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Corrado S, Morgante C, Tassi S, Maccarrone F, Di Massa G, Pontecorvi A, Papi G. Neck Ganglioneuroma Mimicking a Thyroid Nodule in a Four-Year-Old Child: A Case Report and Review of the Literature. Int J Endocrinol Metab 2023; 21:e126486. [PMID: 37662645 PMCID: PMC10474842 DOI: 10.5812/ijem-126486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 02/01/2023] [Accepted: 03/07/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Ganglioneuromas are tumors of neurogenic origin usually located in the abdomen, the adrenal glands, and the mediastinum but infrequently found in the neck region. Case Presentation We describe the case of a four-year-old Albanian girl presenting with an anterior neck mass initially suspected to be a thyroid nodule. From a clinical point of view, there was no evidence of compression on vital cervical structures. Lab tests detected normal serum thyrotropin, calcitonin, and parathormone concentrations. A neck ultrasound showed a huge mass apparently originating from the left thyroid lobe. Cytological examination of fine needle biopsy demonstrated a population of large cells with eosinophilic cytoplasm, regular nuclei, and prominent nucleoli and spindle cells without significant atypia, consistent with a benign lesion of neurogenic origin. Also, the neck MRI displayed a mass with well-defined margins, likely arising from the peripheral nervous system. The patient underwent surgical excision of the mass without complications. The histological exam was diagnostic for ganglioneuroma. Conclusions We discuss the cytological and histological features peculiar to such a rare neck lesion and review the differential diagnosis.
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Affiliation(s)
- Stefania Corrado
- Department of Pathology, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Cesare Morgante
- Division of Endocrinology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCSS, 00168 Rome, Italy
| | - Sauro Tassi
- Otolaryngology Unit, Azienda USL Modena, 41100 Modena, Italy
| | | | - Gianluca Di Massa
- Department of Pathology, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Alfredo Pontecorvi
- Division of Endocrinology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCSS, 00168 Rome, Italy
| | - Giampaolo Papi
- Division of Endocrinology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCSS, 00168 Rome, Italy
- Endocrinology Unit, Azienda USL Modena, 41100 Modena, Italy
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García Pascual L, González Mínguez C, Elías Mas A. Thyroid-associated paraganglioma. ENDOCRINOL DIAB NUTR 2021; 68:288-289. [PMID: 34266641 DOI: 10.1016/j.endien.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/27/2019] [Indexed: 06/13/2023]
Affiliation(s)
- Luis García Pascual
- Servicio de Endocrinología, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain.
| | - Clarisa González Mínguez
- Servicio de Anatomía Patológica, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Andrea Elías Mas
- Servicio de Radiodiagnóstico, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
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García Pascual L, González Mínguez C, Elías Mas A. Paraganglioma asociado al tiroides. ENDOCRINOL DIAB NUTR 2021; 68:288-290. [DOI: 10.1016/j.endinu.2019.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/19/2019] [Accepted: 12/27/2019] [Indexed: 10/24/2022]
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Thyroid Paraganglioma: Our Experience and Systematic Review of the Literature on a Rare Tumor. Am J Clin Oncol 2019; 41:416-423. [PMID: 27163832 DOI: 10.1097/coc.0000000000000295] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Primary paraganglioma (PG) of the thyroid gland is an extremely rare neuroendocrine tumor with potential for misdiagnosis. We describe 2 cases of thyroid PG, suggest a possible diagnostic and therapeutic management strategy, and present a systematic review of the literature. CASE REPORTS Two 67-year-old women presented similarly with asymptomatic but rapidly growing thyroid nodules in which malignancy was suspected after fine needle aspiration biopsy, "THY 4" according to the 2014 SIAPEC classification, both undergoing total thyroidectomy. Unexpectedly, immunohistochemistry showed neuroendocrine cellular architecture that was negative for common markers of well-differentiated follicular neoplasms, thyroglobulin, thyroid transcription factor 1, cytokeratins and medullary thyroid cancer, calcitonin, carcinoembryonic antigen, whereas neuron-specific enolase, synaptophysin, chromogranin A, and S-100 protein were highly expressed, confirming the diagnosis of primary thyroid PG. The patients were both discharged on postoperative day 2, without any other therapy and are currently well without evidence of local recurrence of metastatic disease, after 4 years and 3 months of follow-up, respectively. DISCUSSION These are the only 2 cases of thyroid PG experienced in our center which specializes in thyroid surgery. Thyroid PG is a rare neuroendocrine neoplasm first described by Van Miert in 1964 with just over 50 cases reported in the literature. Our experience is concordant with the literature that the diagnosis of the primary PG of the thyroid is challenging, due to its low prevalence and the cytologic and histopathologic similarities with other more frequently diagnosed benign and malignant thyroid tumors. Immunohistochemistry is required for definitive diagnosis but gross tumor characteristics are also helpful for diagnosis. Surgical resection is the recommended standard treatment.
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Dong YJ, Zhang ZW, Wang Z, Wang XY, Tian ZZ, Zhang XS. Primary Melanotic Paraganglioma of Thyroid Gland: Report of a Rare Case With Clinicopathologic and Immunohistochemical Analysis and a Literature Review. Clin Med Insights Pathol 2017; 10:1179555716684670. [PMID: 28469514 PMCID: PMC5398289 DOI: 10.1177/1179555716684670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/23/2016] [Indexed: 11/24/2022] Open
Abstract
Background: Pigmented paraganglioma is a special type of paraganglioma, and it is rare in the thyroid. Case Presentation: We report a case of a 41-year-old woman who had complained of a mass in the thyroid gland. Histology revealed tumor cells arranged in a nest-like or organoid pattern, separated by delicate fibrovascular septa. Two distinct components were observed. In the first, which constituted the majority of the tumor cells, no pigments were observed. In the second, a few cells with pigment showed intercellular substance, but the structure was unclear. Using immunohistochemistry, cells in the first component were confirmed to be diffuse strong positive for synaptophysin, but negative for chromogranin A, pan-cytokeratin, calcitonin, and thyroglobulin. About 1% of tumor cells were stained by Ki-67. In the margins of the tumor, a few cells were observed to be positive for HMB-45 and Melan A after bleaching by oxalic acid. The stromal cells were positive for S-100. Using electron microscopy, a few cells containing many round melanin bodies with greater electron density granules of nonuniform size were observed. The diagnosis of primary melanotic paraganglioma of the thyroid gland was made. Conclusion: Primary melanotic paraganglioma of the thyroid gland is a rare, low malignant potential tumor. To the best of our knowledge, this is the first case described.
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Affiliation(s)
- Yan-Jun Dong
- Department of Imageology, Binzhou Medical University Hospital, Binzhou, China
| | - Zhi-Wen Zhang
- Department of Pathology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhen Wang
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Xin-Ying Wang
- Department of Pathology, People's Hospital of Guangrao County, Shandong, China
| | - Zhi-Zhen Tian
- Department of Pathology, People's Hospital of Guangrao County, Shandong, China
| | - Xiang-Sheng Zhang
- Department of Imageology, Binzhou Medical University Hospital, Binzhou, China
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Navaratne L, Mathew RG, Kousparos G, McCombe A. The Management of Locally Invasive Primary Thyroid Paraganglioma: A Case Report and Review of the Literature. Head Neck Pathol 2016; 11:139-145. [PMID: 27438004 PMCID: PMC5429269 DOI: 10.1007/s12105-016-0745-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/14/2016] [Indexed: 11/26/2022]
Abstract
Paragangliomas (PG) are very rare neuroendocrine tumours, arising from neural crest derived paraganglia of the autonomic nervous system. Primary thyroid paraganglioma (PTPG) is a rare site of PG and only 45 cases have been previously reported. The preoperative diagnosis of PTPGs presents a challenge as the clinical, cytological and histological features overlap with more common primary thyroid cancers. A 55 year old male was found to have significant enlargement of the left lobe of his thyroid. Following lobectomy, the thyroid lobe showed unencapsulated tumour which was positive for synaptophysin, CD56 and S100 (sustentacular cells). Post-operative imaging demonstrated incomplete resection. There was no post-operative radiotherapy and monitoring was by 6-12 monthly MRI. 48 months after his surgery he is alive and well with no evidence of disease progression. The diagnosis of PTPG was only made postoperatively, and although rare should be considered in the differential diagnosis of a hypervascular thyroid nodule.
