scholarly journals A Killian-Jaimeson Diverticulum Masquerading as a Thyroid Nodule

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A914-A914
Author(s):  
Reema Patel ◽  
Maha Abdulla ◽  
Jianyu Rao ◽  
Abemayor Elliot ◽  
Dianne Cheung
Keyword(s):  
Thyroid Nodule ◽  
Thyroid Tissue ◽  
Disease Process ◽  
Neck Surgery ◽  
Needle Aspiration ◽  
Neck Mass ◽  
Care Physician ◽  
Pathology Report ◽  
Left Neck ◽  
Foreign Materials

Abstract Background: A Killian-Jaimeson diverticulum is a rare outpouching in the cervical esophagus, just below the cricopharyngeus muscle, that can be easily mistaken for a thyroid nodule on ultrasonography (1). Clinical Case: A 65-year-old woman underwent a thyroid ultrasound after her primary care physician noted left-sided thyromegaly. The ultrasound described a 33 mm solid, hypoechoic, wider-than-tall nodule in the left mid gland with an obscured posterior margin as well as macro- and microcalcifications. Given the size and highly suspicious features on ultrasound, she was referred to endocrinology clinic for a fine needle aspiration (FNA). She underwent ultrasound-guided FNA of what appeared to be the previously described thyroid nodule. Surprisingly, the pathology report noted degenerative changes with amorphous debris and possible foreign materials (vegetable or food) without any thyroid tissue. She was sent for an MRI neck, which showed the left neck mass communicating with the esophagus, favoring a left lateral projecting Killian-Jamieson esophageal diverticulum with internal debris. She was referred to head and neck surgery. Given only minimal symptoms of dysphagia, there are no current plans for surgery. Conclusion: This case illustrates the possibility of mistaking a Killian-Jaimeson diverticulum as a thyroid nodule. Recognition of this rare disease process in the differential diagnosis of thyroid nodules with high risk ultrasound characteristics may prompt more advanced imaging with MRI or CT, and lead to an accurate diagnosis prior to subjecting patients to unnecessary and potentially harmful FNAs (2). References: (1) Kim HK, Lee JI, Jang HW, et al. Characteristics of Killian-Jamieson diverticula mimicking a thyroid nodule. Head Neck. 2012;34(4):599-603. doi:10.1002/hed.21575. (2) Bonacchi G, Seghieri M, Becciolini M. Killian-Jamieson diverticulum: real-time sonographic findings. J Ultrasound. 2016;19(4):295-298. Published 2016 Apr 21. doi:10.1007/s40477-016-0208-3.

scholarly journals Peripheral Halo in a Thyroid Nodule - A Sign of Benignity

2021 ◽  
Vol 10 (11) ◽  
pp. 852-853
Author(s):  
Bhavik Unadkat ◽  
Suresh Vasant Phatak ◽  
Asish Pavanan ◽  
Prerna Anup Patwa
Keyword(s):  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Adult Population ◽  
Thyroid Tissue ◽  
Malignant Lesion ◽  
Morphological Characteristics ◽  
Needle Aspiration ◽  
Endocrine Gland ◽  
Thyroid Lesion ◽  
Thyroid Cells

Thyroid pathology is very common in general population, even when on inspection no abnormality is detected, nodules are seen on ultrasound sonography (USG). We are describing importance of peripheral halo sign in the diagnosis of benign nodules. Among all the endocrine gland lesions noted in India, thyroid lesion is the most common. In about 19 - 60 % of the adult population thyroid nodules are seen; however, less than 1 % of the thyroid nodules are malignant. Halo seen on ultrasound near the thyroid is considered as reliable and specific sign of benignity. 1 The morphological characteristics that suggest that the thyroid nodule is benign are echogenicity of thyroid gland in that being the identical echo signal or being moderately hyperechogenic corresponding to surrounding normal thyroid tissue. The solid nodule may be accompanied by a hypoechoic halo, which represents compressed thyroid tissue, fibrous connective tissue and vessels. The cystic nodule lesion contains colloid, and this appears as a hyper-echogenic spot with “comet-tail shadowing or ring-down sign”.2 The spongiform appearance on ultrasound has specificity of 99.7 % for benign disease it has 98.5 % negative predictive value for malignancy. 3,4 At the peripheries of the nodule, complete eggshell calcification is noted.5 A thyroid nodule with the above-mentioned characteristics is considered to be benign nodule and it does not require fine-needle aspiration cytology (FNAC) and in such patients there is neither a risk of malignancy nor a follow up USG is recommended.2 In benign thyroid lesion, there is rapid and controlled growth of thyroid cells compressing the surrounding thyroid parenchyma appearing as the echogenic rim called as sonolucent halo, on the contrary, malignant lesion has spontaneous but uncontrolled growth of the cells which lack cellular cohesion causing incomplete halo.6

Calcifying Fibrous Pseudotumor of the Neck: Diagnostic Challenges of a Rare Benign Lesion

2005 ◽  
Vol 71 (12) ◽  
pp. 1051-1054 ◽  
Author(s):  
Evan B. Goldstein ◽  
Richard H. Savel ◽  
Filiz Sen ◽  
Peter Shamamian
Keyword(s):  
Benign Lesion ◽  
Needle Aspiration ◽  
Neck Mass ◽  
Surgical Removal ◽  
Neck Masses ◽  
Collagenous Tissue ◽  
Supraclavicular Fossa ◽  
Left Neck ◽  
Rare Lesion ◽  
Calcifying Fibrous Pseudotumor

Neck masses, frequently encountered by physicians, comprise a vast range of diagnoses, with malignancy being the greatest concern. Calcifying fibrous pseudotumor (CFP) is a rare lesion with unknown pathogenesis, characterized pathologically by a predominance of abundant hyalinized collagenous tissue with focal lymphoplasmacytic infiltrate and psammomatous or dystrophic calcifications. We present the case of a 29-year-old woman who presented with a 4-cm left neck mass, accompanied by constitutional symptoms of vague weakness and lethargy. After the lesion failed to respond to a course of antibiotic therapy, fine-needle aspiration was performed, the pathology of which was indeterminate. The concern was that the lesion was a lymphoproliferative disorder–further workup was performed. CT of the chest, abdomen, and pelvis revealed no evidence of adenopathy or neoplasms. Subsequently, an incisional biopsy was performed, suggesting a diagnosis of CFP. