A rare case of primary tuberculosis in a solitary thyroid nodule.

Tuberculosis (TB) of the thyroid gland is extremely rare with fewer than 200 cases reported worldwide. We report a case of primary TB of the thyroid in a 73-year-old gentleman with no risk factors for TB, presenting with a painless right neck mass of one week's duration. A pre-operative ultrasound scan reported a solid-cystic, right TIRADS 5 nodule, and initial fine needle cytology showed granulomatous inflammation and was negative for AFB on Ziehl-Neelsen stain. A right hemithyroidectomy was done subsequently, and histology demonstrated necrotizing granulomatous inflammation, but TB-PCR detected Mycobacterium DNA. Primary TB of the thyroid is rare and can manifest in patients with no apparent risk factors for TB. Initial cytology may only yield granulomatous inflammation and surgery is needed to ascertain the exact cause of granulomatous inflammation and additional TB-PCR can help clinch the diagnosis.

Primary Pituitary Tubercular Abscess: A Case Report.

Primary pituitary tubercular abscess is a very rare disease. It may present clinically with visual loss, headache, seizure, hormonal abnormalities or with cranial nerve palsies. MRI is the diagnostic modality and shows a cystic-solid mass in the sellar and suprasellar region, isointense on T1 and T2W images with heterogeneous areas and ring enhancement on contrast. Surgery remains the initial treatment and it is approached through the trans-sphenoidal/trans-nasal or transcranial route followed by anti-tubercular therapy. We report a case of primary pituitary tubercular abscess managed successfully with a brief review of its pathology. Keywords: abscess; pituitary gland; pyogenic; sella; tuberculosis.

Hyperthyroidism due to involvement of thyroid gland in disseminated tuberculosis: A rare entity.

Involvement of the thyroid gland with tuberculosis (TB) is unusual and is commonly associated with hypothyroidism. Involvement of the thyroid as a part of disseminated TB is even rarer. Dissemination is an indication of immunosuppression. We present a 16-year-old immunocompetent girl with disseminated TB involving the thyroid gland and the right radius bone with features of hyperthyroidism. The patient responded well to anti-TB treatment.

Tuberculosis of the Breast in Togo: A Series of 28 Presumed Cases.

Our study aimed to describe the epidemiological, clinical and histological aspects of mammary tuberculosis in Togo. This is a descriptive cross-sectional study of breast tuberculosis for which the diagnosis was presumed on histological grounds in the pathology department (LAP) of the Lomé Tokoin university hospital from January 1995 to December 2016 (20 years). A total of 28 presumed cases of mammary tuberculosis were identified. There were 26 women and 2 men, with an average age of 34.2 ± 0.3 years. The clinical signs were nodule (84.1%), tumefaction (75%), abscess (63.6%) and tumefaction with cutaneous fistulization (59.1%). Breast involvement was isolated in 31.8% of cases and associated with pleuropulmonary tuberculosis in 54.5% of cases. Co-infection with HIV was found in 63.9 % of cases. Histology showed inflammatory granulomas made of Langhans giant cells, epithelioid cells and lymphocytes around the foci of caseous necrosis. Thoracic radiography was abnormal in 16 patients (57.1%).Mammary tuberculosis is not rare in our country. Clinical presentation is often misleading and is a diagnostic challenge, more particularly with breast abscess or cancer.

Association of tuberculous thyroiditis and papillary carcinoma of the thyroid: a rare coincidence.

We report the case of a 25 year-old patient with no medical history, admitted to our unit for nodular goiter of the right lobe without clinical or laboratory signs of hyperthyroidism. We carried out a right lobo-isthmectomy revealing the association of tuberculosis and thyroid papillary carcinoma. A left lobectomy has, therefore, been performed in a second stage. The patient underwent a six-month antituberculosis treatment with a good clinical outcome. We discuss this rare association and its best diagnostic and therapeutic support, with a review of the literature.

[Unilateral adrenal tuberculosis: a case report].

Computed tomography (CT) performed for a 75-year-old man as a follow-up examination for deep vein thrombosis in October 2010 revealed a left adrenal mass (diameter, 8 mm). In December 2012, the adrenal mass increased to 28 mm in diameter, and he was referred to our department. Several blood examinations revealed that the adrenal mass was non-functioning, and only peripheral lesions were observed to be enhanced by using CT in the arterial phase. Malignancy was suspected due to the irregular shape and growth of the mass, and left adrenalectomy was performed in February 2013. The histopathological diagnosis was adrenal mycobacteriosis, and clinical diagnosis was adrenal tuberculosis. No other tuberculosis infection-related lesion was detected, and the patient was treated with multidrug antituberculous chemotherapy.

