Cáncer en quiste tirogloso, con tiroides agenésica y nódulo ectópico. Caso clínico

Introducción: La glándula tiroides tiene su origen embriológico en la base de la lengua, desde donde desciende al cuello. Este proceso migratorio puede detenerse o continuar más allá, dando diferentes cuadros de tiroides ectópica. El quiste tirogloso es la alteración embriológica más frecuente en el cuello, pudiendo desarrollar cáncer como una complicación rara. Caso clínico: Paciente de 21 años con aumento de volumen cervical, se diagnostica quiste tirogloso, la biopsia identifica cáncer papilar en el quiste. Se decide completar tiroidectomía, se objetiva agenesia de glándula. Ante respuesta bioquímica incompleta se realiza cintigrama que identifica nódulo retrolingual, el cual es resecado. Discusión: La resección del quiste tirogloso se debe realizar según la descripción de Sistrunk para evitar recidivas. La historia natural del cáncer en quiste tirogloso es bastante menos conocida y podría tener un peor pronóstico que el cáncer tiroideo habitual. Existen grupos que defienden la necesidad de completar tiroidectomía y, eventualmente, realizar disecciones cervicales como parte de su manejo. Conclusión: El cáncer de quiste tirogloso es una patología infrecuente, Existen diferentes lineas de manejo que se discuten en la literatura. Aún el análisis individualizado de los pacientes en comités multidisciplinario de expertos es la conducta sugerida.

Introduction: The thyroid gland has its embryological origin from the base of the tongue, where it descends to the neck. This migratory process can stop early or continue beyond, giving rise to differents cases of ectopic thyroid. The thyroglossal cyst is the most frequent embryological alteration in the neck, and it can develop cancer as a rare complication. Clinical case: A 21 year old patient with a cervical volume increase is diagnosed a thyroglossal cyst. Biopsy identifies papilary cancer in the cyst. It is decided to complete de thyroidectomy, and agenesis of the gland is observed. Due to incomplete biochemical response, a scintigram is performed, wich identifies a retrolingual nodule that is resected. Discussion: The resection of the thyroglossus cyst should be performed according to the description of Sistrunk to avoid recurrence. The natural history of cancer in the thyroglossal cyst is much less known and could have a worst prognosis than usual thyroid cancer. Some groups advocate for the need to complete a thyroidectomy and eventually perform cervical dissections as part of its management. Conclusion: The cancer on a thyroglossal cyst is a rare pathology. There are diferents management approaches that are discussed in the literature. However, an individualized analysis of patients in multidisciplinary expert committees it still the suggested aproach.

Traveling together! - Intrathymic thyroid tissue in a patient with Graves' disease

ABSTRACT Ectopic thyroid tissue is rare in the general population and more prevalent in people who have existing thyroid disease. Common anatomical sites of ectopic thyroid tissue include the lateral cervical region, thyroglossal duct, mediastinum, lingual, sublingual, and submandibular region. Intrathymic ectopic thyroid tissue is exceedingly rare. The purpose of this report is to describe one such case in a 52-year-old African-American female with Graves' disease. The patient presented for a physical exam and follow-up. During the exam, an incidental mediastinal mass was discovered, which was evaluated by imaging studies and subsequently was resected. Histologically, the mass was composed of variable-sized thyroid follicles lined by a monolayer of cuboidal to columnar follicular epithelial cells and filled with eosinophilic colloid, surrounded by a rim of unremarkable compressed thymic tissue.

Research progress in imaging manifestations and diagnosis and treatment of ectopic thyroid / 中国医师杂志

Ectopic thyroid (ETG) is a thyroid tissue located outside the normal anatomical position, often occurring in the chest. Clinical symptoms are related to its location and its impact on adjacent structures. In ETG imaging examination, single photon emission computed tomography (SPECT) nuclide imaging of thyroid perchlorate ( 99Tc mO 4-) is the most commonly used method for localization and characterization. ETG with normal function shows high radiation uptake in the corresponding area. For difficult to distinguish tumors in the base of the tongue and the thyrohyoid region, 131I or 123I imaging with more specificity for thyroid tissue uptake is needed. ETG exhibits a variety of manifestations in computed tomography (CT) and magnetic resonance imaging (MRI), mostly irregular soft tissue density masses with clear boundaries and uneven density. There are low-density cystic changes or high-density calcifications within the masses, with uneven or uniform enhancement. In ultrasound, ETG is mainly hypoechoic, with some showing cystic solid echoes and abundant blood flow signals within the gland. Asymptomatic ETG patients usually do not require treatment, while symptomatic patients often require surgical resection and have a good prognosis. Before surgery, relevant examinations should be combined to clarify the nature of the tumor as much as possible, to avoid permanent hypothyroidism caused by misdiagnosis and misresection.

