Thyroid

Malignant paraganglioma of the thyroid gland with synchronous bilateral carotid body tumors

February 25, 2013     Nadia Mohyuddin, MD; Karen Ferrer, MD; Urjeet Patel, MD, FACS
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Abstract

We describe a case of primary malignant paraganglioma of the thyroid gland that was found in a 55-year-old woman who had undergone surgery for bilateral carotid body tumors. The paraganglioma was treated with a total thyroidectomy followed by radiation therapy, and the patient was disease-free after more than 2 years of follow-up. Malignant paragangliomas of the thyroid gland are extremely rare. The diagnosis of malignancy is based on histopathologic findings, tumor behavior, and metastasis. These tumors can be misdiagnosed as other types of thyroid malignancies, thus resulting in less than optimal treatment. A genetic etiology was suspected in our patient.

Primary papillary carcinoma of the thyroid arising in a branchial cyst: Case report and review of the literature

February 25, 2013     Parvathidevi K. Gollahalli, SSAHE; Panduranga Chikkannaiah, MD, SSAHE; Vamseedhar Annam, MD, SSAHE
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Abstract

We report a case of papillary carcinoma of the thyroid that arose in a branchial cyst. The patient, a 45-year-old woman, presented with a left lateral neck mass of 3 months' duration. The cyst was removed intact. Because we could not rule out the possibility that a small primary malignancy was present within the gland, we performed a total thyroidectomy; however, no occult primary tumor of the thyroid was found. The patient was placed on thyroid hormone replacement therapy, and she was well at 2 years of follow-up. We briefly review the literature regarding the possible embryologic origin of such a phenomenon and the role of fine-needle aspiration cytology in differentiating a branchial cyst from a metastatic lymph node. To the best of our knowledge, this is only the 11th reported case of a thyroid papillary carcinoma arising in ectopic thyroid tissue within a branchial cyst, and the second such report from India.

Nasopharyngeal metastasis of follicular carcinoma of the thyroid with extensive clear cell change: A case report

December 31, 2012     Trupti Shreyans Patel, MD; Swapan L. Desai, MD; Priti P. Trivedi, MD; Manoj J. Shah, MD
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Abstract

Thyroid carcinoma metastatic to the maxillofacial area is extremely rare. Other carcinomas can metastasize to this area, but very few cases of follicular thyroid carcinoma metastasizing to the nasopharynx have been reported. Carcinoma from the kidney, liver, large bowel, prostate, and thyroid are known to have the potential for clear cell differentiation, and all of them can metastasize to the sinonasal area. Histochemical and immunohistochemical evaluations, along with clinical details, are useful in distinguishing metastases of these clear cell tumors from primary sinonasal tumors. In this article we describe a rare case of metastatic thyroid carcinoma with clear cell change mimicking metastatic renal cell carcinoma in the nasopharynx.

Traumatic thyroid hematoma associated with thyroid carcinoma

September 7, 2012     Carlos M. Rivera-Serrano, MD; Brian J. Park, MD, MPH; Robert L. Ferris, MD
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Abstract

Thyroid hematoma secondary to blunt trauma is uncommon, and no consensus exists for its management. We describe the case of a 46-year-old man who presented with neck swelling after he had sustained a blunt-trauma injury to his neck while playing soccer. Imaging revealed a large mass consistent with a thyroid hematoma. The patient was admitted for observation and followed up with serial imaging. He was eventually discharged without surgical intervention. However, he later underwent a thyroid lobectomy to treat compressive symptoms and for cosmetic reasons. Pathology revealed that the patient had a papillary thyroid carcinoma, which might have predisposed him to the hemorrhage. Thyroid hematoma secondary to blunt trauma has been documented in normal thyroid glands and in glands with preexisting benign pathology, but to the best of our knowledge, no report associating this condition with a thyroid carcinoma has previously been reported in the literature. A neoplasm should be suspected in a case of thyroid hematoma that fails to resolve with conservative treatment. The management of this condition is surgeon- and case-specific, and the overall prognosis is good.

