Int J Thyroidol.  2020 Nov;13(2):181-186. 10.11106/ijt.2020.13.2.181.

A Case of Ectopic Thyroid Papillary Carcinoma with Incidental Papillary Thyroid Microcarcinoma

• Han WG
• Oh KH
• Kwon SY

• KMID: 2509208
• DOI: http://doi.org/10.11106/ijt.2020.13.2.181

Abstract

Ectopic thyroid is known to be a very rare disease. Its prevalence is 1 in 100,000-300,000, and it is the most common form of thyroid dysgenesis. In addition, it is known that primary thyroid cancer arising from ectopic thyroid tissue is rare. A 41-year-old male patient with mass in the anterior of the neck was admitted to our department of Otolaryngology. A surgical excision of the neck mass was carried out and the histopathology revealed papillary thyroid carcinoma. Total thyroidectomy and bilateral central neck dissection were then performed after 3 months from previous operation. As a result of histopathologic examination after surgery, we incidentally identified papillary microcarcinoma in the right thyroid lobe. We report a case of ectopic thyroid papillary carcinoma with incidental papillary thyroid microcarcinoma with a literature review.

Keyword

Ectopic thyroid; Ectopic thyroid carcinoma; Papillary thyroid carcinoma; Papillary thyroid microcarcinoma

Figure

• 

  Fig. 1 Profile photo. 1.5 cm sized movable, round mass in mid-anterior neck, thyroid cartilage level (black-lined circle).

• 

  Fig. 2 Computed tomography finding. A 1.3×1.0 cm sized lesion with mild enhancement under the thyroid cartilage (arrow).

• 

  Fig. 3 Ultrasound finding. (A) A 0.99×0.74 cm sized well-marginated hypoechoic lesion with no connection to thyroid isthmus. (B) Several small colloid cysts in the both thyroid gland, and no thyroid nodules suspected of malignancy. The nodule confirmed as papillary carcinoma as a result of histopathology after total thyroidectomy (arrows).

• 

  Fig. 4 Histopathologic finding (Hematoxylin and Eosin stain). (A) Proliferation of atypical formed of papillae with fibrovascular cores, suggests for papillary carcinoma with suspective locally minimal invasion in thyroid tissue. (B) Tall cell variant of papil-lary carcinoma (×100).

• 

  Fig. 5 Ultrasound finding. (A) 1 cm sized spongiform nodule in the left thyroid isthmus (arrow). (B) 1.2 cm sized isoechoic nodule with cystic change in right thyroid lower pole, confirmed benign by fine needle aspiration (arrow).

Reference

References

1. Noussios G, Anagnostis P, Goulis DG, Lappas D, Natsis K. 2011; Ectopic thyroid tissue: anatomical, clinical, and surgical implications of a rare entity. Eur J Endocrinol. 165(3):375–82. DOI: 10.1530/EJE-11-0461. PMID: 21715415.

2. Santangelo G, Pellino G, De Falco N, Colella G, D'Amato S, Maglione MG, et al. 2016; Prevalence, diagnosis and management of ectopic thyroid glands. Int J Surg. 28 Suppl 1:S1–6. DOI: 10.1016/j.ijsu.2015.12.043. PMID: 26708843.

3. Gopal RA, Acharya SV, Bandgar T, Menon PS, Marfatia H, Shah NS. 2009; Clinical profile of ectopic thyroid in Asian Indians: a single-center experience. Endocr Pract. 15(4):322–5. DOI: 10.4158/EP08362.ORR1. PMID: 19454389.

4. Yoon JS, Won KC, Cho IH, Lee JT, Lee HW. 2007; Clinical characteristics of ectopic thyroid in Korea. Thyroid. 17(11):1117–21. DOI: 10.1089/thy.2007.0004. PMID: 17887928.

5. Ulug T, Ulubil SA, Alagol F. 2003; Dual ectopic thyroid: report of a case. J Laryngol Otol. 117(7):574–6. DOI: 10.1258/002221503322113076. PMID: 12901819.

6. Ohnishi H, Sato H, Noda H, Inomata H, Sasaki N. 2003; Color Doppler ultrasonography: diagnosis of ectopic thyroid gland in patients with congenital hypothyroidism caused by thyroid dysgenesis. J Clin Endocrinol Metab. 88(11):5145–9. DOI: 10.1210/jc.2003-030743. PMID: 14602741.

7. Goldstein B, Westra WH, Califano J. 2002; Multifocal papillary thyroid carcinoma arising in a lingual thyroid: a case report. Arch Otolaryngol Head Neck Surg. 128(10):1198–200. DOI: 10.1001/archotol.128.10.1198. PMID: 12365894.

