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Ectopic thyroid as multiple nodules in bilateral lung lobes: a case report.

ABSTRACT: Ectopic thyroid rarely occurs in the thoracic or abdominal cavity, especially in the lung. Here, we describe an intrapulmonary thyroid tissue case in bilateral lung lobes without thyroid malignant history, which was found during a routine physical examination. A 37-year-old Chinese female showed multiple pulmonary nodules appearing in bilateral lung lobes on a computed tomography (CT) scan during a routine medical examination. To rule out the possibility of lung metastasis from occult cancer, a percutaneous lung biopsy was performed on a larger nodule. Histopathological examination confirmed that the nodule was completely consistent with normal thyroid tissue, which prevented the patient from requiring any unnecessary treatment. During the patient's follow-up, there was no abnormal thyroid function, and there was no change in the size of the nodule in the lung during serial CT scan. Currently, there is no guidance or consensus on the diagnosis of ectopic thyroid with bilateral multiple pulmonary nodules due to its rarity in clinical practice. When such pulmonary nodules are encountered, very careful diagnosis and follow-up should be performed.

SUBMITTER: Cheng L

PROVIDER: S-EPMC7347806 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Ectopic thyroid as multiple nodules in bilateral lung lobes: a case report.

Cheng Ling L Jiang Xudong X Jiang Yueqiang Y

Gland surgery 20200601 3

Ectopic thyroid rarely occurs in the thoracic or abdominal cavity, especially in the lung. Here, we describe an intrapulmonary thyroid tissue case in bilateral lung lobes without thyroid malignant history, which was found during a routine physical examination. A 37-year-old Chinese female showed multiple pulmonary nodules appearing in bilateral lung lobes on a computed tomography (CT) scan during a routine medical examination. To rule out the possibility of lung metastasis from occult cancer, a ...[more]

PMID: 32775272

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Project description:IntroductionEctopic thyroid tissue is a rare entity, and accounts for approximately 1% of all mediastinal tumours. It is a differential diagnosis of the mediastinum tumors or metastatic deposits from an orthotopic gland, as well as other benign or malignant masses. Although most cases are asymptomatic and discovered incidently by imaging, symptoms related to tumor size and its compression of adjacent structures may also appear which necessites explorations and lead to diagnosis.Case presentationThis is a 59-year-old women, followed for glaucoma and operated for bilateral congenital cataract reffered to our structure by the service of pnemology for a right laterotracheal mediastinal mass. The patient presented respiratory symptoms over four months, and the physical examination found patient in good condition with PS 0 and normal vital signs, a poor oral health was noticed. The CT scann showed a left basal opacity and a right laterotracheal mediastinal mass at the upper right mediastinum, pushing forward the superior vena cava and compressing the trachea on the contralateral side, with well-defined borders and without signs of infiltration of adjacent structure. The brochoscopy was perfomed which showed the yellowish granulous aspect and the pathophysiology revealed a pulmonary actinomycosis. The patient was treated with antibiotic based on parenteral infusion of penicillin G at 20 million / day for 6 weeks relayed by oral administration of 3 g / day for 3 months with a good response and the left basal opacity disappeared on the CT control but the mediastinal mass persisted. After multidisciplinary concertation, the mediastinoscopy was perfomed and has revealed an ectopic thyroid which was removed by Uniportal Videoassisted Thoracoscopic Surgery (U-VATS) approach.DiscussionThe first case of ectopic thyroid gland was described by Hickman in 1869, since a few cases have been reported by the literature. Its prevalence is about 1 per 100 000-300 000 people, rising to 1 per 4000-8000 patients with thyroid disease. The main techniques indicated in the management of undetermined lesions of the anterior mediastinum, are midline exploratory sternotomy, anterior lateral thoracotomy and VATS. U-VATS has demonstrated its feasibility and safety compared to conventional techniques by several advantages.ConclusionEctopic mediastinal thyroid is an unusual presentation of thyroid pathology. Complete surgical resection remains a therapeutic and a key diagnosis. The aim of this study is to prouve the feasibility, efficiency and efficacity of U-VATS approach as minimally invasive thoracic surgery for mediastinal mass resection.

Project description:IntroductionRheumatoid nodules occur in 30 percent of patients with active rheumatoid arthritis. Common sites include the buttocks or the extensor surface of the forearm, with one group documenting their presence in the thyrohyoid membrane. To the best of our knowledge, rheumatoid nodules have not been described in the thyroid bed.Case presentationWe present the case of a 46-year-old Caucasian woman with active rheumatoid arthritis and Hashimoto's thyroiditis who presented with compressive neck symptoms. An ultrasound scan revealed that both lobes of her thyroid were enlarged. The right lobe measured 7.9×3.4×3.3cm and the left 8.3×3.3×3.1cm. A solitary 1.0×0.6×0.8cm nodule was seen in the right lower lobe. Her thyroid-stimulating hormone level was 4.22uU/mL (0.34 to 5.60). A total thyroidectomy was performed due to her symptoms and the possible growth of a nodule when on levothyroxine. A postoperative ultrasound scan showed no remaining thyroid tissue. The pathology revealed several small neoplasms ranging from a well-encapsulated adenoma to highly atypical follicular and papillary Hurthle cell lesions in the setting of Hashimoto's thyroiditis. Low-dose radioactive iodine (33.4mCi) was given. Four months later, our patient complained of a feeling of fullness in her neck. A solid nodule of mixed echogenicity (5.6×3.3×2.3cm) was seen in the right level VI of the neck, and solid tissue of mixed echogenicity (2.9×2.3×1.7cm) on the left. Following repeat surgery, the pathology from the right specimen showed Hashimoto's thyroiditis. The left specimen had areas of granuloma formation with fibrinoid necrosis and palisading histiocytes, consistent with the histology of rheumatoid nodules. No evidence of malignancy was seen. The patient continues to do well and remains disease-free.ConclusionsRheumatoid nodules have not been reported in the thyroid bed. Their pathogenesis is not clear. Postoperative release of tumor necrosis factor alpha and local vascular damage may have triggered the nodule formation in this case. Rheumatoid nodules must be kept in the differential diagnosis of an enlarging thyroid in the setting of active rheumatoid arthritis. A fine-needle aspiration biopsy may show granuloma formation and be the most cost-effective initial diagnostic step, especially if there is a concern for malignancy. Early identification of these nodules will help decrease morbidity from unnecessary interventions and result in treatment that is both timely and appropriate.

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Ectopic thyroid as multiple nodules in bilateral lung lobes: a case report.

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Ectopic thyroid as multiple nodules in bilateral lung lobes: a case report.

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