An intrapericardial ectopic thyroid mimicking metastasis in a patient with papillary thyroid cancer: Localization, differential diagnosis by 18F-FDG PET/CT and ablation by 131I.

We report a very rare case of incidental intrapericardial thyroid in a papillary thyroid cancer patient. Post ablation scan revealed iodine-131 (131I) uptake in the mid-chest. Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) was performed and showed a 18F-FDG avid lesion between the right atrium and the ascending aorta, (which was) shown to be an ectopic thyroid and not metastasis. The lesion disappeared on a 6 month follow-up 123I whole body scan while serum thyroglobulin was negative. Although intrapericardial ectopic thyroid is reported to show high iodine uptake, low 18F-FDG avidity of the lesion could be helpful in the exclusion of metastases.

Ectopic orbital meningioma: report of two cases and literature review.

Ectopic orbital meningioma is a rare tumor usually affecting the medial orbit. We present two cases that occurred in a 56-year-old woman and a 28-year-old man. The tumors in both patients were subtotally excised via orbitotomy surgery and were located in the superior quadrant in one of our patients and in the temporal quadrant in the other. Following histopathologic diagnosis, external beam radiotherapy (EBRT) was administered to one patient and intensity modulated radiotherapy to the other. We identified 12 other well-documented cases of ectopic orbital meningioma previously reported. Ectopic meningioma should be considered in the differential diagnosis of medial as well as lateral and superior orbital tumors. The tumor is usually well circumscribed but can be ill defined in imaging studies. There are intralesional calcifications and sclerosis of adjacent bone in some cases. Ectopic orbital meningioma can recur after incomplete excision. Based on the efficacy of EBRT in optic nerve sheath meningioma, we used this treatment to decrease the risk of recurrence in our two patients and found no tumor recurrence at follow-ups of 24 and 74 months, but one patient had severe vision loss from radiation retinopathy.

Outcome of radical resection and postoperative radiotherapy for thyroid carcinoma showing thymus-like differentiation.

BACKGROUND: Carcinoma showing thymus-like differentiation (CASTLE) is a rare disease that is difficult to diagnose. The aim of this study was to assess the effects of combined-modality treatment in CASTLE patients. METHODS: We retrospectively studied patients identified between January 1, 2000 and December 31, 2009 as having CASTLE and who subsequently underwent surgery and radiotherapy or chemotherapy. Preoperative laboratory findings, ultrasonographic (US) and computed tomographic (CT) features, and fine-needle aspiration biopsy (FNAB) specimens were evaluated. RESULTS: Seven patients with CASTLE were identified (four men, three women). The median age at initial diagnosis was 48 years (range 25-56 years). The five newly diagnosed patients were treated with curative surgery and postoperative radiotherapy, whereas two patients with recurrent disease were treated with salvage surgery plus radiotherapy or chemotherapy. All patients were disease-free at a median follow-up period of 34 months (range 12-61 months). The pattern of immunohistochemical staining was similar to that of thymic carcinoma. Specimens from all seven patients stained positively for CD5, CD117, and cytokeratin but were uniformly negative for thyroglobulin, thyroid transcription factor 1 (TTF-1), and calcitonin. CONCLUSIONS: Patients with CASTLE have excellent outcomes after curative resection and postoperative radiotherapy compared with patients with anaplastic thyroid carcinoma. Even patients with local recurrent disease benefited from salvage surgery with subsequent operation and/or radiotherapy. CD5 immunohistochemical staining on FNAB samples may help identify the possible entities that are part of the differential diagnosis.

Axillary breast cancer in a Nigerian woman.

Ectopic breast cancer is rare and diagnosis is commonly delayed. We report the case of a 34-year-old Nigerian woman with a locally advanced invasive ductal carcinoma in the axillary breast. She underwent an axillary mastectomy and is due to receive adjuvant chemotherapy and radiotherapy. The management of this patient is discussed in relation to existing medical literature on the subject.

[A diagnostic pitfall: papillary adenocarcinoma arising in ectopic thyroid tissue within a branchial cyst]. / Un piège diagnostique: l'adénocarcinome papillaire survenant sur une ectopie thyroïdienne située dans un kyste branchial.

A case of thyroid papillary carcinoma arising in ectopic thyroid tissue within a branchial cleft cyst is described. Complete dissection of the thyroid gland was necessary to rule out the differential diagnosis of primary thyroid carcinoma. The thyroglossal duct tract is an unusual localization for thyroid carcinomas in ectopic thyroid tissue. Thyroid carcinoma arising in ectopic thyroid tissue within a branchial cyst is extremely rare. Complete thyroidectomy may be necessary to eliminate an occult thyroid carcinoma.

Lingual thyroid: iodine 131: a viable treatment modality revisited.

