Cases reported "Thyroid Nodule"

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11/20. sarcoidosis presenting as cold thyroid nodules: report of two cases.

    sarcoidosis is a systemic disease characterized by noncaseating granulomas. Thyroid involvement is rare in sarcoidosis. In this paper, two sarcoidosis patients who demonstrated cold thyroid nodules are presented. A 42-year-old woman presented with multinodular goiter and was diagnosed as having sarcoidosis when noncaseating granulomas were observed during the pathological examination of the thyroidectomy specimen. Enlarged mediastinal lymph nodes were observed in the routine preoperative chest X-ray in another 53-year-old woman, while she was being prepared to undergo a thyroidectomy. The pathological examination of the thyroid specimens showed noncaseating granulomas in both patients, and the diagnosis was confirmed by either hepatic biopsy or chest X-ray findings. In conclusion, thyroid involvement should be suspected in sarcoidosis patients who present with cold nodules in the thyroid. Furthermore, if noncaseating granulomas are observed in thyroid specimens after a thyroidectomy in an otherwise healthy person, the patient should be evaluated further for sarcoidosis.
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12/20. Accessory thyroid nodule in sub-mandibular region.

    A case of an accessory thyroid nodule with a diagnosis of focal lymphocytic thyroiditis, in 23 years old lady, on histopathological examination, is presented. Patient had a single swelling in the left submandibular region without any abnormality. Postoperative thyroid scan showed thyroid gland in its normal anatomical location with suppressed activity and thyroid profile revealed subclinical hypothyroidism.
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13/20. Controversial ectopic thyroid: a case report of thyroid tissue in the axilla and benign total thyroidectomy.

    A 43-year-old woman presented with a mass in her left axilla, which was surgically excised. Histologically, the tissue was a reactive lymph node with adjacent thyroid follicular tissue. The differential diagnosis included benign ectopic thyroid versus metastatic well-differentiated follicular-derived thyroid carcinoma. Because of the possibility of carcinoma, the patient underwent a diagnostic total thyroidectomy. The thyroid was grossly normal with no histologic evidence of malignancy. Post-operatively, the patient underwent a whole body 131I scan. Aside from an expected residual uptake in the thyroid bed region, there was no extrathyroidal uptake to suggest additional ectopic thyroid tissue or metastatic disease. At the time of this scan, her thyrotropin (TSH) was 92.8 microU/mL, thyroglobulin was less than 0.3 ng/mL, and thyroglobulin antibody was less than 3 IU/mL. Abnormalities in the embryologic development and migration of the thyroid gland can result in ectopic thyroid tissue. The most frequent locations are along the midline from the base of the tongue to the mediastinum. Only rare case reports exist of ectopic thyroid in other locations, including the chest (heart, trachea), abdomen (liver, gallbladder, pancreas), and pelvis (vagina). This case represents the first description of thyroid tissue in the axilla with a histologically benign thyroid gland.
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14/20. Intranodular reactive endothelial hyperplasia in adenomatous goitre.

    Endothelial hyperplasia has rarely been recognized in the thyroid. Ischaemic events or hemorrhage, sometimes as a result of fine needle aspiration procedures, have been regarded as possible causes. To clarify the morphological pattern and the clinical significance of this lesion, we studied a series of adenomatous goitres and selected 11 cases showing prominent endothelial hyperplasia in an individual nodule. Grossly, the parenchyma of the affected nodule was substituted by greyish, friable tissue surrounded by a fibrous capsule and by a thin rim of residual thyroid parenchyma. Microscopically, fibrinous and haemorrhagic material was crossed by intercommunicating vascular channels or papillary structures. These were lined by plump endothelial cells. In only one case had pre-operative fine needle aspiration biopsy been performed: smears yielded a haemorrhagic background, fibrin and numerous elongated cells; colloid and follicular cells were virtually absent. In both surgical and cytological specimens a differential diagnosis with a vascular neoplasm, a rare occurrence in the thyroid, was taken into consideration. We conclude that intranodular reactive endothelial hyperplasia is a relatively common occurrence (1.6%) in adenomatous goitre and is of diagnostic interest in both surgical and cytological specimens, since it can mimic vascular tumours and may lead to unnecessary treatment if misdiagnosed.
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15/20. Nodular disease during pregnancy.