Bocio multinodular ectópico submandibular: a propósito de un caso y revisión de la literatura / Submandibular ectopic multinodular goiter: case report and literature review

Resumen El tiroides ectópico es una alteración congénita infrecuente que presenta una prevalencia entre 1/100.000-1/300.000. En el 90% de los casos se encuentra en la línea media cervical, siendo los casos de tiroides ectópico cervical lateral muy infrecuentes. Presentamos el caso de una paciente de 44 años que consultó por presentar una tumoración submandibular izquierda de más de seis meses de evolución. Las pruebas de imagen (ecografía, tomografía computarizada y gammagrafía) sugirieron un bocio ectópico multinodular; la punción aspiración con aguja fina (PAAF) informó de tejido tiroideo sin atipias (Bethesda II) y el estudio sanguíneo de hormonas tiroideas fue normal, orientando finalmente el caso como un bocio multinodular ectópico submandibular eutiroideo. Ante la ausencia de síntomas y signos sugerentes de malignidad, en conjunto con una PAAF con características de benignidad, se decidió realizar seguimiento. En el momento que presentó clínica por efecto masa se decidió realizar la exéresis de la lesión, que confirmó el diagnóstico de bocio multinodular ectópico. Los casos descritos en la literatura de bocio multinodular ectópico submandibular como único tejido tiroideo funcionante son excepcionales. El tiroides ectópico se debe considerar en el diagnóstico diferencial de una masa submandibular. Aunque actualmente no existe un consenso en relación con el manejo de dicha patología, el crecimiento de la masa puede contribuir a la decisión de una exéresis completa del tiroides ectópico, aun tratándose del único tejido tiroideo funcionante.

Abstract Ectopic thyroid is an uncommon congenital disorder with a prevalence between 1/100,000-1/300,000. In 90% of cases, it is placed in cervical midline, being the cases of lateral cervical ectopic thyroid very infrequent. We present the case of a 44-year-old female patient who had a left submandibular mass during more than six months. Imaging tests (ultrasound, computed tomography and scintigraphy) suggested a multinodular ectopic goiter; fine needle aspiration (FNA) reported thyroid tissue without atypia (Bethesda II) and the thyroid hormone blood tests were normal, finally orienting the case as a euthyroid submandibular ectopic multinodular goiter. In the absence of symptoms and signs suggestive of malignancy, together with an FNA with benign characteristics, it was decided to follow up. When the patient presented clinical symptoms due to mass effect, it was decided to perform excision of the lesion, which confirmed the diagnosis of ectopic multinodular goiter. There are very few cases described in the literature of submandibular ectopic multinodular goiter as the only functioning thyroid tissue. Ectopic thyroid should be considered in the differential diagnosis of a submandibular mass. Although there is currently no consensus on the management of this pathology, the growth of the mass may contribute to the decision of a complete excision of the ectopic thyroid, even if it is the only functioning thyroid tissue.

Tiroides Ectópica Lingual: caso Clínico / Lingual Ectopic Thyroid: a clinical case

La tiroides ectópica lingual es una patología muy poco frecuente, producida por la detención en el descenso normal de la glándula durante el desarrollo embrio-nario. La localización lingual de tejido tiroideo es la más común entre las tiroides ectópicas o aberrantes. Esta enfermedad puede ser asintomática pero, cuan-do los signos y síntomas están presentes, guardan estrecha correlación con la localización de la lesión y son proporcionales a su tamaño. El diagnóstico debe realizarse clínicamente y con el complemento de es-tudios por imágenes y endocrinológicos. En los aná-lisis de laboratorio se debe incluir dosaje de las hor-monas TSH, T4 libre y T3, vinculadas con la función tiroidea. Las biopsias deben evitarse ya que causan desequilibrio en la producción hormonal de la glándu-la y peligro de profusas hemorragias. En este artículo se desarrolla una descripción de las generalidades de la tiroides ectópica lingual, y se presenta un caso clínico de un niño con un tumor lingual, que fue deri-vado por su médica pediatra a cirugía para realizar una biopsia. Asimismo, se comenta la importancia que tiene para el odontólogo conocer esta patología a fin de poder evitar sus posibles complicaciones (AU)

Lingual thyroid is a rare disorder produced by a failure in the descent of thyroid gland to its normal position during embryological development. Lingual localization of thyroid tissue is the most common among the ectopic or aberrant thyroids. This condition can be asymptomatic, although when symptoms take place, they are connected to the lesion location and depend on its size. Diagnosis should be made clinically and complemented with imaging and endocrine studies. Laboratory analysis must include dosage of TSH, free T4 and T3, thyroid function-linked hormones. Due to the possible imbalance in the gland hormone production and the risk of massive bleeding, biopsy should be avoided. In this article, a brief description of lingual ectopic thyroid generalities is developed and a clinical case of a 7-years old child is provided. Additionally, dentistry importance of knowing this condition is commented, in order to prevent its possible complications (AU)

One case of cervical ectopic thyroid carcinoma with lung metastasis / 中华内分泌外科杂志

Ectopic thyroid gland refers to the presence of thyroid tissue outside the normal position of the neck, which is relatively rare in clinical practice, and ectopic and cancer change is rare. This article focuses on a patient with "supraclavicular mass" as the first symptom admitted to the Thyroid Surgery Department of Binzhou People’s Hospital, After the operation, the pathology confirmed ectopic thyroid cancer with lymph node metastasis, and the imaging showed lung metastasis. This article summarizes the case data.

Giant retrosternal goiter masquerading as, right posterior mediastinal mass: a rare case report

Complete mediastinal plunging thyroid gland is a rare entity, accounting for 1% of all mediastinal tumours, particularly posterior mediastinal tumour much more rare. We would like to present, a 30-year-old lady presented to ENT department with neck swelling and its further investigation shown to be giant posterior mediastinal mass. Thyroid function tests were normal. CT scans of the neck and chest revealed a large right mediastinal mass compressing the trachea from the right side and extending to the superior part of the posterior mediastinum with enlarged right thyroid gland in the cervical position. Midline extended sternotomy was done for complete surgical excision of the mass along with right hemi thyroidectomy. It was well circumscribed, capsulated, multinodular firm inconsistency, and vascular. Histopathology revealed thyroid tissue negative for malignancy. Giant plunging thyroid in the mediastinum is very rare. It should be differentiated from other mediastinal mass. The plunging goiter in posterior mediastinum is surgically challenging. Transsternal surgical removal is the treatment of choice in such cases.

Lingual thyroid with hypothyroidism in a child

Ectopic thyroid is an uncommon embryological abnormality characterized by the presence of thyroid tissue in a site other than its usual pretracheal location. Of all ectopic thyroids 90% are found to be lingual. Lingual thyroid is estimated to occur in 0.2 per cent of normal children, being more common in females. It is a rare congenital anomaly appearing with prevalence of 1:100000. This embryological anomaly originates from failure of thyroid gland to descend from foramen caecum to its normal pre laryngeal site. Interestingly, only 0.01% of these patients present with any overt symptoms. If symptomatic: dyspnoea dysphagia, dysphonia and stomatolalia are some common clinical features associated with it. In females these symptoms manifest during stress as in pregnancy, puberty and menstruation. Some rare clinical presentations reported in literature are hyperthyroidism, malignancy and hemoptysis. Hereby authors are reporting a 7-year-old female child who presented to our department with dysphagia who on evaluation diagnosed to have lingual thyroid with hypothyroidism.

One case of intracardiac ectopic thyroid / 中华内分泌外科杂志

Ectopic thyroid gland is a kind of congential deformity which occurs during thyroid embryo development. Combined with this case, our study introduced the diagnosis, treatment process and the postoperative outcome of "intracardiac ectopic thyroid" in the case, discussed the causes of this kind of disease from the perspective of tissue and embryo, and summarized the basic characteristics of this disease. Through the research and analysis of our study, we come to the conclusion and wish to offer some suggestions: although this disease is relatively rare, it should also be paid attention to to avoid misdiagnosis and mistreatment if encountered middle-age female patients with the intracardiac mass located in the right ventricle outflow tract.

One case of intracardiac ectopic thyroid / 中华内分泌外科杂志

Ectopic thyroid gland is a kind of congential deformity which occurs during thyroid embryo de-velopment. Combined with this case, our study introduced the diagnosis, treatment process and the postoperative outcome of "intracardiac ectopic thyroid" in the case, discussed the causes of this kind of disease from the per-spective of tissue and embryo, and summarized the basic characteristics of this disease. Through the research and analysis of our study, we come to the conclusion and wish to offer some suggestions: although this disease is rela-tively rare, it should also be paid attention to to avoid misdiagnosis and mistreatment if encountered middle-age female patients with the intracardiac mass located in the right ventricle outflow tract.