Papillary carcinoma in a lingual thyroid: An unusual presentation

July 5, 2012     Kiran M. Bhojwani, MS; Mahesh Chandra Hegde, MS; Arathi Alva, MS; K.V. Vishwas, MBBS, MS
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Abstract

A lingual thyroid is a mass of ectopic thyroid tissue located in the midline of the base of the tongue. Its estimated prevalence ranges from 1 in 3,000 to 1 in 10,000 population. We report the interesting case of a 28-year-old woman who presented with a primary papillary carcinoma in a lingual thyroid and a histologically normal thyroid gland. To the best of our knowledge, this case probably represents only the second reported case of a follicular variant of a papillary carcinoma arising in a lingual thyroid.

Subglottic thyroglossal duct cyst: A rare intralaryngeal presentation

July 5, 2012     Regi Kurien, MS; Rajiv Michael, MS, DLO
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Abstract

Thyroglossal duct cysts are common midline neck swellings that can present at any site along their migratory pathway. They are frequently situated just below the hyoid bone. Extension to the subglottic area is very rare; such an unusual presentation can complicate the diagnosis of a thyroglossal duct cyst. We report the case of a 30-year-old man who presented with a subglottic thyroglossal duct cyst and associated laryngeal symptoms. To the best of our knowledge, only 2 similar cases have been previously reported in the literature, both of which occurred in 2-year-old boys. We believe, therefore, that ours is the first reported case of a subglottic thyroglossal duct cyst in an adult. We discuss the clinical presentation, diagnosis, and treatment of our patient, and we summarize the literature on intralaryngeal thyroglossal duct cysts.

Fourth branchial cleft cyst with no identifiable tract: Case report and treatment approach

July 5, 2012     Peter Dziegielewski, MD; Jason Chau, MD, FRCSC; Sarfaraz Banglawala, MD; Hadi Seikaly, MD, FRCSC
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Abstract

We describe a rare case of a fourth branchial cleft cyst that had no identifiable tract. The patient was a 23-year-old man who presented with recurring neck abscesses. After six similar episodes, computed tomography finally demonstrated that the most recent abscess had extended into the thyroid gland, a finding that led to the correct diagnosis. Extensive surgical extirpation of the cyst with an adjacent neck dissection was performed, and the patient remained symptom-free at 25 months of follow-up. The occurrence of a fourth branchial cleft cyst with no clear tract presents a surgical dilemma, as complete dissection cannot be guaranteed. Consequently, such patients are predisposed to recurrence. We propose that definitive management of a fourth branchial cleft cyst with no identifiable tract focus on eliminating the likely embryologically based path of bacterial seeding. This includes a hemithyroidectomy in conjunction with a selective neck dissection to cover all areas where a fourth branchial tract may lie within the neck.

Thyroid hemiagenesis

April 30, 2012     Kuang-chun Hsieh, MD; Montu Patel, MD; Enrique Palacios, MD, FACR; Harold R. Neitzschman, MD, FACR
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In cases of incidental thyroid hemiagenesis, findings on endocrinologic and functional studies are usually normal, and there is no evidence that the incidence of thyroid pathology is any greater in these patients than it is in the general population.

Lateral ectopic thyroid: A case diagnosed preoperatively

March 31, 2012     H├ęctor Prado, MD, Alejandro Prado, MD, and Bertha Castillo, MD
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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.

Thyroid carcinoma with intravascular metastasis to the internal jugular vein

December 15, 2011     Ryan F. Osborne, MD, Hootan Zandifar, MD, and Reena Gupta, MD
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Papillary thyroid carcinoma with nodular fasciitis-like stroma: A case report

October 26, 2011     Bevinahalli N. Nandeesh, MD, DNB, Anuradha Ananthamurthy, MD, Yeliur K. Inchara, MD, DNB, Marjorie M.A. Correa, MD, and Isha Garg, MD
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Abstract

Papillary thyroid carcinoma (PTC) is the most frequently occurring malignant neoplasm of the thyroid gland and is known to have several morphologic variants. PTC with nodular fasciitis-like stroma (PTC-NFS) is one of the unusual variants of PTC, with only a few cases being reported in the literature. This neoplasm is characterized by extensive reactive stromal proliferation, which may occupy 60 to 80% of the tumor along with areas of a typical papillary carcinoma. We report a case of PTC-NFS and address the diagnostic difficulties posed by the condition's extensive reactive stromal proliferation. We also emphasize that when one encounters a fibroproliferative lesion of the thyroid, a diligent search should also be made for PTC to avoid diagnostic errors.

Hyalinizing trabecular adenoma of the thyroid gland

September 20, 2011     Lester D.R. Thompson, MD
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