Follicular adenoma with a papillary architecture originating from an ectopic thyroid gland: a case report

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.

Tongue Base Ectopic Thyroid Tissue-Is It a Rare Encounter?

Failure in the embryological development of the thyroid in adults is rarely seen. We present the case of a 79-year-old female patient who complained of dysphagia and progressive upper respiratory obstruction, which started 12 months prior to her admission. An ENT clinical exam revealed a tongue base, spherical, well-defined tumour covered by normal mucosa. Further assessments established the diagnosis of the tongue base ectopic thyroid tissue. Due to the patient's symptoms, a transhyoid tongue base tumour removal was performed. The selected patient gave consent for participation and inclusion in this paper, in compliance with the 1964 Helsinki declaration.

131 treatment in dogs with hyperthyroidism caused by a non-resectable ectopic thyroid tumour: 5 cases (2008-2019)

OBJECTIVES

This study aimed to describe the clinical and diagnostic characteristics, as well as outcomes of radioiodine treatment in dogs with hyperthyroidism caused by a non-resectable ectopic thyroid tumour.

MATERIALS AND METHODS

This retrospective study reviewed the medical records between 2008 and 2018 of dogs diagnosed with hyperthyroidism secondary to a non-resectable ectopic thyroid tumour and treated with radioiodine.

RESULTS

Five dogs were included in the study. Three dogs had sublingual ectopic tumours, of which one also had a unilateral cervical thyroid tumour. The remaining two dogs were diagnosed with an ectopic thyroid tumour at the level of the caudal pharynx and the heart base, respectively. All cases were treated with radioiodine. The size of the ectopic masses decreased after radioiodine treatment. Total thyroxine concentrations returned to reference ranges in all dogs. Further, clinical signs of hyperthyroidism disappeared after treatment in all patients. One dog developed myelosuppression secondary to radioiodine treatment. The dog with metastasis had a very short survival compared to the four dogs without metastasis (3 months compared to 7, 36, 50 and 24 months, respectively) and succumbed most likely to thyroid-related problems. In the remaining four dogs, their quality of life improved. They died due to diseases unrelated to the ectopic thyroid tumour.

CLINICAL SIGNIFICANCE

Radioiodine therapy should be considered as a treatment option in dogs diagnosed with hyperthyroidism due to a non-resectable ectopic thyroid tumour.

AGGRESSIVE PAPILLARY CARCINOMA OF THE LATERAL ABERRANT THYROIDE: A CASE REPORT AND REVIEW OF THE LITERATTUREggressive papillary carcinoma of the lateral aberrant thyroide: A case report and review of the literatture

INTRODUCTION

Ectopic thyroid tissue can be found in many sites. Ectopic thyroid tissue may also be involved in the same processes as normal thyroid gland. These processes include tumors, inflammation and hyperplasia. The appearance of such tissue in rare locations may lead to diagnostic and therapeutic dilemmas.

PRESENTATION OF CCASE

We report a rare case of primary papillary carcinoma in an ectopic thyroid in the jugulocarotid regionbased on the bifurcation of the carotid artery, in a 62-year-old woman with history of diabetes and high blood pressure, with a normal thyroid gland.

DISCUSSION

The origin of lateral ectopic thyroid tissue is not fully understood and controversial.The lateral localisation is a rare entity and debated extensively in the literature.

CONCLUSION

Though rare, the possibility of an ectopic thyroid carcinoma must always be considered by the surgeon in cases of a pathological mass in the neck.

[Case of thyroid ectopia in the hyoid region in a young Malagasy girl]

L'ectopie thyroïdienne est une pathologie rare liée à une défaillance de migration de la glande thyroïde lors de son développement embryonnaire. Elle est le plus souvent asymptomatique. Nous rapportons un cas d'ectopie thyroïdienne à localisation hyoïdienne chez une jeune fille malgache, révélée par une gêne esthétique, associée à une hypothyroïdie infraclinique. Le diagnostic était confirmé par l'échographie cervicale et la scintigraphie au technétium 99m. Même si l'hypothyroïdie est infraclinique, une hormonothérapie substitutive est de règle permettant ainsi d'obtenir une euthyroïdie biologique et de maintenir la bonne évolution clinique.

99mTc Sodium Pertechnetate Uptake in Ectopic Mediastinal Thyroid Tissue on Hybrid Thyroid Scintigraphy

Ectopic thyroid is a rare/incidental imaging finding. When discovered, 90% of ectopic thyroid is found typically along the pathway of embryologic migration of thyroid tissue, whereas around 10% have been discovered in other anatomical locations including the mediastinum and the heart. Thyroid scintigraphy with Tc sodium pertechnetate (TcO4) is peculiar for thyroid tissue uptake. The current case, clinically euthyroid, had heterogeneous uptake in multinodular goiter with uptake in the ectopic thyroid tissue in right paratracheal location on functional imaging with TcO4. Subsequent single photon emission computed tomography/computed tomography (SPECT/CT) imaging confirmed the ectopic thyroid tissue.

