RESUMO
BACKGROUND: Granulomatous disease in the thyroid gland has been linked to viral, bacterial and autoimmune etiologies. The most common granulomatous disease of the thyroid is subacute granulomatous thyroiditis, which is presumed to have a viral or post-viral inflammatory cause. Bacterial etiologies include tuberculosis, actinomycosis, and nocardiosis, but are extremely rare. Disseminated actinomycosis and nocardiosis more commonly affect organ-transplant patients with the highest susceptibility within the first year after transplant surgery. CASE: A 45-year-old African American male, who received his third kidney transplant for renal failure secondary to Alport Syndrome, presented with numerous subcutaneous nodules and diffuse muscle pain in the neck. Further workup revealed bilateral nodularity of the thyroid. Fine needle aspiration of these nodules demonstrated suppurative granulomatous thyroiditis. Subsequent right thyroid lobectomy showed granulomatous thyroiditis with filamentous micro-organisms, morphologically resembling Nocardia or Actinomyces. CONCLUSION: Disseminated granulomatous disease presenting in the thyroid is very rare, and typically afflicts immune-compromised patients. The overall clinical, cytologic and histologic picture of this patient strongly points to an infectious etiology, likely Nocardia, in the setting of recent organ transplantation within the last year.
Assuntos
Hospedeiro Imunocomprometido , Nocardiose/imunologia , Nocardia/imunologia , Glândula Tireoide/imunologia , Nódulo da Glândula Tireoide/imunologia , Tireoidite Subaguda/imunologia , Tireoidite Supurativa/imunologia , Biópsia por Agulha Fina , Humanos , Falência Renal Crônica/etiologia , Falência Renal Crônica/cirurgia , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Nefrite Hereditária/imunologia , Nefrite Hereditária/fisiopatologia , Nocardia/isolamento & purificação , Nocardiose/microbiologia , Nocardiose/fisiopatologia , Reoperação/efeitos adversos , Glândula Tireoide/microbiologia , Glândula Tireoide/patologia , Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/microbiologia , Nódulo da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia , Tireoidite Subaguda/microbiologia , Tireoidite Subaguda/patologia , Tireoidite Subaguda/cirurgia , Tireoidite Supurativa/microbiologia , Tireoidite Supurativa/patologia , Tireoidite Supurativa/cirurgia , Resultado do TratamentoRESUMO
Thymic neuroendocrine carcinomas are the most common mediastinal neuroendocrine tumor. These malignancies are not often diagnosed by fine-needle aspiration (FNA), as they are more commonly diagnosed by biopsy or excision. We describe a case of a FNA of a paratracheal mass from a 38-year-old man who presented with Cushing syndrome. A low-grade neuroendocrine carcinoma with oncocytic features was diagnosed, which was later confirmed by excision of the thymus, anterior mediastinal and paratracheal soft tissue, and lymph nodes. Oncocytic features in these tumors are a rare finding and bring metastatic medullary thyroid carcinomas as well as other metastases into the differential diagnosis. The prognosis of neuroendocrine carcinomas in this location is worse than neuroendocrine carcinomas in other areas, and close follow-up is recommended.
