Cases reported "Thyroid Neoplasms"

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1/473. Hurthle cell carcinoma of the thyroid gland with extensive tumor necrosis: a case report.

    Hurthle cell neoplasm of the thyroid gland is rarely associated with tumor necrosis. We report a case of Hurthle cell carcinoma of the thyroid gland with extensive necrosis. An 82-year-old man had had a right neck mass for more than 10 years. Approximately two to three weeks before he was hospitalized, this neck mass became progressively enlarged. An 131I scan could not demonstrate the right lobe of the thyroid gland, while the contralateral lobe was unremarkable. A 99mTc-sestamibi scan showed increased uptake on the lesion side. Fine needle aspiration cytology showed necrosis with macrophages in the initial aspirate, and the secondary aspirate appeared suspicious for a Hurthle cell tumor. The patient had a total thyroidectomy, and the pathology proved to be Hurthle cell carcinoma with tumor necrosis.
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2/473. Tall cell variant of papillary thyroid carcinoma with foci of columnar cell component.

    We report a case of the tall call variant of papillary thyroid carcinoma with foci of columnar cell component in a 67-year-old Japanese man. Tall cell variant occupied more than 70% of the tumour, and columnar cell component was of two types in representative sections. One showed striking stratification of nuclei with scanty cytoplasm, and the other appeared clear. Characteristic nuclear features of papillary carcinoma were also observed in the area of the tall cell variant. The patient died of the thyroid cancer with aspiration pneumonia 10 years and 6 months after operation. Although autopsy was not performed, metastatic lymph nodes of the neck removed during life also showed papillary carcinoma with both tall cell and columnar cell components. Our case indicates that tall cell and columnar cell variants may coexist in the same tumour although the pathogenesis remains unclear.
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3/473. Normal thyroid pathology in patients undergoing thyroidectomy for finding a RETgene germline mutation: a report of three cases and review of the literature.

    Genetic screening for germline RET proto-oncogene mutation in hereditary medullary thyroid cancer (MTC) is accurate and allows for preventive total thyroidectomy to be performed early in patients who are gene carriers. We report 3 children who underwent preventive total thyroidectomy based on the finding of a RETgene germline mutation, but who had no evidence of MTC or C-cell hyperplasia on permanent histology, even after calcitonin immunostaining. review of the English literature of patients undergoing preventive thyroidectomy for a positive RETgene germline mutation, shows that 3.4% of these patients (a total of 209 patients) had normal thyroid glands. Also, 8.6% of patients undergoing preventive total thyroidectomy with prophylactic central neck node dissection had cervical node metastases. We conclude that preventive thyroidectomy in patients screened early for germline RETgene mutation allows for earlier diagnosis and treatment of patients, sometimes even before any hyperplasia or neoplasia can be demonstrated because cervical node metastases can occur early and be demonstrated even with small tumors (< 1 cm), we recommend prophylactic central neck node dissection at the time of preventive thyroidectomy.
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4/473. Neoplastic thrombotic endocarditis of the tricuspid valve in a patient with carcinoma of the thyroid. Report of a case.

    A rare case of neoplastic thrombotic endocarditis of the tricuspid valve in a patient with poorly differentiated follicular carcinoma of the thyroid is described. Although some previous reports documented extension of the follicular thyroid carcinoma into the great veins of the neck to the right cardiac chambers, this seems to be the first report of a neoplastic thrombotic lesion of the tricuspid valve in a patient with thyroid carcinoma. In our institute, where about 2,500 autopsies are performed yearly, and about 600 valvular lesions are discovered, such a lesion was never detected. In patients with carcinoma, a neoplastic thrombotic endocarditis may be a source of microembolic neoplastic spread leading to a possible pulmonary colonisation.
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5/473. Dendritic cell sarcoma of the thyroid.

    BACKGROUND: Follicular dendritic cell sarcoma (FDCS) arises from nonlymphatic antigen-presenting cells found in lymph node B-cell follicles. This extremely rare tumor, which usually arises in lymph nodes, does occur in extranodal head and neck sites such as the tonsil and soft palate. methods: A retrospective review of the patient followed at the University of Pittsburgh Medical Center from 1993 to the present was performed. CONCLUSIONS: This is the first reported case of an FDCS of the thyroid. A review of the literature provides useful information to aid in detection, treatment, and outcome of this unusual soft tissue malignancy.
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6/473. Mucosa-associated lymphoid tissue (MALT) lymphoma of the thyroid: report of a case.