Thyroid tuberculosis - role of PCR in diagnosis of a rare entity.

BACKGROUND: Tuberculosis is a rare cause of granulomatous thyroiditis, whose diagnosis may be difficult with routine cytopathology and staining for acid-fast bacilli (AFB). STUDY DESIGN: Amongst 7962 cases of various thyroid lesions subjected to fine needle aspiration cytology (FNAC) over a period of 12 years, 34 cases (0.43%) were found to have cytological features of granulomatous inflammation with or without necrosis, which could be due to tuberculosis, granulomatous thyroiditis or other causes of granulomatous inflammation such as sarcoidosis or fungal infections. DNA was extracted from the material available on May-Grünwald-Giemsa-stained smears from the archival material. PCR for Mycobacterium tuberculosis was performed for insertion sequence IS6110. RESULTS: The age of the patients ranged from 32 to 58 years (median 48 years); 24 were female and 10 male. FNAC from thyroid swellings showed epithelioid granulomas with giant cells and/or necrosis. Although acid-fast bacilli were only seen in smears in two cases, 19/34 (55.9%) showed the presence of 123 bp DNA band under ultraviolet transillumination. Five control cases were negative. CONCLUSION: Our study of archival cytological material illustrates the importance of PCR as a potentially useful tool for the detection of M. tuberculosis DNA from FNAC of thyroid lesions, which could provide an alternative for rapid diagnosis of thyroid tuberculosis in AFB-negative cases.

Primary thyroid tuberculosis: a rare etiology of hypothyroidism and anterior cervical mass mimicking carcinoma.

OBJECTIVE: The involvement of the thyroid by tuberculosis (TB) is rare. Hypothyroidism caused by tissue destruction is an extremely rare report. Our aim was to report a patient with primary thyroid TB emphasizing the importance of diagnosis, despite the rarity of the occurrence. CASE REPORT: Women, 62 years old, showing extensive cervical mass since four months, referring lack of appetite, weight loss, dysphagia and dysphonia. Laboratorial investigation revealed primary hypothyroidism. Cervical ultrasound: expansive lesion in left thyroid lobe, involving adjacent muscle. Computed tomography scan: 13 cm diameter cervical mass with central necrosis. Fine needle biopsy: hemorrhagic material. SURGERY: total thyroidectomy, left radical neck dissection and protective tracheotomy. The pathological examination showed chronic granulomatous inflammatory process with areas of caseous necrosis and lymph node involvement. The thyroid baciloscopy was positive. Pulmonary disease was absent. The patient was treated with antituberculosis drugs. CONCLUSIONS: Thyroid TB is not frequent, and should be considered as differential diagnosis of hypothyroidism and anterior cervical mass.

Histopathologic diagnosis of thyroid tuberculosis.

BACKGROUND: Thyroid tuberculosis is rarely encountered. Due to the absence of specific signs and symptoms, the diagnosis is difficult without histopathologic examination of surgical material. In this study, we aim to present histopathologic findings of our patients with thyroid tuberculosis. METHODS: We retrospectively reviewed 800 thyroidectomy specimens from the pathology laboratories of two medical centers that were obtained over a 5-year period. We reviewed clinical and laboratory data, fine-needle aspiration cytology smears, and 4-microm formalin-fixed paraffin-embedded hematoxylin-eosin sections and Erlich Ziehl Nelsen-stained sections of granulomatous thyroiditis. RESULTS: We found nine cases of granulomatous thyroiditis and detected five cases of thyroid tuberculosis. Thyroid ultrasound revealed hypoechoic nodules ranging between 1.3 and 2.5 cm in all patients with thyroid tuberculosis. Fine-needle aspiration cytology smears, which showed thyrocytes, macrophages, and lymphocytes with a colloid background, were nonspecific. Microscopic examination of all thyroids revealed granulomas of different sizes, which were composed of Langhans' giant cells, epithelioid histiocytes, and lymphocytes around caseation necrosis. In Erlich Ziehl Nelsen-stained sections of three cases, bacilli were seen. Bacilli were identified in the microbiology culture of the remaining two patients. CONCLUSIONS: Thyroid tuberculosis is diagnosed by histopathologic examinations and microbiologic cultures. When granulomatous thyroiditis is encountered, tuberculosis should be kept in mind and Erlich Ziehl Nelsen staining should be performed for prompt diagnosis.