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Çetin Ş, Kir G, Yilmaz M. Thyroid Paraganglioma Diagnosed by Fine-Needle Aspiration Biopsy, Correlated With Histopathological Findings: Report of a Case. Diagn Cytopathol 2016; 44:643-7. [DOI: 10.1002/dc.23496] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 03/13/2016] [Accepted: 04/25/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Şenay Çetin
- Pathology Department; Umraniye Education and Research Hospital; Istanbul Turkey
| | - Gözde Kir
- Pathology Department; Umraniye Education and Research Hospital; Istanbul Turkey
| | - Müberra Yilmaz
- Pathology Department; Umraniye Education and Research Hospital; Istanbul Turkey
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Feghaly J, Astras G, Loizou M, Panayiotou G, Mooradian A. Primary Paraganglioma of the Thyroid Gland: Clinical and Immunohistological Analysis with a Literature Review. EUROPEAN MEDICAL JOURNAL 2016. [DOI: 10.33590/emj/10314311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Primary paraganglioma of the thyroid is a rare neuroendocrine tumour, often mistaken for other thyroid neoplasms. Here, we describe a case of initially misdiagnosed primary paraganglioma of the thyroid and study its clinical presentation, management, investigation, and immunohistological findings.
A 72-year-old male presented with a left-sided solitary thyroid lobe and isthmus nodule. Ultrasound, fine needle aspiration, and computed tomography did not provide a clear diagnosis and subsequently, a left lobectomy and isthmusectomy were performed. The initial histopathological findings of the tumour revealed positivity to chromogranin and calcitonin, suggesting a medullary carcinoma replacing the left lobe of the thyroid. In a second histopathological review at an external laboratory, the tumour cells showed positive focal staining for chromogranin, but were negative for both calcitonin and monoclonal carcinoembryonic antigen, suggesting thyroid paraganglioma. This case highlights the importance of accurate histopathological diagnosis and the need to be aware of the possibility of thyroid paraganglioma initially presenting as a thyroid nodule.
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Affiliation(s)
- Julien Feghaly
- St. George’s University of London (Cyprus), Nicosia, Cyprus
| | - George Astras
- Oncology Department, American Medical Center, Nicosia, Cyprus
| | - Marios Loizou
- General Surgery Department, Nicosia General Hospital, Nicosia, Cyprus
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Taweevisit M, Bunyayothin W, Thorner PS. Thyroid Paraganglioma: "Naked" Nuclei as a Clue to Diagnosis on Imprint Cytology. Endocr Pathol 2015; 26:232-8. [PMID: 26116097 DOI: 10.1007/s12022-015-9380-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A cytologic diagnosis of paraganglioma of the thyroid is difficult to make because the thyroid gland is an unusual location for such a tumor and the cytologic findings overlap with other benign and malignant thyroid tumors. We report the case of a 28-year-old female presenting with a solitary mass of the right thyroid gland. A diagnosis of paraganglioma was made on the resected specimen. At the time of tumor resection, imprint cytology was performed. The imprint was hypercellular with cohesive sheets of round cells showing anisokaryosis and anisocytosis. Moreover, there was a second cell type consisting of oval nuclei with dispersed nuclear chromatin present within the sheets and separate as "naked" nuclei. By immunohistochemistry, the cohesive round cells were positive for chromogranin A, indicating chief cells. The naked nuclei were positive for S-100 protein, indicating sustentacular cells. To the best our knowledge, this is the first case report describing naked nuclei as a cytologic feature of paraganglioma. Identification of sustentacular cells provides a clue for the cytologic diagnosis of paraganglioma.
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Affiliation(s)
- Mana Taweevisit
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, 1873 King Rama IV Street, Pathumwan, Bangkok, 10330, Thailand,
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Yu X, Wang Y, Wang P, Ji CH, Miao CDI, Zheng S. Primary thyroid paraganglioma mimicking medullary thyroid carcinoma: A case report. Oncol Lett 2015; 10:1000-1002. [PMID: 26622613 DOI: 10.3892/ol.2015.3292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 04/30/2015] [Indexed: 12/20/2022] Open
Abstract
Primary thyroid paraganglioma (TP) is an uncommon tumor, and in rare cases, this disease tends to mimic medullary thyroid carcinoma (MTC). The present study reports a rare case of primary TP mimicking thyroid carcinoma, accompanied by hyperthyroidism. A 30-year-old female presented with an anterior cervical mass. Pre-operative radiological studies and operative frozen section analysis indicated an atypical MTC. Primary TP was finally diagnosed by pathology and immunohistochemical staining. Laboratory examinations (thyroid hormones tests) and Tc99m emission computed tomography revealed hyperthyroidism. Gene analysis of TP-associated gene mutations was negative. Surgical resection was performed as a curative approach and there is currently no metastasis after 36 months of follow-up. Surgeons must be aware of this disease in order to ensure a correct diagnosis and to prevent them from performing unnecessary procedures. The current study presents a case of primary TP mimicking MTC, discusses the radiographic results and histological characteristics, and provides a review of the associated literature.
