J Korean Thyroid Assoc.  2013 Nov;6(2):131-134. 10.11106/jkta.2013.6.2.131.

Co-existence of Papillary Thyroid Cancer with Tuberculosis Involving the Thyroid and Ipsilateral Paratracheal Lymph Node: A Case Report

• Sah DJ
• Choi JH
• Kim YJ
• Kim SW

• KMID: 1845386
• DOI: http://doi.org/10.11106/jkta.2013.6.2.131

Abstract

There are relatively rare cases concerning about concurrent papillary thyroid cancer and thyroid tuberculosis with cervical tuberculous lymphadenitis in English literature so far. Cervical lymphadenitis (scrofula) is a common manifestation of extra-pulmonary invasion of the tuberculosis. A cervical tuberculous lymphadenitis could be confused with metastatic lymph node from the thyroid cancer. A 49-year-old woman with multiple right thyroid nodules of Bethesda category VI referred our department for surgery. We performed the right thyroid lobectomy with anterior compartment neck dissection. The histopathology revealed concurrent papillary thyroid carcinoma and thyroid tuberculosis with cervical tuberculous lymphadenitis. We report a unique case of concurrent papillary thyroid cancer and tuberculosis involving the thyroid gland and ipsilateral paratracheal lymph node with literature review. To our best knowledge, such case has not been reported earlier.

Keyword

Papillary carcinoma; Thyroid; Tuberculosis; Lymph node

MeSH Terms

Carcinoma
Carcinoma, Papillary
Female
Humans
Lymph Nodes*
Lymphadenitis
Middle Aged
Neck Dissection
Thyroid Gland*
Thyroid Neoplasms*
Thyroid Nodule
Tuberculosis*
Tuberculosis, Lymph Node

Figure

• 

  Fig. 1. Neck sonography shows round shape hypoechoic thyroid nodule which is probable PTC lesion.

• 

  Fig. 2. Contrast-enhanced neck CT scan shows irregularly-margined and heterogeneously enhanced nodule on right thyroid gland (A), and several enlarged central lymph nodes (B, white arrows).

• 

  Fig. 3. The cut surface of the right thyroid gland. Black arrow shows suspicious tuberculous lesion and white arrow shows suspicious PTC lesion (A). Enlarged paratracheal lymph node (B). Photomicrograph showing caseating necrosis of right thyroid (C) and lymph node (D) which are compatible with PTC (H & E stain, original magnification: C, X200; D, X100).

Reference

References

1. Korean Center for Disease Control and Prevention.Annual report on the notified tuberculosis patients in Korea (2012.1- 2012.12). 2013; [cited Nov 10, 2013] Available from:. http://www.cdc.go.kr.

2. Das DK, Pant CS, Chachra KL, Gupta AK. Fine needle aspiration cytology diagnosis of tuberculous thyroiditis. A report of eight cases. Acta Cytol. 1992; 36(4):517–22.

3. Pandit AA, Joshi AS, Ogale SB, Sheode JH. Tuberculosis of thyroid gland. Ind J Tub. 1997; 44:205–7.

4. Soh EY, Clark OH. Surgical considerations and approach to thyroid cancer. Endocrinol Metab Clin North Am. 1996; 25(1):115–39.

5. Grebe SK, Hay ID. Thyroid cancer nodal metastases: biologic significance and therapeutic considerations. Surg Oncol Clin N Am. 1996; 5(1):43–63.

6. Ord RJ, Matz GJ. Tuberculous cervical lymphadenitis. Arch Otolaryngol. 1974; 99(5):327–9.

7. Appling D, Miller RH. Mycobacterium cervical lymphadenopathy: 1981 update. Laryngoscope. 1981; 91(8):1259–66.

8. Chung EW, Chang YS, Lee J, Choi SY, Lee NJ, So YK, et al. Evaluation of lymph nodes in patients with concurrent papillary thyroid carcinoma and cervical tuberculous lymphadenitis. Korean J Otorhinolaryngol-Head Neck Surg. 2012; 55(9):571–7.

9. Bulbuloglu E, Ciralik H, Okur E, Ozdemir G, Ezberci F, Cetinkaya A. Tuberculosis of the thyroid gland: review of the literature. World J Surg. 2006; 30(2):149–55.

10. Kataria SP, Tanwar P, Singh S, Kumar S. Primary tuberculosis of the thyroid gland: a case report. Asian Pac J Trop Biomed. 2012; 2(10):839–40.

11. Modayil PC, Leslie A, Jacob A. Tuberculous infection of thyroid gland: a case report. Case Rep Med. 2009; 2009:416231.

12. Parmar H, Hashmi M, Rajput A, Patankar T, Castillo M. Acute tuberculous abscess of the thyroid gland. Australas Radiol. 2002; 46(2):186–8.

13. Kang M, Ojili V, Khandelwal N, Bhansali A. Tuberculous abscess of the thyroid gland: a report of two cases. J Clin Ultrasound. 2006; 34(5):254–7.

14. Reede DL, Som PM. Lymph nodes, the neck. In:. Som PM, Bergeron RT, editors. editors. Head and neck imaging. 2nd ed.St. Louis Mosby Year Book;1991; 558–77.

15. Liote HA, Spaulding C, Bazelly B, Milleron BJ, Akoun GM. Thyroid tuberculosis associated with mediastinal lymphadenitis. Tubercle. 1987; 68(3):229–31.

16. Ozekinci S, Mizrak B, Saruhan G, Senturk S. Histopathologic diagnosis of thyroid tuberculosis. Thyroid. 2009; 19(9):983–6.

17. Maitra A. The endocrine system. In:. Kumar V, Abbas AK, Fausto N, Aster JC, editors. editors. Robbins and Cotran pathological basis of disease. 8th ed.Philadelphia: Elsevier;2010; 1097–164.

18. Majid U, Islam N. Thyroid tuberculosis: a case series and a review of the literature. J Thyroid Res. 2011; Article ID 359864. [cited Nov 10, 2013] Available from:. http://www.hindawi.com/journals/jtr/2011/359864/.

19. el Malki HO, el Absi M, Mohsine R, Ait Taleb K, Chefchaouni MC, Oulbacha S, et al. Tuberculosis of the thyroid. Diagnosis and treatment. Ann Chir. 2002; 127(5):385–7.

20. Bayazit YA, Bayazit N, Namiduru M. Mycobacterial cervical lymphadenitis. ORL J Otorhinolaryngol Relat Spec. 2004; 66(5):275–80.