Primary thyroid tuberculosis: a rare etiology of hypothyroidism and anterior cervical mass mimicking carcinoma / Tuberculose tireoidiana primária: rara etiologia de hipotireoidismo e massa cervical anterior mimetizando carcinoma

OBJECTIVE: The involvement of the thyroid by tuberculosis (TB) is rare. Hypothyroidism caused by tissue destruction is an extremely rare report. Our aim was to report a patient with primary thyroid TB emphasizing the importance of diagnosis, despite the rarity of the occurrence. CASE REPORT: Women, 62 years old, showing extensive cervical mass since four months, referring lack of appetite, weight loss, dysphagia and dysphonia. Laboratorial investigation revealed primary hypothyroidism. Cervical ultrasound: expansive lesion in left thyroid lobe, involving adjacent muscle. Computed tomography scan: 13 cm diameter cervical mass with central necrosis. Fine needle biopsy: hemorrhagic material. Surgery: total thyroidectomy, left radical neck dissection and protective tracheotomy. The pathological examination showed chronic granulomatous inflammatory process with areas of caseous necrosis and lymph node involvement. The thyroid baciloscopy was positive. Pulmonary disease was absent. The patient was treated with antituberculosis drugs. CONCLUSIONS: Thyroid TB is not frequent, and should be considered as differential diagnosis of hypothyroidism and anterior cervical mass.

OBJETIVO: A tuberculose tiroidiana ocorre raramente. O hipotireoidismo decorrente da destruição tiroidiana é um relato raríssimo. Nosso objetivo foi descrever o caso de paciente com tuberculose tiroidiana primária e ressaltar a raridade e a importância da doença. RELATO DO CASO: Mulher, 62 anos, apresentando massa cervical extensa há quatro meses, associada à inapetência, à perda de peso, à disfonia e à disfagia. A investigação laboratorial mostrou hipotireoidismo primário. Ultrassonografia: lesão expansiva em lobo esquerdo, envolvendo musculatura subjacente. Tomografia computadorizada: massa heterogênea com centro necrótico, 13 cm de diâmetro. Biópsia por agulha fina: material serossanguinolento. Cirurgia: tireoidectomia, dissecção radical à esquerda e traqueostomia protetora. Exame anatomopatológico: processo inflamatório crônico granulomatoso com áreas de necrose caseosa e comprometimento linfonodal. Baciloscopia tiroidiana positiva. Ausência de comprometimento pulmonar. A paciente foi tratada com drogas antituberculosas. CONCLUSÕES: Tuberculose tireoidiana não é frequente, mas deve ser considerada como diagnóstico diferencial de hipotireoidismo e massa cervical anterior.

Tuberculosis of the thyroid gland. A case report.

Tuberculosis of the thyroid gland is a very rare condition. A case of a 47-year-old female with a history of a euthyroid multi-nodular goitre is presented. The patient developed hoarseness due to right recurrent laryngeal nerve paralysis, confirmed with indirect laryngoscopy. On repeated ultrasound, volumetric progression of a dominant nodule in the inferior part of the right thyroid lobe was noticed. Fine needle aspiration was inconclusive. Diagnosis was ultimately based on histopathology of the surgical resection specimen.

Sellar lesion: not always a pituitary adenoma.

Inflammatory lesions of the hypophysis account for 0.5% of all symptomatic diseases of the pituitary, which include lymphocytic hypophysitis, granulomatous hypophysitis with or without specific etiology and pituitary abscess. Sellar tuberculoma is a rare type of granulomatous hypophysitis. We document a case of a postmenopausal lady who presented with galactorrhea, headache and blurring of vision. Based on preliminary investigations, a clinical diagnosis of pituitary adenoma was made and the pituitary gland was surgically excised. Histopathological examination showed caseating granulomas, along with normal areas of preserved pituitary gland and a final diagnosis of tuberculous hypophysitis was made. This case is being documented due to the extremely rare involvement of the pituitary gland by granulomatous lesions such as tuberculosis and to emphasize the role of intraoperative consultation to obviate the need for radical surgery in such lesions.

Unilateral asymptomatic adrenal tuberculoma: the role of percutaneous biopsy.

We report the case of a 55-year-old male with a large left adrenal mass that conformed to the normal shape of the adrenal gland. Percutaneous biopsy revealed tuberculosis and, following anti-tuberculosis therapy, there was a >75% decrease in the size of the mass. In large tumefactions of the adrenal glands in which a normal adrenal contour is maintained, a percutaneous biopsy may obviate the need for major intervention.