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Affiliation(s)
- Xing Yu
- Department of Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
| | - Yong Wang
- Department of Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
| | - Ping Wang
- Department of Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
| | - Cai-Hong Ji
- College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310058, P.R. China
| | - Chun-DI Miao
- College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310058, P.R. China
| | - Shu Zheng
- Department of Oncology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
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Yu BH, Sheng WQ, Wang J. Primary paraganglioma of thyroid gland: a clinicopathologic and immunohistochemical analysis of three cases with a review of the literature. Head Neck Pathol 2013; 7:373-80. [PMID: 23943066 PMCID: PMC3824793 DOI: 10.1007/s12105-013-0467-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 06/11/2013] [Indexed: 10/26/2022]
Abstract
Thyroid paraganglioma is an extremely rare tumor and frequently mistaken for other thyroid neoplasms. Increased awareness of its potential presentation in thyroid and its characteristic features is essential for avoiding diagnostic and therapeutic pitfalls. We describe here three additional cases of primary thyroid paraganglioma and analyze their clinical findings and pathological characteristics. Patients included two women and one man presenting with asymptomatic thyroid nodules. Radiological examinations were nonspecific and none had been diagnosed correctly before surgery. On intraoperative frozen section consultation they were all misdiagnosed as carcinomas, either primary or metastatic. However, the permanent sections showed features consistent with paraganglioma. Of note, two cases displayed extension into adjacent thyroid tissues, one of which exhibited increased mitotic activity, confluent tumor necrosis and vascular invasion. Immunohistochemically, the neoplastic chief cells expressed chromogranin, synaptophysin, neuron-specific enolase and CD56, whereas the sustentacular cells were highlighted by S100 protein. All three patients were well with normal hormone secretion, without local recurrence or distant metastasis at last follow-up (range 10-47 months). We further reviewed the literature to summarize the characteristics of this distinctive entity. Albeit being very rare, paraganglioma should be included in the differential diagnosis of hypervascular thyroidal neoplasms. Accurate diagnosis relies on the histopathogical findings and adjunctive immunohistochemcial studies. To date, all the reported cases have pursued a benign course. Although atypical features seem to have no association with clinical behavior, long time postoperative surveillance with biochemical screening of hormone secretion, cervical ultrasonography and whole-body CT scan is recommended.
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Affiliation(s)
- Bao-Hua Yu
- />Department of Pathology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032 China
- />Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
| | - Wei-Qi Sheng
- />Department of Pathology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032 China
- />Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
| | - Jian Wang
- />Department of Pathology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032 China
- />Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
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Abstract
BACKGROUND Thyroid paraganglioma (TP) is a very rare neoplasm that can be misdiagnosed. We evaluated the clinical and pathologic characteristics of three patients with TP. PATIENT FINDINGS The records of all patients from 1981 to 2008 who had thyroidectomy with a final histologic diagnosis of TP were retrieved, and histology was reviewed by a single pathologist. Head and neck paragangliomas arising outside of the thyroid were excluded. TP accounted for 3 of all 6782 (0.04%) patients undergoing thyroidectomy during three decades. One patient has been previously reported and will not be discussed. In the remaining two patients and a surgical pathology consult case that we also describe herein, the mean age at diagnosis was 56 years (40-67) and two patients were men. Presenting features were indicative of advanced local invasion, including stridor, tracheal invasion, compression of the great vessels, and hemoptysis. The diagnosis of TP was not suspected preoperatively; in two patients, fine-needle aspiration (FNA) cytology was inadequate for diagnosis because of excessive blood. Intraoperative frozen section analysis suggested medullary thyroid cancer in two patients and oncocytic (Hurthle) cell carcinoma in one patient. Local invasion was common, requiring concurrent tracheal resection in two of three patients, and present histologically in all three patients. In all three cases, immunohistochemical analysis was negative for cytokeratin AE1/3, calcitonin, and thyroglobulin but positive for S100, highlighting sustentacular cells. After resection of a large TP with tracheal and vascular invasion, a 67-year-old woman experienced a 7-year disease-free interval. CONCLUSIONS Primary TP is indeed rare. It does occur in men, frequently presents with compressive symptoms, and is typically locally aggressive, but does not appear to cause symptoms suggestive of catecholamine excess. Despite invasion of adjacent structures, aggressive resection can achieve a long disease-free interval.
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Affiliation(s)
- Michaele J Armstrong
- Division of Endocrine Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA
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Thyroid paraganglioma. Report of 3 cases and description of an immunohistochemical profile useful in the differential diagnosis with medullary thyroid carcinoma, based on complementary DNA array results. Hum Pathol 2011; 43:1103-12. [PMID: 22209341 DOI: 10.1016/j.humpath.2011.08.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 08/12/2011] [Accepted: 08/18/2011] [Indexed: 11/24/2022]
Abstract
Thyroid paraganglioma is a rare disorder that sometimes poses problems in differential diagnosis with medullary thyroid carcinoma. So far, differential diagnosis is solved with the help of some markers that are frequently expressed in medullary thyroid carcinoma (thyroid transcription factor 1, calcitonin, and carcinoembryonic antigen). However, some of these markers are not absolutely specific of medullary thyroid carcinoma and may be expressed in other tumors. Here we report 3 new cases of thyroid paraganglioma and describe our strategy to design a diagnostic immunohistochemical battery. First, we performed a comparative analysis of the expression profile of head and neck paragangliomas and medullary thyroid carcinoma, obtained after complementary DNA array analysis of 2 series of fresh-frozen samples of paragangliomas and medullary thyroid carcinoma, respectively. Seven biomarkers showing differential expression were selected (nicotinamide adenine dinucleotide dehydrogenase 1 alpha subcomplex, 4-like 2, NDUFA4L2; cytochrome c oxidase subunit IV isoform 2; vesicular monoamine transporter 2; calcitonin gene-related protein/calcitonin; carcinoembryonic antigen; and thyroid transcription factor 1) for immunohistochemical analysis. Two tissue microarrays were constructed from 2 different series of paraffin-embedded samples of paragangliomas and medullary thyroid carcinoma. We provide a classifying rule for differential diagnosis that combines negativity or low staining for calcitonin gene-related protein (histologic score, <10) or calcitonin (histologic score, <50) together with positivity of any of NADH dehydrogenase 1 alpha subcomplex, 4-like 2; cytochrome c oxidase subunit IV isoform 2; or vesicular monoamine transporter 2 to predict paragangliomas, showing a prediction error of 0%. Finally, the immunohistochemical battery was checked in paraffin-embedded blocks from 4 examples of thyroid paraganglioma (1 previously reported case and 3 new cases), showing also a prediction error of 0%. Our results suggest that the comparative expression profile, obtained by complementary DNA arrays, seems to be a good tool to design immunohistochemical batteries used in differential diagnosis.
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Abstract
BACKGROUND Paragangliomas in the region of the thyroid gland are rare tumors that can present a diagnostic challenge by mimicking follicular and c-cell derived thyroid tumors. SUMMARY Thyroid-associated paragangliomas are likely a subset of laryngeal paragangliomas and, although quite rare, should be considered in the differential diagnosis of a hypervascular thyroid nodule. The preoperative diagnosis of thyroid-associated paragangliomas can be challenging since the cytologic and histologic features overlap with more common primary thyroid neoplasms, in particular medullary carcinoma. Differential expression of a panel of immunohistochemical markers, including neuro-specific enolase, chromogranin A, synaptophysin, keratin, and S100, can be used to distinguish thyroid-associated paragangliomas from primary thyroid tumors. Intraoperatively, thyroid-associated paragangliomas may be associated with significant intraoperative bleeding and are often densely adherent to surrounding tissues, including the recurrent laryngeal nerve. Interestingly, the aggressive local behavior of these tumors does not correspond to potential for malignancy, as there are no patients with malignant thyroid-associated paragangliomas reported in the medical literature. Therefore, these tumors may be treated with limited resection. Postoperatively, patients with paragangliomas should receive hormonal evaluation for functional disease, imaging evaluation for multicentric and metastatic disease, and genetic counseling. CONCLUSION Thyroid-associated paragangliomas are an important part of the differential diagnosis of a hypervascular thyroid nodule, especially in a patient with a fine-needle aspiration biopsy suggestive of medullary thyroid carcinoma, but with unremarkable serum calcitonin levels. Consideration of a thyroid-associated paraganglioma also has important operative and postoperative implications for determining the extent of thyroid resection as well as follow-up testing.