    The incidence of autoimmune disease of the thyroid approaches 10% in women. This autoimmune state, which predisposes to the development of thyroid neoplasia, especially in patients with subclinical hypothyroidism, combined with tumor growth and immunologic factors that occur in the pregnant state, account for the significant incidence of nodular thyroid disease in pregnancy. Thyroid carcinoma of follicular cell origin in a young woman can generally be expected to pursue a slow course with ample time for preoperative preparation and operative treatment. However, the pregnant state should be considered an exception and thyroid nodular disease with suspicious aspiration cytologic features should be managed with a certain degree of urgency. In an excellent article on the subject of pregnancy as a predisposing factor in thyroid neoplasia, Rosen and Walfish present a series of 30 patients with thyroid neoplasia arising during pregnancy. The incidence of thyroid carcinoma was 43% and the incidence of adenoma 37%, for an 80% overall incidence of neoplasia. Furthermore, during the course of the pregnancy, 20% of the patients showed marked increase in nodular growth, including a 26-year-old primiparous woman who developed a small nodule in the first trimester which proved to be cellular on needle aspiration biopsy. In spite of thyroid hormone treatment, the nodule grew markedly in the last trimester. At postpartum operation, the patient was found to have a papillary carcinoma with extensive unilateral neck and mediastinal node disease, which was clinically occult. These authors stress the importance of the operative treatment of thyroid neoplasia of pregnancy, either in the second trimester or immediately after delivery. We agree.
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16/20. Atypical thyroglossal duct cyst: a rare cause for a solitary cold thyroid nodule in childhood.

    A case of an atypical thyroglossal duct cyst is described in a 9-year-old boy who presented with a lateral neck mass that was hypofunctioning on thyroid scan and clinically indistinguishable from a thyroid nodule. Preoperative fine needle aspiration biopsy results demonstrating abundant, normal appearing squamous epithelial cells and keratinaceous material was suggestive of the diagnosis. Definitive diagnosis was made only after complete mobilization of the left lobe of the thyroid gland and cyst resection. A standard Sistrunk procedure was performed, and cyst excision was accomplished without resection of the left lobe of the thyroid gland. Microscopic examination disclosed a keratinizing pseudostratified squamous epithelium that has not been previously reported with thyroglossal duct cysts.
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17/20. Asymptomatic and normocalcemic parathyroid adenoma: detection by preoperative ultrasound.

    hyperparathyroidism is often detected in the asymptomatic stage at the present time with the advent of mass screening for hypercalcemia. There may be patients with parathyroid disease who are asymptomatic and who do not have detectable elevations of their serum calcium. Many patients who undergo surgery for thyroid conditions may have synchronous parathyroid disease which is asymptomatic and not detectable by routine laboratory screening. Preoperative ultrasound scans may be of utility in identifying coexistent disease in those patients scheduled for thyroid surgery so that both disease entities may be treated at the same operation.
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18/20. Thyroid cancers. I. Papillary, follicular, and Hurthle cell.

    The well differentiated thyroid carcinomas, papillary, follicular, and Hurthle cell, comprise the majority of malignant thyroid diseases. This article presents guidelines for the evaluation and treatment of these malignancies. Prognostic factors, surgical treatment of the thyroid and regional lymph nodes, postoperative detection of recurrence, and treatment of distant metastases are discussed.
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19/20. technetium-99m-pertechnetate uptake by intrathyroidal parathyroid adenoma.

    A 57-yr-old woman was referred for preoperative scintigraphic localization of a parathyroid adenoma. Double-phase 99mTc-sestamibi imaging was performed followed by a separate-day [99mTc]pertechnetate thyroid scan. There was marked accumulation of both tracers by a right lower pole inverted question markthyroid' nodule which, at surgery, proved to be an intrathyroidal parathyroid adenoma. Hypervascularity is the presumed explanation for rare cases of pertechnetate-avid parathyroid adenomas.
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20/20. Schwannoma of the neck simulating a thyroid nodule.

    A 31-year-old man is reported with the rare occurrence of a neurogenic tumor simulating a thyroid nodule. A growing nodule of the right neck was the only clinical symptom. ultrasonography revealed a hypoechogenic nodule on the right side of the thyroid gland. technetium (Tc)-99m pertechnetate showed a normal thyroid scintiscan. Due to ultrasonography-guided fine-needle aspiration biopsy, a schwannoma (neurilemmoma) was suspected. Surgical intervention removed the nodule and histology confirmed a schwannoma with Antoni A structures. To avoid unnecessary or inappropriate surgical intervention in cases of hypoechogenic nodules in connection with the thyroid gland, other nonthyroidal structures that may cause hypoechogenic patterns with ultrasonography should also be considered. The key preoperative investigations in such cases are ultrasonography and sonographically guided fine-needle aspiration biopsy.
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