[Ectopic thyroid tissue in the adrenal gland : A case report and review of the literature]

Ectopic thyroid tissue in adrenal gland - A case report and review of literature

Ectopic thyroid tissue along the line of descent of thyroid from foramen caecum along thyroglossal duct to the normal anatomic location in neck has been reported. Ectopic thyroid tissue in adrenal gland (ETTAG) is rarely encountered and very few cases have been reported in literature. The most common differential diagnosis to be considered when thyroid follicles are noted in adrenal gland are metastasis from a thyroid malignancy or a teratoma or an ectopic thyroid tissue in adrenal gland. We present a case of an adrenal incidentaloma in a young pregnant female which was diagnosed to be ectopic thyroid tissue in adrenal gland. The review of literature of similar cases of this rare embryological aberrance is discussed. To our knowledge, only 16 such cases have been documented in literature and our case is the first one from Indian subcontinent and the largest documented with respect to size.

Personalized Management of Malignant and Non-Malignant Ectopic Mediastinal Thyroid: A Proposed 10-Item Algorithm Approach

We aimed to analyze the management of the ectopic mediastinal thyroid (EMT) with respect to EMT-related cancer and non-malignant findings related to the pathological report, clinical presentation, imaging traits, endocrine profile, connective tissue to the cervical (eutopic) thyroid gland, biopsy or fine needle aspiration (FNA) results, surgical techniques and post-operatory outcome. This was a comprehensive review based on revising any type of freely PubMed-accessible English, full-length original papers including the keywords "ectopic thyroid" and "mediastinum" from inception until March 2024. We included 89 original articles that specified EMTs data. We classified them into four main groups: (I) studies/case series (n = 10; N = 36 EMT patients); (II) malignant EMTs (N = 22 subjects; except for one newborn with immature teratoma in the EMT, only adults were reported; mean age of 62.94 years; ranges: 34 to 90 years; female to male ratio of 0.9). Histological analysis in adults showed the following: papillary (N = 11/21); follicular variant of the papillary type (N = 2/21); Hürthle cell thyroid follicular malignancy (N = 1/21); poorly differentiated (N = 1/21); anaplastic (N = 2/21); medullary (N = 1/21); lymphoma (N = 2/21); and MALT (mucosa-associated lymphoid tissue) (N = 1/21); (III) benign EMTs with no thyroid anomalies (N = 37 subjects; mean age of 56.32 years; ranges: 30 to 80 years; female to male ratio of 1.8); (IV) benign EMTs with thyroid anomalies (N = 23; female to male ratio of 5.6; average age of 52.1 years). This panel involved clinical/subclinical hypothyroidism (iatrogenic, congenital, thyroiditis-induced, and transitory type upon EMT removal); thyrotoxicosis (including autonomous activity in EMTs that suppressed eutopic gland); autoimmune thyroiditis/Graves's disease; nodules/multinodular goiter and cancer in eutopic thyroid or prior thyroidectomy (before EMT detection). We propose a 10-item algorithm that might help navigate through the EMT domain. To conclude, across this focused-sample analysis (to our knowledge, the largest of its kind) of EMTs, the EMT clinical index of suspicion remains low; a higher rate of cancer is reported than prior data (18.8%), incident imagery-based detection was found in 10-14% of the EMTs; surgery offered an overall good outcome. A wide range of imagery, biopsy/FNA and surgical procedures is part of an otherwise complex personalized management.

Two Cases of Adrenal Cysts Lined by Thyroid Follicular Epithelium: Addressing Cellular Origin and Malignancy Concerns