A Case of Lateral Ectopic Thyroid Mimicking the Metastatic Lymphadenopathy / 대한이비인후과학회지

Ectopic thyroid means that thyroid tissue is present at an unusual area rather than at the orthotropic thyroid position. The most common form of ectopic thyroid is lingual thyroid, followed by thyroglossal duct cyst. Ectopic thyroid in the lateral neck area is extremely rare, with only a few case reports found in the literature review. Several studies recommended that metastasizing malignancy should be considered in lateral ectopic thyroid. Described here is a case of 60 year-old woman with lateral ectopic thyroid, which was newly found during a follow-up and was mistaken for metastatic lymphadenopathy.

A Case of Dual Ectopic Thyroid / 대한이비인후과학회지

Ectopic thyroid is an uncommon status characterized by the presence of thyroid tissue in a site other than in its usual region. It is rare for dual ectopic thyroid to have two ectopic foci simultaneously. Three cases of dual ectopic thyroid have been reported in the Korean literature. Clinically, most cases in ectopic thyroid were noted at adolescence or postpartum due to increased physiologic hormonal demands. Clinical manifestation, thyroid function test, and radiologic imaging should be employed to make a diagnosis and therapeutic plan of this disease. We present a patient with dual ectopic thyroid tissue in the suprahyoid and infrahyoid area without thyroid tissue in its normal thyroid bed.

Cáncer diferenciado de tiroides en tiroides lingual, presentación de un caso / Differentiated thyroid cancer in the lingual thyroid, presentation of a case

The lingual thyroid carcinoma is very uncommon neoplasia with an incidence of less than 1 percent. The papillary variant is the most frequent. Cervical MRI helps differentiate muscle from thyroid tissue. The definitive diagnosis is given by histology. Management is similar to that of orthotopic thyroid cancer. We present the case of a 23-year-old woman with hypothyroidism undergoing treatment with dysphagia and sensation of pharyngeal foreign body and malodorous oral bleeding. Nasopharyngoscopy showed a rounded mass at the base of the tongue; the biopsy was compatible with thyroid neoplasia. Image study with ultrasound confirms empty thyroid bed with presence of lingual ectopic thyroid. The team of surgeons performed surgery with Trotter Technique, they removed a tumor of 4 centimeters of diameter. The definitive biopsy concludes minimally invasive follicular carcinoma. The treatment was completed with 100 mCi of radioiodine. Systemic screening at 7 days was negative, as the post-operative thyroglobulin (Tg)

Clinical Features of Patients with Congenital Hypothyroidism Due to Ectopic Thyroid

OBJECTIVE: This study aimed to describe the clinical features of patients with congenital hypothyroidism due to ectopic thyroid including locations of ectopic thyroid, thyroid function, age of treatment, and starting dose of medication. METHODS: A total of 71 children with congenital hypothyroidism due to ectopic thyroid diagnosed by thyroid ultrasonography (USG) or 99mTc-petechnetate thyroid scan in the department of pediatrics, Soonchunhyang University Seoul Hospital from 1992 to 2015 were enrolled and analyzed retrospectively. RESULTS: Among 71 patients, 26 patients (36.6%) were male and 45 patients (63.4%) were female as the gender ratio was 1:1.73. The locations of ectopic thyroid confirmed by USG or scan were found to be sublingual in 52 patients (73.2%), lingual in 17 patients (23.9%), prelaryngeal in 1 patient (1.4%), and combined in 1 patient (1.4%), respectively. The average value of serum thyroid stimulating hormone was 267.5 µIU/mL and free thyroxin was 0.63 ng/dL. The average value of thyroglobulin (TG) was 217.6 ng/mL. Fifty two patients (73.2%) started treatment within the 1 month of age and 19 patients (26.8%) started after the 1 month of age. The average of the medication starting dose was 12.2 µg/kg/day. There was no significant difference on TG value and starting medication dose. CONCLUSION: As the previous literatures, the presence of ectopic thyroid was more common in female than male. It was coincident with this study. It is generally accepted that lingual ectopic thyroid is most common ectopic location, but in this study, proportion of sublingual thyroid was most common.