Importance of ectopic thyroid tissue detected in the midline of the neck: single center experience

OBJECTIVE

Ectopic thyroid tissue (ETT) is a rare abnormality of the thyroid gland and the true prevalence and importance is not known. The aim of this study was to evaluate ultrasonography (US) guided fine needle aspiration biposy (FNAB) results, sonographic features, and frequency of ETT detected in the midline of the neck.

SUBJECTS AND METHODS

Five thousand five hundred and twenty outpatients who were referred to our thyroid clinic between September 2010 and April 2012 and underwent thyroid US, were retrospectively analyzed. Patients with ETT, detected in the midline of the neck in US were included in the study. Thyroid functions, sonographic features, and US guided FNAB results were evaluated.

RESULTS

There were 81 (81.8%) female and 18 (18.2%) male patients with a mean age of 50.9 ± 11.7. The ETT in the midline was present in 1.79% (99/5,520) of the patients. In the majority of the patients, benign sonographic features (isoechoic, regular margin, type 1 vascularization) were detected. There were 92 (92.9%) patients with a previous history of thyroidectomy and all were histopathologically benign. In 7 (7.1%) patients, there was no history of thyroid operation. FNAB results of ETT were benign.

CONCLUSION

This study evaluated the importance of ETT detected incidentally in the midline of the neck. Especially in patients with a history of thyroidectomy, the thyroid masses in the midline of the neck can be found as incidental with imaging methods. Our results suggests that the incidence of malignancy in this group is much lower than orthotopic thyroid nodules and they are often benign.

Midline Ectopic Thyroid Mimicking as a Thyroglossal Duct Cyst

Ectopic thyroid tissue is a rare developmental abnormality. A case is reported here of ectopic thyroid tissue that presented as a midline mass, mimicking a thyroglossal duct cyst. The thyroid gland was not visualized in its normal position. This report highlights the importance of imaging in the preoperative evaluation of a midline neck mass.

Rate of thyroglossal duct remnant visualization after total thyroidectomy for differentiated thyroid carcinoma and its impact on clinical outcome of radioactive iodine (I-131) ablation

Objectives:

The rate and impact of thyroglossal duct remnant (TGDR) visualization in patients with hypothyroidism after total thyroidectomy for differentiated thyroid carcinoma (DTC) have not yet been fully determined. The aim of this study was to assess the rate of TGDR visualization in post total thyroidectomy whole body scan (WBS) for DTC and to evaluate its impact on the outcome of I-131 ablation.

Methods:

A total of 60 consecutive DTC patients (51 papillary thyroid Ca., and 9 Follicular thyroid Ca.), underwent total thyroidectomy, followed by WBS (using I-131 in 28 patients and I-123 in 32 patients), neck ultrasound (US), thyroglobulin (Tg) and Tg anti-bodies (TgAb) assay after 40 days and subsequent I-131 ablation. At 6 months later follow-up I-131 WBS, neck U/S, Tg and TgAb were performed following suspension of L-thyroxine for 1-month (thyroid stimulating hormone [TSH] >30 μIU/ml) in 53 patients and following recombinant human TSH stimulation in seven patients.

Results:

Of the studied 60 patients, 19/60 (31.7%) had a linear or focal radioactivity at the superior midline of the neck, suggesting TGDR (Group 1), and 41/60 (68.3%) had no uptake to suggest TGDR (Group 2). No significant difference regarding age, gender and histopathology between both groups. Neck US showed no evidence of thyroid tissue in the superior midline of the neck in both groups, and only a small or no residual thyroid tissue in patients of Group 1. There was a significant successful I-131 ablation rate among patients of group 1 compared to group 2 (79% in Group 1 vs. 41.5% in Group 2) (P = 0.007).

Conclusions:

Thyroglossal duct remnant visualization on WBS of hypothyroid subjects after total thyroidectomy suggests presence of only a small or no residual functioning thyroid tissue at the thyroid bed and can predict a good response to I-131 ablation.

Anaplastic carcinoma in submandibular region: A diagnostic dilemma

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Anaplastic carcinoma arising in ectopic thyroid tissue is extremely rare.

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Another possibility that should be taken into account in appearance of thyroid tissue in the lateral cervical region is the presence of a thyroid carcinoma metastasis.

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FNA can contribute significantly to the accurate preoperative assessment of ectopic thyroid tissue, particularly if malignancy is suspected.

•

The presence of anaplastic carcinoma in the submandibular region without any evidence of primary tumor at the orthotopic thyroid gland may pose diagnostic difficulties.

Introduction

Thyroid carcinoma arising in an extrathyroid area is a rare entity.