Adrenal cysts lined by thyroid follicular epithelium are rare, with only 14 reported cases of "ectopic thyroid tissue" to date. While the primary consideration for differential diagnosis is thyroid carcinoma metastasis, exclusion of metastases is determined based on the absence of a primary thyroid lesion, serological euthyroidism, lack of thyroglobulin elevation, and absence of epithelial atypia. Herein, we report 2 cases of adrenal cysts lined by thyroid follicular epithelium. Case 1 was a 60-year-old woman with a right adrenal cyst. Case 2 was a 51-year-old man with a left adrenal cyst. Over time, both cysts became larger, necessitating an adrenalectomy. Cystic epithelia were lined with thyroid follicular epithelium, exhibiting moderate atypia. Human bone marrow endothelial cell marker-1 and galectin-3 were focally positive; CK19 was positive in Case 1, and all 3 markers were positive in Case 2, previously reported as an immunophenotype of thyroid carcinoma. CD56 expression was positive in both cases. Targeted next-generation sequencing revealed several low-frequency mutations; however, no major driver alterations for thyroid cancer were detected. Adrenal cysts can be lined by thyroid follicular epithelium. Challenges arise in determining the malignant or benign nature of adrenal cysts.

Rare Coexistence of Aldosterone-producing Adrenocortical Adenoma Confirmed by an Immunohistochemical Analysis of Steroidogenic Enzymes with Adrenal Ectopic Thyroid Tissue: A Case Report and Literature Review

A 56-year-old man presented with a history of hypertension; clinically, the patient had primary aldosteronism (PA) and a 4-cm left adrenal tumor. The left adrenal glands, resected by adrenalectomy, also contained ectopic thyroid tissue (ETT). An immunohistochemical analysis of steroid-converting enzymes revealed an aldosterone-producing adenoma (APA). Among 19 previously reported cases of adrenal ETT, 4 had adrenal hormonal abnormalities, all of which were PA. This is the first case of adrenal ETT coexisting with APA, confirmed by steroid-converting enzyme expression. Further analyses using cumulative case data are required to clarify the correlation between adrenal ETT and APA.

Hepatic incidentaloma: An asymptomatic ectopic thyroid tissue

An ectopic thyroid is a form of thyroid dysgenesis in which the entire thyroid gland or parts of it may be located in another part of the body than the usual place. The most frequent location is the base of the tongue. Although most cases are asymptomatic, symptoms related to tumor size and its relationship with surrounding tissues, hormonal dysfunction, and seldom malignancy may also occur. Here, we describe the case of an asymptomatic woman who was thyroidectomized 19 years previously for a toxic goiter and treated with conventional L-thyroxine therapy, until we enacted a progressive reduction of dosage of the replacement therapy. Incidentally, because of occasional abdomen discomfort, she was hospitalized in our Division of Endocrinology as there was ultrasound evidence of a large mass in the liver dislocating and imprinting the choledochal duct in the pre-pancreatic site, the gallbladder, and the cystic duct, which could not be dissociated from the contiguous hepatic parenchyma and was in very close proximity to the second duodenal portion and the head of the pancreas. Imaging techniques, such as TC, MR, TC/PET, and ¹³¹I scintigraphy, confirmed the large lesion with a diameter on the axial plane of about 8 × 5.5 cm and a cranio-caudal extension of about 6 cm. The impossibility of surgical debulking and/or radiometabolic ¹³¹I therapy, in the absence of compression symptoms, led to the multidisciplinary decision of a clinical and instrumental follow-up of this rare lesion.

Ectopic thyroid nodes in the mediastinum - report of two cases

Introduction. Ectopic thyroid is rare anomaly characterized by presence of thyroid tissue outside its normal location, which could be the consequence of developmental abnormality, sequestration of thyroid nodes from nodal thyroid goiter or mechanical implantation of thyroid tissue after resection or trauma. Ectopic thyroid commonly is incidentally detected and causes differential diagnostic dilemma towards the neck and mediastinal tumors. The object of this report was to present two types of ectopic thyroid nodes located in the upper mediastinum those were incidentally discovered by computed tomography (CT). Outline of cases. In a 42-year-old woman with the adenocarcinoma of esophagogastric junction in whom CT was performed due to staging purposes, a hyper dense nodular lesion was found in the anterior upper mediastinum. Metastatic left supraclavicular lymph node was considered in the differential diagnosis. However, as node was located in front of the neck fascia and just below the thyroid gland and showed similar density to thyroid tissue, the diagnosis of accessory thyroid gland was made, which was later confirmed by multiple repeated CT scans during the two-year follow-up period. In a 52-year-old woman who was presented with intermittent chest pain and cough, contrast-enhanced CT scan revealed nodal thyroid goiter and three nodes of similar CT texture, located in the upper mediastinum, below the thyroid gland. Accordingly, the diagnosis of parasitic mediastinal goiter thyroid nodes was made. Conclusion. Ectopic thyroid nodes are presented by CT as well-circumscribed nodes of same density as the thyroid gland, typically located anteriorly in the upper mediastinum.