Lateral ectopic thyroid:A case report and literature review / 吉林大学学报(医学版)

Objective:To discuss the clinical characteristics,diagnosis and treatment experience of a case of lateral ectopic thyroid.Methods:The patient with lateral ectopic thyroid was diagnosed by thyroid color ultrasound and single-photon emission computed tomography(SPECT)-CT examination.The right thyroidectomy and the thyroid tissue in cervical section Ⅳ of the patient were removed by received the operation.The pathological examination after operation was performed.The daily usage of euthyrox after operation was 50 μg.Results:The patient recovered well,who accepted 10 months follow-up with normal life and stable condition,and had no recurrence and metastasis.Conclusion:The mechanism of lateral ectopic thyroidy is not clear yet,the surgical treatment can result in good effectiveness and better prognosis.

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.

Ectopic Thyroid Tissue Co-Existing with a Eutopic Thyroid.

Ectopic thyroid tissue, a developmental defect of thyroid gland, is met with rarity in day to day clinical practice. The diagnosis of ectopic thyroid demands a meticulous clinical examination and use of different imaging modalities. We are here reporting a case which presented as an anterior neck swelling, moving with deglutition, and also on and off dysphagia. After necessary investigations she underwent surgery and then the diagnosis of ectopic thyroid was made which was later confirmed with biopsy report which was suggestive of lymphocytic thyroiditis.

Diagnosis and treatment of ectopic thyroid / 中华内分泌外科杂志

Objective To investigate the clinical features , diagnosis and treatment of ectopic thyroid in order to avoid misdiagnosis and mismanagement .Methods Six cases of ectopic thyroid admitted to Fuzhou Gen-eral Hospital from Jan .2000 to Oct.2011 were retrospectively analyzed and the literatures were reviewed .Re-sults Three cases of ectopic thyroid were located in the anterior cervical area , 2 cases were at the base of the tongue and 1 case in the gall bladder .Two cases of aberrant thyroid were confirmed preoperatively in patients whose gland wasn't discovered by imaging examinations at the normal position of the thyroid gland .A symptomless individual of aberrant thyroid did not need other treatment but follow-up.One case with foreign body sensation in pharynx had a good response to thyroxine therapy .Four cases with accessory thyroid were operated because of misdiagnosis .Three cases were ectopic thyroid tissue and one was nodular goiter confirmed by pathology .None of these patients developed hypothyroidism after surgery .Conclusions Ectopic thyroid gland is a rare disease fre-quently misdiagnosed and mistreated .Goiters in the commonly location of ectopic thyroid gland such as the anteri-or cervical area and the base of the tongue should be paid special attention .Hormonal therapy or surgical inter-vention should be chosen according to clinical features , type of the goiter , thyroid function and whether it is be-nign or malignant .Long term follow-up and thyroid function tests are absolutely necessary .

Ectopic Thyroid in Presumed Thyroglossal Duct Cyst.

We report a case of an eight year old female child with a midline neck mass for seven years. Since its early presentation, this midline mass has recently increased in size. A presumptive diagnosis of thyroglossal duct cyst was made clinically & planned for surgery. Preoperative evaluation revealed hypothyroidism, hence she was referred to us for the management of the same prior to excision. On further evaluation 99 Tc-thyroid scan showed that this midline mass was in fact the only functioning thyroid tissue & ultrasonography revealed no thyroid tissue in usual location, therefore no surgery was performed. This case demonstrates the essential role of a thyroid scan and ultrasonography in the preoperative evaluation of a midline neck mass.

Functional lingual thyroid in an adolescent female: a case report and brief literature review.

Background: Lingual thyroid is a rare clinical entity that represents faulty migration of normal thyroid gland. It commonly presents as a benign mass found at the junction of the anterior two-thirds and posterior one-third of the tongue. Although usually asymptomatic, glandular hypertrophy can cause dysphonia, dysphagia, bleeding, or stridor at any time from infancy through adulthood. We report a case that we encountered, discuss the diagnosis and its management, and review the literature. An otherwise asymptomatic 14 year-old girl presented with a posterior tongue mass that had been present since childhood but was never investigated. She was clinically and biochemically euthyroid, with normal thyroid function tests. Physical examination revealed a smooth, globular mass occupying the whole tongue base and valleculae. The epiglottis was slightly displaced posteriorly but the laryngeal inlet was patent. A 99mTcradioisotope scan showed accumulation of tracer in the tongue base and no uptake in the neck. MRI revealed a 1.8-cm diameter soft tissue mass in the posterior part of the tongue. To date she has not required suppressive therapy or surgical intervention. Conclusions: Treatment of lingual thyroid depends on patient symptoms. Most importantly, patients should be followed at regular intervals and educated on the possibility of developing complications.