age of our seven cases was 54 years on the day of surgery, and four were female. Chest pressure, cough, and neck pain were most reported presenting symptoms. Four of our patients had thyroid stimulating hormone (TSH) checks all within normal limits. All patients in our study had computed tomography (CT) imaging of the chest detecting the mediastinal mass. Histopathology of the mass revealed ectopic thyroid tissue negative for malignancy in all cases. Conclusions Ectopic mediastinal thyroid tissue is a rare clinical entity that should be considered in the differential diagnosis of all mediastinal masses as it usually requires different management and treatment.
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Affiliation(s)
- Yasaman Motlaghzadeh
- Department of Medicine, Division of Endocrinology, Stanford University School of Medicine, Palo Alto, USA
| | - Shannon Nesbit
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, USA
| | - H. Henry Guo
- Department of Radiology, Stanford University School of Medicine, Palo Alto, USA
| | - Eric Yang
- Department of Pathology, Stanford University School of Medicine, Palo Alto, USA
| | - Kaniksha Desai
- Department of Medicine, Division of Endocrinology, Stanford University School of Medicine, Palo Alto, USA
| | - Natalie S. Lui
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, USA
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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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Zarogoulidis P, Huang H, Zhou J, Ning Y, Yang M, Wang J, Zhang R, Bai C, Shen X, Huang Z, Petridis D, Kosmidis C, Kosmidou M, Tsakiridis K, Hohenforst-Schmidt W, Baka S, Petanidis S, Zaric B, Kovacevic T, Stojsic V, Sarcev T, Bursac D, Kukic B, Rapti A, Pantea S, Rogoveanu O, Rogoveanu I, Romanidis K, Kesisoglou I, Ioannidis A, Vagionas A, Sapalidis K. Thyroid cancer diagnosis with transdermal probe 22G U/S versus EBUS-convex probe TBNA-B 22G and 19G: pros and cons. Expert Rev Med Devices 2021; 18:197-201. [PMID: 33482695 DOI: 10.1080/17434440.2021.1880891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Thyroid cancer is usually diagnosed both with imaging techniques and transdermal biopsy. Laboratory tests are also included in the initial work-up. PATIENTS AND METHODS One hundred and thirty patients were included in our study with pathological imaging findings in the thyroid region. Biopsies were performed with 22 G with transdermal convex probe, EBUS 22 G Mediglobe® needle and 19 G Olympus® needle. We investigated the efficiency and safety of both techniques and identified the best candidates for each method. DISCUSSION 19 G needle identified cancer types such as; Lymphoma, Medullary thyroid cancer, and Hurthle cell cancer, which we know from previous pathology studies that a larger sample is necessary for diagnosis. No safety issues were observed for both techniques and the EBUS technique produced more cell block material when 22 G needle was compared to transdermal biopsy in peritracheal lesions. CONCLUSION The method of biopsy should be made based on the size and accessibility of the lesion.
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Affiliation(s)
- Paul Zarogoulidis
- 3rdSurgery Department, Medical School of Health Sciences, ``AHEPA`` University Hospital, Thessaloniki, Greece
| | - Haidong Huang
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, P. R. China
| | - Jun Zhou
- Department of Respiratory, Changzhou maternal and child health care hospital affiliated to Nanjing Medical University, Changzhou, Jiangsu Changzhou, China
| | - Yunye Ning
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, P. R. China
| | - Meng Yang
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, P. R. China.,Department of Geriatrics, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jiannan Wang
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, P. R. China
| | - Rong Zhang
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, P. R. China
| | - Chong Bai
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, P. R. China
| | - Xiaping Shen
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhiang Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Henan University, Henan Kaifeng, China
| | - Dimitris Petridis
- Department of Food Technology, School of Food Technology and Nutrition, Alexander Technological Educational Institute, Thessaloniki, Greece
| | - Christoforos Kosmidis
- 3rdSurgery Department, Medical School of Health Sciences, ``AHEPA`` University Hospital, Thessaloniki, Greece
| | - Maria Kosmidou
- Internal Medicine Department, University of Ioannina, Ioannina, Greece
| | - Kosmas Tsakiridis
- Thoracic Surgery Department, ``Interbalkan`` European Medical Center, Thessaloniki, Greece
| | - Wolfgang Hohenforst-Schmidt
- Sana Clinic Group Franken, Department of Cardiology/Pulmonology/Intensive Care/Nephrology, "Hof" Clinics, University of Erlangen, Hof, Germany
| | - Sofia Baka
- Onc/ology Department, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Savas Petanidis
- Department of Pulmonology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Bojan Zaric
- Faculty of Medicine, University of Novi Sad, Institute for Pulmonary Diseases of Vojvodina, Novi Sad, Serbia
| | - Tomi Kovacevic
- Faculty of Medicine, University of Novi Sad, Institute for Pulmonary Diseases of Vojvodina, Novi Sad, Serbia
| | - Vladimir Stojsic
- Faculty of Medicine, University of Novi Sad, Institute for Pulmonary Diseases of Vojvodina, Novi Sad, Serbia
| | - Tatjana Sarcev
- Faculty of Medicine, University of Novi Sad, Institute for Pulmonary Diseases of Vojvodina, Novi Sad, Serbia
| | - Daliborka Bursac
- Faculty of Medicine, University of Novi Sad, Institute for Pulmonary Diseases of Vojvodina, Novi Sad, Serbia
| | - Biljana Kukic
- Faculty of Medicine, University of Novi Sad, Institute for Oncology of Vojvodina, Novi Sad, Serbia
| | - Aggeliki Rapti
- Pulmonary Oncology Department, ``sotiria`` Hospital of Chest Diseases, Athens, Greece
| | - Stelian Pantea
- 3rdSurgery Department, Medical School of Health Sciences, ``AHEPA`` University Hospital, Thessaloniki, Greece.,Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Henan University, Henan Kaifeng, China
| | - Otelia Rogoveanu
- Department of Medical Rehabilitation, University of Medicine and Pharmacy, Craiova, Romania
| | - Ion Rogoveanu
- Department of Medical Rehabilitation, University of Medicine and Pharmacy, Craiova, Romania
| | - Konstantinos Romanidis
- Second Department of Surgery, General University Hospital of Alexandroupolis, Medical School Democritus University of Thrace, Alexandroupolis, Greece
| | - Issak Kesisoglou
- 3rdSurgery Department, Medical School of Health Sciences, ``AHEPA`` University Hospital, Thessaloniki, Greece
| | - Aris Ioannidis
- Surgery Department, ``Genesis`` Private Hospital, Thessaloniki, Greece
| | | | - Konstantinos Sapalidis
- 3rdSurgery Department, Medical School of Health Sciences, ``AHEPA`` University Hospital, Thessaloniki, Greece
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Xu YM, Gong ZJ, Wu HJ. Papillary Thyroid Carcinoma Incidentally Found in Cervical Lymph Nodes During Neck Dissection for Patients With Tongue Squamous Cell Carcinoma: A 3-Case Report and Literature Review. J Oral Maxillofac Surg 2018; 76:2454.e1-2454.e6. [PMID: 30107162 DOI: 10.1016/j.joms.2018.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 02/02/2023]
Abstract
The incidence of papillary thyroid carcinoma (PTC) found in the cervical lymph nodes during neck dissection for patients with tongue squamous cell carcinoma (SCC) is infrequent, with the coexistence of PTC and SCC in the same cervical lymph node being the rarest. Some of these patients present with primary lesions in the thyroid gland, whereas others have no obviously malignant thyroid lesion. The reasons behind this clinical phenomenon and the relationship between tongue SCC and PTC found in the cervical lymph nodes are unclear. Moreover, for surgeons, making the choice between thyroid surgery and follow-up is still a clinical dilemma. Of the 956 patients who underwent neck dissection owing to maxillofacial tumors from January 2011 through December 2017 at Second Xiangya Hospital of Central South University, 3 with tongue SCC presented with PTC in the cervical lymph nodes. Neither the preoperative physical examination nor ultrasonography after surgery showed substantial nodules in the thyroid glands of these patients, so none of them underwent thyroid surgery or chemoradiotherapy. At follow-up (1 to 6.5 years), we found no obviously malignant lesions in the patients' thyroid glands or related metastatic disease. Our study suggests that tongue SCC may not affect the occurrence and development of PTC in the cervical lymph nodes. For patients with tongue SCC presenting with PTC in the cervical lymph nodes, it is not necessary to carry out thyroid surgery immediately if ultrasonography shows no substantially malignant lesion in the thyroid gland. Nevertheless, conducting periodic follow-up is very important.
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Affiliation(s)
- Yu-Ming Xu
- Resident, Department of Stomatology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhao-Jian Gong
- Associate Professor, Department of Stomatology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Han-Jiang Wu
- Professor and Department Head, Department of Stomatology, Second Xiangya Hospital, Central South University, Changsha, China.
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