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Affiliation(s)
- Roy Phitayakorn
- Department of Surgery, The Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Abstract
INTRODUCTION Paragangliomas are rare tumours arising from the paraganglia of the autonomic nervous system. CASE REPORT We present a case of a paraganglioma arising from the hypoglossal nerve and producing an unusual clinical picture at presentation. DISCUSSION We supply radiological evidence of a paraganglioma originating from the hypoglossal nerve, and thus extend the evidence base for this rare site of origin. Our patient presented as an emergency with long tract neurological symptoms and progressive brainstem involvement. This presentation is not characteristic of paragangliomas in general, which usually have an indolent growth pattern and often demonstrate benign symptoms for a number of years prior to diagnosis. The location of a hypoglossal paraganglioma differs significantly from more common paragangliomas described in the neck and skull base, and this should inform the surgical approach undertaken.
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Erem C, Kocak M, Nuhoglu İ, Cobanoglu U, Ucuncu O, Okatan BK. Primary thyroid paraganglioma presenting with double thyroid nodule: a case report. Endocrine 2009; 36:368-71. [PMID: 19816814 DOI: 10.1007/s12020-009-9238-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Accepted: 07/28/2009] [Indexed: 11/27/2022]
Abstract
Paragangliomas (PGs) are exceptionally rare tumors. Only 24 cases have previously been reported. Both preoperative and postoperative differential diagnosis is very difficult. Due to interesting nature in diagnosis and differential diagnosis, we describe the case 58-year-old euthyroid woman with a thyroid PG. The patient had presented with euthyroid multinodular goiter to a secondary hospital. The patient was treated with right lobectomy, isthmectomy, and left partial lobectomy without any imaging procedures. No complication had been developed during and following the operation. Initial pathological examination suggested medullar thyroid carcinoma (MTC) in a nodule of 4.5 cm in diameter on right thyroid lobe and a nodule of 2.5 cm in diameter on the left thyroid lobe without amyloid stroma and referred to our third-stage hospital. Repeated pathological examination involving immunohistochemistry revealed that the tumor was stained positively to neuron-specific enolase, chromogranin A, synaptophysin, and S-100 protein. No immunoreactivity was detected against thyroglobulin, calcitonin, parathormone, carcino-embryonic antigen, thyroid transcription factor-1, and cytokeratin. A diagnosis of thyroid PG was finally made. Laboratory analyses and imaging procedures excluded any neck or extracervical tissues metastasis or multiple endocrine neoplasia. In conclusion, thyroid PG is an elusive tumor. We present this interesting nature thyroid PG case to highlight importance of careful evaluation of clinical and pathological findings to correctly identify paragangliomas which anatomically mimic MTCs. This report is the first case of thyroid PG presenting with multinodular goiter in the literature.
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Affiliation(s)
- Cihangir Erem
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Faculty of Medicine, Karadeniz Technical University, İç Hastalıkları Anabilim Dalı, 61080 Trabzon, Turkey.
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Abstract
Paragangliomas are neuroendocrine tumors. The thyroid gland is one of the anatomic sites in which paraganglia are not normally located and are exceptionally rare. We report a case of a 36-year-old Hispanic woman with a soft mass measuring about 30 mm in the right thyroid lobe. Patient was operated on and the neoplasm showed microscopically a typical nesting organoid pattern (zellballen). The inmunohistochemical analysis revealed that the tumor showed strongly and diffuse stain for NSE, Synaptophysin, Chromogranin A, and S-100 protein in the sustentacular cells, whereas no inmunoreactivity was detected with antibodies against thyroglobulin, calcitonin, TTF-1, CEA, and AE1-AE3. The MIB-1 labeling showed 7% of neoplastic cells. Head and neck paragangliomas usually develop slowly, and this tumor exhibited a low proliferative activity. In view of the uncertain malignant potential of paragangliomas, we recommended a careful long-term follow-up.