PURPOSE: Lingual thyroid has a reported incidence between 1:10 and 1:100,000. When symptomatic, patients may present with dysphagia, choking, and/or dyspnea. Current surgical treatment options range from tumor extirpation or transposition to excision and reimplantation. Tracheotomies are often performed postoperatively for reliable airway control. Iodine 131 (131I) has not been a popular modality of treatment for lingual thyroid because of theoretical fears of increased airway obstruction from thyroiditis. We believe that these fears were not substantiated, and that symptomatic patients needed a reliable, nonsurgical treatment option. Therefore, our goal was to further investigate the use of 131I for the treatment of symptomatic lingual thyroid. PATIENTS AND METHODS: A 6-year retrospective chart review was performed. From 1994 to 2000, 2 patients with symptomatic lingual thyroid presented to the Arkansas Cancer Research Center Head and Neck Oncology clinic, University of Arkansas for Medical Sciences, Little Rock, AR. Patients underwent pretreatment computed tomography, and iodine 123 scans. They then received 1 oral dose of 131I. Doses ranged from 30 to 85 mCi. Patients were then followed daily for signs of airway compromise. RESULTS: Complete resolution of symptoms was seen 2 months after treatment. Patients did not complain of any increased airway compromise during treatment initiation. Patients remain symptom-free and are maintained on thyroid hormone replacement. CONCLUSIONS: Iodine 131 ablation of lingual thyroid is a safe and effective treatment in symptomatic patients and should be included in the algorithm when formulating a treatment plan.

Graves' disease and recurrent ectopic thyroid tissue.

Ectopic thyroid tissue is the result of abnormal migration of the gland as it travels from the floor of the primitive foregut to its destined pretracheal position. The prevalence of ectopic thyroid tissue ranges between 7%-10%. Patients with ectopic thyroid tissue are usually euthyroid, but can present with signs and symptoms of upper aerodigestive tract obstruction. We report a case in which ectopic mediastinal thyroid tissue was removed surgically because of substernal chest pain. It recurred 9 years later when the patient developed Graves' disease. We propose that the recurrence of the ectopic thyroid tissue was due to the influence of thyroid stimulating immunoglobulins (TSI).

Repeated 131I treatment of a residual ovarian teratoma containing malignant thyroid tissue.

A 49-year-old woman with ovarian teratoma received 131I treatment three times for an unresectable mass containing malignant thyroid tissue after surgery. Repeated 131I treatment effectively reduced serum thyroglobulin (Tg) level and tumour uptake of 131I, despite absence of any change in size of the treated tumour. Treatment did not inhibit the increase of serum CA-125 and tumour 201Tl uptake, associated with progression of a radioresistant intratumoral hyper-perfused tissue component, detected by colour Doppler ultrasound. Serum CA-125 level and tumour 201Tl uptake were not significantly changed despite temporary increases in serum Tg level after each 131I treatment. These observations indicate the importance of diagnostic measures using combined functional imaging and tumour markers in managing this rare tumour.

Lingual thyroid: report of three cases.

Lingual thyroid is a rare developmental disorder and is more frequent in women. The pathogenesis is unclear but may be related to the presence of maternal blocking autoantibodies against the thyroid. Treatment of this disorder includes the use of levothyroxine in order to correct the hypothyroidism, which is very frequent and to induce the shrinkage of the gland. When symptoms of obstruction or bleeding appear, ablative therapy by means of surgery or radioiodine is warranted. We report three cases and discuss the approach to diagnosis and a strategy for management.

[Recurrent pterygium over 15 years: epibulbar cartilaginous findings]. / Rezidivierendes "Pterygium" über 15 Jahre: epibulbärer knorpelhaltiger Befund.

BACKGROUND: Epibulbar and extraocular cartilage bearing tumors in adults are extremely rare. PATIENT: A nasally located pterygium in a 24-year-old patient was excised and recurred over the ensuing 15 years six times requiring local excisions, and each time a histological diagnosis of pterygium was made. Only a curative excision including a biopsy of the insertion of the m. rectus medialis and a sclerokeratoplasty revealed the tumor to bear cartilage histologically in an unusual place. A Ruthenium-106 brachytherapy was followed by a triple procedure for visual rehabilitation, and no further recurrences were observed. CONCLUSION: The differential diagnosis of a cartilaginous tumor most likely a choristoma growing in an unusual localisation should be considered in adults suffering from recurrent pterygia without known physical risk factors, and a curative excision be performed. Further treatment options depend on the appearance of the tumor.

Radiation-induced meningioma evaluated with positron emission tomography with fludeoxyglucose F 18.

We describe a patient with radiation-induced meningioma 12 years after cranial irradiation for ectopic germinoma. PET scans with fludeoxyglucose F 18 showed a high glucose metabolic rate in the meningioma despite a benign histologic appearance.

Functioning ectopic supradiaphragmatic pituitary adenomas.

Pituitary adenomas arising far from the pituitary gland occur rarely as a result of defects in embryological migration. Likewise, there have been reports of isolated suprasellar adenomas (clinically nonfunctioning), presumably derived from cells of the pars tuberalis. In this report, we present four cases of functional pituitary adenomas (three adrenocorticotrophic hormone, one prolactin) confined to the supradiaphragmatic region. In each case, the tumors were initially treated unsuccessfully by operations via the transsphenoidal route because of expected intrasellar processes with suprasellar extension.