Multiple ectopic goiter in the retroperitoneum, abdominal wall, liver, and diaphragm: A case report and review of literature

BACKGROUND

Ectopic thyroid is a rare developmental disorder, typically found in lingual areas, and most distantly in the abdomen. Thyroid ectopia in multiple regions is extremely rare. To date, there are no reports of ectopic goiter in four regions of the abdominal cavity in a single patient.

CASE SUMMARY

We present a case of thyroid ectopia in four areas of the abdomen, comprising normal orthotopic thyroid tissue. A 36-year-old woman, who underwent ovarian teratoma resection 10 years previously due to symptomatic ovarian teratoma, was referred to our hospital for treatment of an incidental hepatic mass. Magnetic resonance imaging and computed tomography (CT) of the abdomen showed a heterogeneously enhanced lobulated lesion in the sixth and seventh hepatic segment adjacent to the diaphragm. The mass was surgically excised, and histologic examination determined an ectopic nodular goiter. At the one-year follow-up, the abdominal CT scan, whole-body radionuclide I131 examination, and abdominal wall biopsy showed similar lesions in the left renal fascia and anterior abdominal wall.

CONCLUSION

Multiple para-ectopic thyroid is often misdiagnosed, owing to its extremely rare incidence and non-specific clinical manifestations and imaging features. A combination of multiple examinations is necessary for diagnostic accuracy.

Ectopic thyroid tissue in adrenal gland, case report and review of literature

Ectopic thyroid tissue is a rare pathological finding bellow the diaphragm and extremely rare finding is ectopic thyroid tissue in the adrenal gland (ETTAG). Thyroid tissue can be located anywhere along the way of embryological migration pathway of thyroglossal duct. In most cases of ectopic thyroid tissue, it is located in the neck. Here we present a case of 29 years old patient that was laparoscopically operated because of adrenal incidentaloma which showed 28 mm in maximal diameter on MRI. The patient had normal adrenal function. Pathohistological finding confirmed ETTAG. Follicular cells express TTF-1, Thyroglobulin, PAX8, and cytokeratin 7, and lack expression of calretinin. This is the 15th such case described in literature. Women are much more affected than men (14:1), and it usually presents in the fifth decade (mean age 49). In all cases ETTAG was composed of normal follicular cells, and C cells were not found. Review of the literature reveals that adrenal ectopic thyroid tissue is almost always cystic, and has distinctive pathologic features. The most important thing is that ETTAG must be distinguished from metastatic deposits from thyroid gland carcinoma. Our patient had normal thyroid function, without any nodules in thyroid gland. We report the youngest patient with ectopic thyroid tissue located in the adrenal gland.

Incidence of ectopic thyroid tissue in the adrenal gland

Ectopic thyroid tissue is a rare pathological finding bellow the diaphragm and extremely rare finding is ectopic thyroid tissue in the adrenal gland. Thyroid tissue can be located anywhere along the way of embryological migration pathway of thyroglossal duct. In most cases of ectopic thyroid tissue, it is located in the neck. Pathohistologically ectopic thyroid tissue in all cases was formed of follicular cells that expressed TTF-1, Thyroglobulin, PAX8, and cytokeratin 7, and there was lack expression of calretinin. In the literature we found 15 such cases. Women are much more affected than men (14:1), and it usually presents in the fifth decade (mean age 49). In all cases it was composed of normal follicular cells, and C cells were not found. Review of the literature reveals that adrenal ectopic thyroid tissue is almost always cystic, and has distinctive pathologic features. The most important thing is that ectopic thyroid tissue must be distinguished from metastatic deposits from thyroid gland carcinoma.