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Chen HC, Chang KM, Su WK. Incidental pharyngoesophageal diverticulum mistaken for a thyroid nodule: Report of two cases. Diagn Cytopathol 2019; 47:503-506. [PMID: 30632292 DOI: 10.1002/dc.24144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 12/17/2018] [Accepted: 12/24/2018] [Indexed: 11/05/2022]
Abstract
Pharyngeal or Zenker's diverticulum is an infrequent disorder that results from an outpouching of pharyngeal mucosa through a weakened area in the posterior pharyngeal wall. As it may mimic a thyroid nodule on ultrasonography (US), accurate diagnosis is important to ensure appropriate treatment. Fine-needle aspiration (FNA) is recommended for the initial evaluation of thyroid nodules. We report the FNA diagnosis of two cases of Zenker's diverticulum that were suspected to be thyroid nodules on US. Pap stained aspirate smears showed findings characteristic of Zenker's diverticulum: benign squamous cells, bacteria, and vegetable debris and the absence of colloid and/or thyroid epithelial cells. US and CT findings were consistent with the diagnosis.
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Affiliation(s)
- Hsiao-Ching Chen
- Department of Pathology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Kuo-Ming Chang
- Department of Pathology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Wen-Ko Su
- Department of Radiology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
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Nauschuetz KK, Ogden LL, Starling CE, Saleh MJ, Golding AC, Traweek ST. Pharyngoesophageal diverticula simulating thyroid nodules: An unusual occurrence with unique features. Diagn Cytopathol 2017; 46:193-197. [PMID: 28925594 DOI: 10.1002/dc.23817] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 12/18/2022]
Abstract
Pharyngoesophageal diverticula (PED) of the Zenker's and Killian-Jamieson types arise in close proximity to the thyroid gland, and may rarely be confused with a thyroid nodule on ultrasonography. In this brief report, we detail the cytologic, clinical, and radiologic findings of three PED that were thought to be thyroid nodules, and were subjected to fine-needle aspiration (FNA). The patients were females with an age range of 51-64 years. All three patients had multiple thyroid nodules, and two patients reported symptoms attributable to the diverticulum. Nodule sizes ranged from 1.0 to 2.7 cm, and either the right or left thyroid lobe could be involved. Microcalcifications were present by ultrasonography in all three cases. FNA of these thyroid nodule mimics showed squamous cells with granular or amorphous debris, bacterial and/or fungal colonies, inflammation, and food particles. These cytologic features, particularly the presence of vegetable or meat fragments, are characteristic, and have also been reported in the few previous reports of PED. The presence of a diverticulum was confirmed with imaging studies in all our patients. Although a rare occurrence, the inadvertent FNA of a PED masquerading as a thyroid nodule is important to recognize, as a recommendation for appropriate radiologic studies could potentially avoid inappropriate therapy for thyroid disease.
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Affiliation(s)
| | | | | | | | - Allan C Golding
- The Memorial Center for Integrative Endocrine Surgery, Hollywood, Florida
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Cao L, Ge J, Zhao D, Lei S. Killian-Jamieson diverticulum mimicking a calcified thyroid nodule on ultrasonography: A case report and literature review. Oncol Lett 2016; 12:2742-2745. [PMID: 27698850 DOI: 10.3892/ol.2016.4984] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 07/01/2016] [Indexed: 11/05/2022] Open
Abstract
As a rare hypopharyngeal diverticulum, Killian-Jamieson diverticulum (KJD) is usually incidentally detected, small, asymptomatic and likely to be misdiagnosed as a thyroid nodule. In order to avoid unnecessary treatments resulting from misdiagnosis, principles to distinguish between esophageal diverticula and thyroid nodules should be noted clearly. The current study presents a case of an asymptomatic unilateral KJD that mimicked a calcified thyroid nodule. In the current case, a 40-year-old man presented with a 'suspected malignant thyroid nodule' in the left thyroid gland, and underwent left thyroid lobectomy and a neck exploration. However, no visible 'suspected tumor', but a sac protruding from the left anterolateral wall of the cervical esophagus, was observed during the surgery. A swallow test on ultrasonography (US) in combination with pharyngoesophagography was then performed, which confirmed the diagnosis. The patient recovered well during the 3-month follow-up after the operation. The present study indicates that real-time US and pharyngoesophagography are important techniques to distinguish a KJD from a thyroid nodule so that unnecessary surgical intervention can be avoided.
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Affiliation(s)
- Li Cao
- Department of Breast Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Junna Ge
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Donghui Zhao
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Shangtong Lei
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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Shao Y, Zhou P, Zhao Y. Ultrasonographic findings of pharyngoesophageal diverticulum: two case reports and review of literature. J Med Ultrason (2001) 2015; 42:553-7. [DOI: 10.1007/s10396-015-0631-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 03/27/2015] [Indexed: 11/30/2022]
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Mimatsu K, Oida T, Kano H, Kawasaki A, Fukino N, Kida K, Kuboi Y, Amano S. Killian-jamieson diverticula presenting synchronously with thyroid adenoma. Case Rep Gastroenterol 2013; 7:188-94. [PMID: 23687487 PMCID: PMC3656691 DOI: 10.1159/000350672] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Killian-Jamieson diverticulum is a rare hypopharyngeal diverticulum, less commonly encountered compared with Zenker's diverticulum. These hypopharyngeal diverticula that cause dysphagia often mimic a thyroid tumor incidentally detected on neck ultrasonography. However, to our knowledge, Killian-Jamieson diverticula complicated by a thyroid tumor have not been previously described. We experienced a rare case of bilateral Killian-Jamieson diverticula synchronously complicated by a thyroid adenoma in a 74-year-old woman who became aware of dysphagia and a tumor in the left side of her neck. Pharyngoesophagography revealed bilateral diverticula protruding from the lateral wall of the esophagopharyngeal junction, but the appearance of the cricopharyngeal bar representing the cricopharyngeus muscle above the diverticula had become unclear because the thyroid tumor was pressing on the diverticula and the cervical esophagus. However, the diverticula were diagnosed as Killian-Jamieson diverticula because cervical computed tomography showed bilateral diverticula arising from the cervical esophagus just below the level of the cricoid cartilage, and operative finding showed that the diverticula were located above the upper esophageal longitudinal muscle. Radiographic imaging is useful for diagnosis as cause of dysphagia and cervical tumor.