[Papillary thyroid carcinoma in a median ectopic thyroid associated with intra-abdominal thyroid tissue]. / Papilläres Schilddrüsenkarzinom in einer median ektopen Schilddrüse mit zusätzlichem intraabdominalem Schilddrüsengewebe.

A 17-year-old female underwent surgical removal of a painless submental lump presumed to be a median cervical cyst. Histology showed a papillary thyroid carcinoma with invasion of the surrounding connective tissue. A 99m-technetium scan, performed in preparation for a planned total thyroidectomy, demonstrated no thyroid tissue. On subsequent 123-iodine scanning there was an area of increased uptake about 3 cm above the larynx, but no normal thyroid tissue. Histological sections, obtained during further surgical exploration of the base of the tongue, showed scattered thyroid cell rests in the lingual muscles. Whole-body scanning, carried out in connection with administration of radioiodine for ablation of remaining thyroid tissue, disclosed an unexpected area of increased uptake in the epigastrium. Sonography and CT scans failed to demonstrate any corresponding morphological abnormality. Following a further dose of radioiodine 4 months later, no areas of increased uptake were noted.

Para-articular ossification in total hip replacement: an indication for irradiation therapy.

The results of postoperative irradiation therapy after total hip replacement or resection of para-articular ossification in 25 patients are reported. The patients were kept under radiological observation for an average period of 26 months and clinical observation for an average period of 31 months after surgery. There were only two clinically relevant recurrences of para-articular ossification. The earlier radiotherapy with a total dose of 2000 rads (2000 cGy) was begun, the better was the effect. In this small population sample statistical significance could not be calculated. No side effects were detected.

Radionuclide turnover studies on ectopic thyroid glands--case report and survey of the literature.

A 72-yr-old woman who had previously undergone partial thyroidectomy for "toxic goiter" and subhyoid gland resection presented with signs and symptoms of ectopic lingual thyroid at the base of the tongue. The combination of lingual subhyoid and pretracheal thyroid is a rarity with only three cases reported. Discovery of ectopic thyroid tissue should raise suspicion of other ectopic thyroid tissues along the path of embryologic migration from its origin to the porta hepatis. This may necessitate assessment of radionuclide uptake and imaging of numerous areas. Sodium levothyroxine is the mainstay of therapy. In patients with obstructive symptoms, 131I ablation of the ectopic thyroid tissues has proven successful and may be more advantageous than surgery. In addition, radioiodide studies during ablation therapy gave new information that the ectopic lingual thyroid had more rapid iodide turnover compared with the postsurgical pretracheal thyroid gland.

[Radiotherapy of paraplegia caused by extramedullary hematopoietic tissue]. / Zur Radiotherapie der durch extramedulläres hämatopoetisches Gewebe bedingten Paraplegien.

The presentation by computed tomography of an extramedullar epidural intraspinal hemopoisis has only been described sporadically. It has been possible to visualize by CT-scans the regression under radiotherapy of a sensory and motor paraplegia in a 17 years old patient with beta-thalassemia major. The central nervous system (thoracic and lumbar zone as well as os sacrum) was exposed to a total reference dose of 30 Gy which was administered within twenty days by a 60Co unit in single doses of 2 Gy each. From 4 Gy on, the paraplegic symptoms regressed continuously. The control CT taken after 26 Gy- the paraplegia had completely disappeared at this time-showed a significant regression of the intraspinal soft tissue masses. Radiotherapy is very important in the treatment of this disease. A direct correlation is found between clinical symptoms and CT-presentation.

Radiotherapy in the prevention of recurrence of paraarticular ossification in total hip prostheses.

Ectopic bone formation or paraarticular ossification after total hip arthroplasty can be a very disabling factor. In patients with this problem, range of motion and walking ability may be reduced and pain can occur. In severe cases it seems logical to remove this paraarticular ossified tissue, but without measures to prevent its recurrence this will be of no real value. This study shows the effectiveness of irradiation soon after excision of the ectopic bone mass, with a total dosage of 20 Gy (2000 rad) given in ten fractions, in preventing, or at least inhibiting, the recurrence of paraarticular ossification in 16 patients. A dramatic improvement in hip function, walking ability, and relief of pain is demonstrated.

[A case of carcinoma originating from accessory breast tissue of the axilla].

We report a case of carcinoma originating from accessory breast tissue of axilla and review 33 reported cases of carcinoma in heterotopic breast tissue. Although the incidence of accessory breast cancer is not high, early diagnosis and treatment are necessary, keeping in mind the possibility of this carcinoma when subcutaneous nodules of uncertain origin are found around the breast. Surgical treatment which must at least include wide local extirpation including the surrounding tissues and dissection of the axillary lymph nodes is necessary and adjunctive chemotherapy and irradiation appear to be useful.