Int J Thyroidol.  2022 May;15(1):49-53. 10.11106/ijt.2022.15.1.49.

Paraesophageal Anthracofibrosis Mimicking Metastatic Lymphadenopathy in Papillary Thyroid Cancer: a Case Report

• Yoon TM
• Lee KH

• KMID: 2530126
• DOI: http://doi.org/10.11106/ijt.2022.15.1.49

Abstract

Anthracofibrosis is luminal narrowing with a black anthracotic pigmentation on the bronchial mucosa. Extrapulmonary anthracofibrosis is very rare in head and neck region, and anthracofibrosis associated with adhesion to adjacent tissue can be misdiagnosed to malignancy. We report a rare case of a paraesophageal anthracofibrosis in a patient with advanced papillary thyroid cancer. The paraesophageal anthracofibrosis presented as a black colored hard mass with severe adhesion to the recurrent laryngeal nerve (RLN) during thyroid surgery, suspecting metastatic lymphadenopathy. With intraoperative frozen biopsy, unnecessary aggressive surgery with the injury of RLN can be avoided. Permanent histopathological examination of the mass revealed anthracofibrosis with strong positivity on Masson’s trichrome staining. This case highlights that anthracofibrosis should be included in differential diagnosis of paraesophageal masses, and frozen sectional biopsy can help in decision making during surgery. In addition, collagen might be involved in the adhesion of the anthracotic mass to the surrounding tissues.

Keyword

Anthracosis; Fibrosis; Lymphatic metastasis; Papillary thyroid cancer

Figure

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  Fig. 1 Thyroid ultrasonography showing a 1.8× 1.7×2.2-cm hypoechoic, ill-defined mass with microcalcification and extrathyroidal invasion in the right thyroid gland (A) and a 5.7× 3.4×5.9-cm mixed-echoic mass in the left thyroid gland (B).

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  Fig. 2 Neck computed tomography with enhancement showing a 2.2×1.8×1.4-cm irregular subtle enhancing low attenuated nodule with calcification and extrathyroidal extension in the right thyroid gland and a 7×4.5×5-cm heterogeneously enhancing mass in the left thyroid gland.

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  Fig. 3 Operative findings after thyroidectomy shows a 1.5-cm black colored, right paraesophageal mass (black arrow), suspected as metastatic lymphadenopathy, under the right recurrent laryngeal nerve (black arrowheads) (A). The cut surface of the mass (black arrow) obtained for intraoperative frozen sectional biopsy was as black as coal. Black arrowheads indicated the right recurrent laryngeal nerve (B). T: trachea

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  Fig. 4 Histopathological examination of the paraesophageal mass revealed anthracotic pigment deposition and dense fibrotic changes (Hematoxylin and Eosin [H&E] stain, ×40).

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  Fig. 5 Histopathological findings of Masson’s Trichrome staining (MT, ×200) in 4 cases with anthracosis. (A) This case and another case with a paratracheal mass had severe adhesion to adjacent tissues. A prominent increase in blue collagen fibers were seen on MT staining. (B) Two other cases of cervical anthracosis had no adhesion to adjacent tissues. These cases showed negative on MT staining (H&E stain, ×100).

Reference

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