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Affiliation(s)
- Kenji Mimatsu
- Department of Surgery, Social Insurance Yokohama Central Hospital, Yokohama, Tokyo, Japan
| | - Takatsugu Oida
- Department of Surgery, Social Insurance Yokohama Central Hospital, Yokohama, Tokyo, Japan
| | - Hisao Kano
- Department of Surgery, Social Insurance Yokohama Central Hospital, Yokohama, Tokyo, Japan
| | - Atsushi Kawasaki
- Department of Surgery, Social Insurance Yokohama Central Hospital, Yokohama, Tokyo, Japan
| | - Nobutada Fukino
- Department of Surgery, Social Insurance Yokohama Central Hospital, Yokohama, Tokyo, Japan
| | - Kazutoshi Kida
- Department of Surgery, Social Insurance Yokohama Central Hospital, Yokohama, Tokyo, Japan
| | - Youichi Kuboi
- Department of Surgery, Social Insurance Yokohama Central Hospital, Yokohama, Tokyo, Japan
| | - Sadao Amano
- Department of Breast and Endocrine Surgery, Nihon University School of Medicine, Tokyo, Japan
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Ko HM, Boerner SL, Geddie WR. Fine-needle aspiration of a pharyngoesophageal diverticulum mimicking a calcified thyroid nodule on ultrasonography. Diagn Cytopathol 2012; 41:752-3. [PMID: 22241534 DOI: 10.1002/dc.22818] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 11/10/2011] [Indexed: 11/09/2022]
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Kim HK, Lee JI, Jang HW, Bae SY, Lee JH, Kim YS, Shin JH, Kim SW, Chung JH. Characteristics of Killian-Jamieson diverticula mimicking a thyroid nodule. Head Neck 2010; 34:599-603. [PMID: 22389264 DOI: 10.1002/hed.21575] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 05/25/2010] [Accepted: 07/09/2010] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Killian-Jamieson (K-J) diverticula have been incidentally detected on neck ultrasonography and could be misdiagnosed as thyroid nodules. The purpose of this study was to define the clinical and ultrasonographic characteristics of K-J diverticula. METHODS We analyzed 13 patients with K-J diverticula mimicking thyroid nodules including 4 of our patients and 11 previously reported cases between 1984 and August 2009. RESULTS Seven patients (54%) were women, and all patients were asymptomatic. The average lesion's diameter was 1.5 cm (range, 0.5-4.0). Most of the lesions (92%) were located in the left thyroid lobe. Ultrasonography showed heterogeneous echogenic masses with echogenic foci and hypoechoic rims. A connection with the adjacent esophageal wall was found in 7 diverticula (54%) at the time of initial diagnosis. CONCLUSION The K-J diverticula had unique ultrasonographic findings. Awareness of the fact that K-J diverticula can be misdiagnosed as thyroid nodules is important to avoid unnecessary interventions.
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Affiliation(s)
- Hee Kyung Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Singaporewalla RM, Mukherjee JJ, Thamboo TP, Cheah WK. Pharyngoesophageal diverticulum resembling a thyroid nodule on ultrasound. Head Neck 2010; 33:1800-3. [DOI: 10.1002/hed.21474] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2010] [Indexed: 11/06/2022] Open
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Oertel YC, Khedmati F, Bernanke AD. Esophageal diverticulum presenting as a thyroid nodule and diagnosed on fine-needle aspiration. Thyroid 2009; 19:1121-3. [PMID: 19772399 DOI: 10.1089/thy.2009.0136] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Brücher BLDM, Sarbia M, Oestreicher E, Molls M, Burian M, Biemer E, Stein HJ. Squamous cell carcinoma and Zenker diverticulum. Dis Esophagus 2007; 20:75-8. [PMID: 17227315 DOI: 10.1111/j.1442-2050.2007.00648.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Squamous cell carcinoma in a Zenker diverticulum is a very rare condition. We report a case of a patient with a Zenker carcinoma, who was primarily functionally inoperable and therefore received neoadjuvant radiochemotherapy before cardiac bypass surgery. After a complicated course with cardiogenic shock and myocardial infarction, a re-evaluation of functional risk analysis and the tumor situation revealed operability. Subsequently, partial hypopharyngectomy and partial cervical esophageal resection with lymphadenectomy was performed. Reconstruction of the gastrointestinal continuity was made by interposition of a free small bowel graft and microvascular anastomosis. The postoperative course showed a small anastomotic leakage of the hypopharyngeal-small bowel anastomosis, which was successfully treated conservatively.
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Affiliation(s)
- B L D M Brücher
- Department of Surgery, Technical University of Munich, Munich, Germany.
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