Presentation of case

We report a case of anaplastic carcinoma in the submandibular region occurring in a 70-year-old woman.

Discussion

The location of the mass along with no evidence of primary tumor at the orthotopic thyroid gland posed a diagnostic dilemma: was this an ectopic thyroid carcinoma or rather a case of occult differentiated thyroid carcinoma metastasis that transformed to anaplastic carcinoma? Based on the histopathological findings we concluded that the tumor arised in ectopic thyroid tissue. Although the mass was completely resected, the patient died 10 months after diagnosis due to pulmonary metastases.

Conclusion

Conclusively, the possibility of ectopic thyroid tissue, with or without disease, should be considered in cases of a mass in the submandibular region.

Ectopic mediastinal thyroid tissue with a normally located thyroid gland

Ectopic thyroid tissue (ETT) is a rare entity and a challenging differential diagnosis. This is a report of a case of a mediastinal mass that was found to be an ectopic mediastinal thyroid tissue, in a 77-year-old woman who was admitted to our hospital for breast cancer management. The mediastinal mass was identified in the postsurgical computed tomography (CT) scan of the chest and was suspected as mediastinal lymph node metastasis. A CT-guided percutaneous transthoracic punch biopsy (CT-TPB) proved to be an adequate diagnostic tool to exclude malignancy and provide a definite diagnosis of the mediastinal mass. We find that CT-guided punch biopsy as a useful diagnostic alternative enabling histopathological specimens to be obtained from mediastinal masses and lymph nodes suspected of malignancy.

Microfollicular adenoma of ectopic thyroid gland masquerading as salivary gland tumor - a diagnostic and therapeutic challenge: a case report

Introduction

Ectopic thyroid tissue may appear in any location along the trajectory of the thyroglossal duct from the foramen cecum to the mediastinum. Rarely, there is incomplete descent of the gland where the final resting point may be high resulting in sublingual ectopic thyroid tissue. Ectopic thyroid tissue carries a low risk of malignancy. Most recently reported neoplasms in ectopic thyroid tissue have been papillary carcinoma of thyroid. Individual case reports of clear cell type of follicular adenoma within the ectopic thyroid tissue have been described in the literature.

Case presentation

We present a rare case of microfollicular follicular adenoma in an ectopic sublingual thyroid tissue presenting as submental swelling in a euthyroid 24-year-old Dravidian woman.

Conclusion

Findings in this case emphasize that when confronted with a submental/sublingual mass lesion, the evaluation of thyroid function tests and ultrasonography of the neck should be included in a pre-operative workup.

Ectopic thyroid tissue in submandibular and infrahyoid region

The thyroid is the first endocrine gland to form during embryogenesis. At this stage, incomplete or anomalous migration of thyroid tissue causes ectopic localization of the gland. Submandibular ectopic thyroid tissue with a coexisting normally located thyroid gland is extremely rare. In this case aimed to present the findings of the 65-years-old female patient who is bilateral subtotal thyroidectomy operation performed for multinodular goiter of 12 years ago. Case, painless mass in the right submandibular and infrahyoid region for 6 months was admitted to our clinic with complaints. Result of contrast-enhanced neck computed tomography, ultrasound-guided fine-needle aspiration biopsy and thyroid scintigraphy were found of functional residual thyroid tissue in the normal localization as well as 2×3 cm mass in the submandibular area and 1×2 cm mass lesion in the infrahyoid region. The patient referred to excisional biopsy. Normal thyroid follicules and no evidence of malignancy were found in specimen pathologically. Postoperative follow-up of thyroid function tests were normal.

Lateral Ectopic Thyroid: A Case Diagnosed Preoperatively

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.

Ectopic thyroid tissue: anatomical, clinical, and surgical implications of a rare entity

Ectopic thyroid tissue is a rare entity resulting from developmental defects at early stages of thyroid gland embryogenesis, during its passage from the floor of the primitive foregut to its final pre-tracheal position. It is frequently found around the course of the thyroglossal duct or laterally in the neck, as well as in distant places such as the mediastinum and the subdiaphragmatic organs. Although most cases are asymptomatic, symptoms related to tumor size and its relationship with surrounding tissues may also appear. Any disease affecting the thyroid gland may also involve the ectopic thyroid, including malignancy. The clinician must distinguish between ectopic thyroid and metastatic deposits emerging from an orthotopic gland, as well as other benign or malignant masses. Thyroid scintigraphy plays the most important role in diagnosing ectopy, but ultrasonography contributes as well. In cases of symptomatic disease, surgery is the treatment of choice, followed by radioiodine ablation and levothyroxine suppression therapy in more refractory cases. This review provides current understanding about the wide clinical spectrum of this rare condition, also referring to optimal diagnostic approach, differential diagnosis, and management strategies.

Ectopic, submandibular thyroid causing hyperthyroidism

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.

Ectopic thyroid presenting as a submandibular mass

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.