Plasma cell granuloma of the thyroid: a conservative approach to a rare condition and review of the literature

Inflammatory Myofibroblastic Tumor in the Thyroid Gland: A Retrospective Case Series Study and Literature Review

Background: The objective of this study was to investigate the clinical characteristics, diagnosis and treatment of inflammatory myofibroblastoma tumor (IMT) in the thyroid gland. Methods: A total of 17 patients with IMT by pathology from 2010 to 2020 were included in this study. Clinical features, imaging features, treatment and prognosis were analyzed in this retrospective study. Results: The case series comprised 5 males and 12 females, with an average age of 49.6±15.36 years. The patients were divided into two cohorts: with IMT without further pathological changes and with further pathological changes of the thyroid gland (for example nodular goiter or autoimmune thyroid disease). No significant differences were detected in tumor size and extrathyroid extension between the two groups. Fine needle aspiration biopsy examination before the operation was performed in 2 cases, and rapid freezing pathology examination during the operation was performed in 7 cases. Ultrasound images of 5 cases with only one type of pathology, IMT presented a high and intermediate risk of malignancy. In the other 11 cases with further pathological changes of the thyroid gland, the image could be very low risk of malignancy or benign feature. Only 2 cases showed a high risk of malignancy ultrasound features. 5/17 patients underwent preventive cervical lymph node dissection additional to thyroid surgery. None of the lymph nodes were confirmed positive by postoperative pathology. Thyroid ultrasound, computed tomography scan of the lungs, abdomen ultrasound and thyroid function tests were routine follow-up tests. During the follow-up period of 26-141 months, 2 cases were lost, and remaining 15 cases had no recurrence or metastasis and were considered cured. Conclusion: IMT in the thyroid gland is a rare disease with a good prognosis and surgical resection is the preferred treatment.

A case report of recurrent thyroid inflammatory myofibroblastic tumor and its metastasis in soft tissue

RATIONALE

Inflammatory myofibroblastic tumor (IMT) is a neoplasm of low malignant potential. The most frequent site of IMT is in the lung, whereas recurrent and metastasis of thyroid IMT has been seldom reported.

PATIENT CONCERNS

A 57-year-old male presented with a 3-year history of painless thyroid mass. The physical examination revealed a diffusely enlarged thyroid which was firm. The thyroid function and antibodies were normal. Thyroid ultrasound revealed a hypoechoic mass in the left lobe and heterogeneous echo in the right lobe. Neck computed tomography showed a diffused enlargement of thyroid with the homogeneously low intensity and the moderate enhancement.

DIAGNOSES

A diagnosis of thyroid IMT was made according the postoperative histological and immunohistochemical analysis.

INTERVENTIONS

The patient underwent subtotal thyroidectomy. Seventeen months after the surgery, the patients presented with a firm nodule of right adductor magnus and a relapsing mass of thyroid. Needle core biopsy of the thyroid mass suggested the relapsing of thyroid IMT. The mass excision of the right adductor magnus was performed and an IMT was confirmed by histopathology. The patient underwent thyroid radiation therapy and steroid therapy.

OUTCOMES

The size of the tumor was smaller than the preradiation size and the patient is now under follow-up.

LESSONS

This is the seldom reported patient with recurrent thyroid IMT with metastasis. IMT of the thyroid is an unusual but distinct disease entity. The clinical and radiological features are not specific and its diagnosis is based on the histological features. Although tumor resection and radiation seem to be effective, no standard treatment for such disease has been established.

Inflammatory Myofibroblastic Tumour of Thyroid with its Prominent Spindle Cell Pattern: A Rare Case Report

Inflammatory myofibroblastic tumour of thyroid is very rare. Only 18 cases reported so far. Here we report a case of Inflammatory myofibroblastic tumour with its prominent spindle cell (fibrohistiocytic) pattern in a 61-year-old male patient. The dominant histological pattern in our case was myofibroblastic in contrast to prominent lymphoplasmocytic pattern in other previously reported cases. The tumour was strongly positive for vimentin, Anaplastic lymphoma kinase and showed focal positivity for Smooth Muscle Actin. The patient was treated with total thyroidectomy and he is comfortable after surgery.

Cytological findings for the diagnosis of primary thyroid mucosa-associated lymphoid tissue lymphoma by fine needle aspiration

OBJECTIVE

We examined cytological findings for the diagnosis of primary thyroid mucosa-associated lymphoid tissue (MALT) lymphoma by fine needle aspiration.

STUDY DESIGN

During the study period of 4 years, a total of 101 cases including 51 MALT lymphomas, 20 Hashimoto's thyroiditis (HT), and 30 diffuse large-cell B-cell lymphomas were cytologically examined. MALT lymphomas were divided into 44 common MALT and 7 MALT lymphomas with extreme plasmacytic differentiation (MALT-EPCD).

RESULTS

(1) Small- to medium-sized cells displaying irregularly shaped nuclei with prominent nucleoli (ISN-PN) were neoplastic cells. (2) In the case of a frequency of plasma cells (PC) below 15%, the accuracy rate for distinguishing common MALT from HT was 97% for ISN-PN cell frequencies above 20% in combination with the presence of lymphoepithelial lesion clusters (LELC) and mountain range-like clusters (MRLC). The frequency of large-sized cells was below 15% in common MALT. (3) In the case of a frequency of PC above 15%, cases with a sum of PC and ISN-PN cells above 30% were MALT-EPCD. (4) MRLC were cell clusters derived from regions of follicular colonization, and LELC were cell clusters from lymphoepithelial lesions of MALT lymphomas.

CONCLUSION

Useful cytological criteria for the diagnosis of thyroid primary MALT lymphoma, such as neoplastic cells and cell clusters, were defined.