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Pinto FR, de Aquino Capelli F, Maeda SA, Pereira EM, Scarpa MB, Brandão LG. Unusual location of a cervical paraganglioma between the thyroid gland and the common carotid artery: case report. Clinics (Sao Paulo) 2008; 63:845-8. [PMID: 19061012 PMCID: PMC2664290 DOI: 10.1590/s1807-59322008000600024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - Sueli Aparecida Maeda
- Department of Pathology, Salomão & Zoppi Medicina Diagnóstica - São Paulo/SP, Brazil
| | | | | | - Lenine Garcia Brandão
- Head and Neck Surgery, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo/SP, Brazil.
, Tel.: 55 11 5058.5738
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Yano Y, Nagahama M, Sugino K, Ito K, Kameyama K, Ito K. Paraganglioma of the thyroid: report of a male case with ultrasonographic imagings, cytologic, histologic, and immunohistochemical features. Thyroid 2007; 17:575-8. [PMID: 17614779 DOI: 10.1089/thy.2006.0284] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Thyroid paragangliomas are rare tumors, and both preoperative and postoperative differential diagnosis is difficult. We report the case of a 24-year-old man with a thyroid paraganglioma and the ultrasonographic imaging, histologic, and immunohistochemical findings. DESIGN The patient presented with an asymptomatic thyroid nodule. An ultrasonogram showed a 3-cm-diameter solid nodule in the upper portion of the right lobe of thyroid, and color Doppler ultrasonography revealed intranodular hypervascular flows. Fine-needle aspiration biopsy yielded single cells and loose clusters of round to oval cells containing ovoid nuclei. A clinical diagnosis of follicular thyroid tumor was made, and right thyroid lobectomy was performed. The tumor was encapsulated and exhibited a prominent lobular pattern. To differentiate between thyroid paraganglioma and other thyroid neoplasms, paraffin sections of the specimen were immunochemically stained with antibodies to calcitonin (CT), carcinoembryonic antigen (CEA), chromogranin A, neuron-specific enolase (NSE), S-100, and thyroglobulin. MAIN OUTCOME The immunohistochemical staining was positive for chromogranin A and NSE and negative for thyroglobulin, CT, CEA, and S-100. Congo red staining was also negative. Based on these findings, final diagnosis of thyroid paraganglioma was made. CONCLUSIONS The definitive diagnosis of paraganglioma is made on the basis of the results of immunohistochemical staining. The diagnosis of thyroid paraganglioma is difficult to make both preoperatively and postoperatively.
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Abstract
Solitary fibrous tumor (SFT) is a rare spindle-cell neoplasm more commonly involving the pleura, but recognized also in other tissues. Nineteen patients with SFT arising from the thyroid gland have been reported in the literature. The present report reviews these cases and discusses epidemiology, etio-pathogenesis, clinical-pathologic characteristics, differential diagnosis, therapy, and prognosis of thyroid SFT.
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Affiliation(s)
- Giampaolo Papi
- Department of Internal Medicine, Endocrinology Unit, University of Modena and Reggio Emilia, Modena, Italy
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Schmit GD, Gorman B, van Heerden JA, Gharib H. Inferior laryngeal paraganglioma mimicking a primary thyroid tumor. Endocr Pract 2006; 12:432-5. [PMID: 16901801 DOI: 10.4158/ep.12.4.432] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To report an unusual case of inferior laryngeal paraganglioma that manifested as a thyroid neoplasm. METHODS A case report is presented, including ultra-sonographic, surgical, histologic, and immunohistochemical findings, and diagnostic and therapeutic strategies are discussed. RESULTS In a 33-year-old man with a mass in the left side of his neck, color Doppler ultrasonography revealed an extremely hypervascular lesion that appeared to arise in the left lobe of the thyroid gland. Fine-needle aspiration was noncontributory because of bloody samples, but core biopsy specimens suggested a nonthyroidal neoplasm. At surgical intervention, a 3.5-cm mass was found immediately posterior to the left thyroid lobe, not involving the thyroid capsule. Because the mass could not be dissected free from the thyroid, performance of a left thyroid lobectomy and isthmectomy was necessary. The pathology specimen was a paraganglioma. CONCLUSION Paragangliomas may be sonographically similar to thyroid neoplasms and may be included in the differential diagnosis of a hypervascular thyroid mass.
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Affiliation(s)
- Grant D Schmit
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
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Foppiani L, Marugo A, Del Monte P, Sartini G, Bandelloni R, Marugo M, Bernasconi D. Thyroid paraganglioma manifesting as hot toxic nodule. J Endocrinol Invest 2005; 28:479-80. [PMID: 16075934 DOI: 10.1007/bf03347231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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