    The patient was 59-year-old Japanese woman who presented with a neck swelling. ultrasonography and computed tomography demonstrated a round tumor in the thyroid right lobe measuring 2.5 x 1.5 cm in size. A right hemithyroidectomy with lymph node dissection was performed. Histopathological findings demonstrated low-grade B cell lymphoma of the mucosa-associated lymphoid tissue (MALT) associated papillary microcarcinoma. A previous report showed an excellent prognosis of MALT lymphoma of the thyroid without capsular invasion or lymph node involvement. We also describe the concept of MALT lymphoma as a primary lesion in which lymphoid tissue is not present in the normal state.
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7/473. Gastroenteropancreatic neuroendocrine tumor metastases to the thyroid gland: differential diagnosis with medullary thyroid carcinoma.

    neuroendocrine tumors (NET) of the thyroid gland are rare. Apart from medullary thyroid carcinoma (MTC), metastases of gastroenteropancreatic (GEP) NET may also occur. Features of six patients (five men, one female: age range, 39-67 years) with thyroid metastases from a GEP-NET are described. Thyroid metastases were bilateral in all patients and were associated with enlarged neck lymph nodes in five. In four cases, the thyroid tumor was either the first sign of the disease (n = 2) or was an isolated site of recurrence (n = 2). The tumors were well (n = 3) or poorly differentiated (n = 3). Five tumors for which the primary site could be determined corresponded to foregut-derived tumors (3 lungs, 1 thymus and 1 pancreatic NET). One tumor demonstrated calcitonin (CT) production as shown by immunohistochemistry and elevated plasma CT levels. However, the disease history and the clinical features strongly favored a metastasizing GEP-NET. No tumoral RET proto-oncogene mutation was found in this patient. The differential diagnosis between metastatic GEP-NET and MTC is crucial because prognosis, work-up, and treatment differ greatly.
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8/473. Follicular carcinoma in ectopic thyroid gland. A case report.

    Ectopic thyroid rest can be seen anywhere along the path of descent of the gland. The most ectopic thyroid tissue is a thyroglossal duct cyst associated with normal thyroid gland. Sublingual location is less common than a lingual ectopia. True malignant transformation in ectopic thyroid tissue is extremely rare. Such a malignancy is virtually always diagnosed only after surgical excision of the lesion at pathological examination. This report discusses a case of ectopic thyroid follicular carcinoma in the right submandibular region in the absence of orthotopic thyroid, discovered by chance after the surgical excision performed for a preoperative ultrasonically and cytologically misdiagnosed submandibular gland adenocystic carcinoma. The possible aetiology of such an unusual anatomical relationship is discussed as well as the importance of thyroid scanning, ultrasound and/or CT in neck lumps.
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9/473. Signet ring cell adenoma of the thyroid with mucin predominance.

    A 22-year-old male presented with a 1-year history of a right anterior neck mass. He did not have gastrointestinal cancer. Laboratory examination revealed an elevated serum thyroglobulin level of 120 ng/mL. The neck lesion showed poor uptake on 99mTc scan, but enhanced uptake on 201T1 scan. The patient underwent a hemithyroidectomy; the cut surface of the 7 x 3.5 cm lesion was solid and tanned orange. Postoperatively the serum thyroglobulin level decreased to 26 ng/mL. microscopy of the tumor showed signet ring cells and microfollides, both of which were positive for mucicarmin and alcian blue. A small percentage of the follicles were positive for thyroglobulin and periodic acid-Schiff. Our literature search detected 18 patients with signet ring cell lesions positive for thyroglobulin, but none had characteristics similar to ours showing predominance of mucin and poor staining for thyroglobulin.
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10/473. Tall cell variant of papillary carcinoma coexisting with chronic lymphocytic thyroiditis. A case report.

    BACKGROUND: Recent studies have shown a correlation between lymphocytic thyroiditis and papillary carcinoma of the thyroid. It is thought that autoimmune thyroiditis could be a risk factor for the development of thyroid carcinoma, mainly for the papillary variant. CASE: A 59-year-old female presented with a history of enlargement in the neck and five months of dysphagia. Clinical examination showed generalized expansion and an increase in the hardness of the thyroid gland. Hormonal outline showed subclinical hypothyroidism with serum levels of TSH slightly elevated (5 micrograms/dL; range, 0.25-4). thyroglobulin antibodies and thyroperoxidase titers were moderately positive. Given these results, a diagnosis of chronic thyroiditis was made. Thyroid ultrasound scan showed diffuse gland irregularity and the presence of a solitary nodule (2.3 cm in diameter) localized in the right lobe. Fine needle aspiration biopsy (FNAB) of the nodule was performed under ultrasound guidance. CONCLUSION: Although clinical and laboratory results supported the diagnosis of autoimmune thyroiditis only, FNAB of the nodular lesion provided evidence of a rare case of papillary carcinoma, tall cell variant, confirmed by histologic results.
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