8. Tucci G, Rulli F. 1999; Follicular carcinoma in ectopic thyroid gland. A case report. G Chir. 20(3):97–9. PMID: 10217867.

9. Thakur JS, Verma N, Singh R. 2018; Hurthle cell carcinoma in a lingual thyroid. Med Princ Pract. 27(5):489–92. DOI: 10.1159/000490854. PMID: 29898455. PMCID: PMC6243912.

10. Koltsidopoulos P, Sioka E, Fericean A, Zacharoulis D, Skoulakis C. 2015; Anaplastic carcinoma in submandibular region: a diagnostic dilemma. Int J Surg Case Rep. 9:5–7. DOI: 10.1016/j.ijscr.2015.02.015. PMID: 25697543. PMCID: PMC4392330.

11. Borges A, Martins M, Andre S. 2010; Double thyroid ectopia (with incidental papillary thyroid microcarcinoma) (2010: 8b). Eur Radiol. 20(11):2768–71. DOI: 10.1007/s00330-010-1781-z. PMID: 20886341.

12. Shah BC, Ravichand CS, Juluri S, Agarwal A, Pramesh CS, Mistry RC. 2007; Ectopic thyroid cancer. Ann Thorac Cardiovasc Surg. 13(2):122–4. PMID: 17505421.

13. Klubo-Gwiezdzinska J, Manes RP, Chia SH, Burman KD, Stathatos NA, Deeb ZE, et al. 2011; Clinical review: ectopic cervical thyroid carcinoma--review of the literature with illustrative case series. J Clin Endocrinol Metab. 96(9):2684–91. DOI: 10.1210/jc.2011-0611. PMID: 21752893.

14. Choi YS, Hong SW, Kwak JY, Moon HJ, Kim EK. 2012; Clinical and ultrasonographic findings affecting nondiagnostic results upon the second fine needle aspiration for thyroid nodules. Ann Surg Oncol. 19(7):2304–9. DOI: 10.1245/s10434-012-2288-4. PMID: 22395996.

15. Orija IB, Pineyro M, Biscotti C, Reddy SS, Hamrahian AH. 2007; Value of repeating a nondiagnostic thyroid fine-needle aspiration biopsy. Endocr Pract. 13(7):735–42. DOI: 10.4158/EP.13.7.735. PMID: 18194930.

16. Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch ZW. 2012; The Bethesda system for reporting thyroid cytopathology: a meta-analysis. Acta Cytol. 56(4):333–9. DOI: 10.1159/000339959. PMID: 22846422.

17. Yip L, Nikiforova MN, Carty SE, Yim JH, Stang MT, Tublin MJ, et al. 2009; Optimizing surgical treatment of papillary thyroid carcinoma associated with BRAF mutation. Surgery. 146(6):1215–23. DOI: 10.1016/j.surg.2009.09.011. PMID: 19958951.

18. Prasad KC, Bhat V. 2000; Surgical management of lingual thyroid: a report of four cases. J Oral Maxillofac Surg. 58(2):223–7. DOI: 10.1016/S0278-2391(00)90344-6. PMID: 10670604.

19. Winslow CP, Weisberger EC. 1997; Lingual thyroid and neoplastic change: a review of the literature and description of a case. Otolaryngol Head Neck Surg. 117(6):S100–2. DOI: 10.1016/S0194-5998(97)70070-6. PMID: 9419116.

20. Patel SG, Escrig M, Shaha AR, Singh B, Shah JP. 2002; Management of well-differentiated thyroid carcinoma presenting within a thyroglossal duct cyst. J Surg Oncol. 79(3):134–9. discussion 40–1. DOI: 10.1002/jso.10059. PMID: 11870661.

21. Yoshino M, Mizobuchi T, Fujiwara T, Noro M, Akikusa B, Iwai N. 2006; Large mediastinal cyst of an ectopic thyroid with small nodules diagnosed as papillary carcinoma. Jpn J Thorac Cardiovasc Surg. 54(12):550–4. DOI: 10.1007/s11748-006-0055-9. PMID: 17236661.

22. Suda Y, Hanamure Y, Kasano F, Kashima N. 2005; Ectopic thyroid carcinoma lacking a thyroglossal duct cyst in the submental portion: a case report. Nihon Jibiinkoka Gakkai Kaiho. 108(1):27–30. DOI: 10.3950/jibiinkoka.108.27. PMID: 15712494.

23. Wang YJ, Chu PY, Tai SK. 2010; Ectopic thyroid papillary carcinoma presenting as bilateral neck masses. J Chin Med Assoc. 73(4):219–21. DOI: 10.1016/S1726-4901(10)70046-0. PMID: 20457446.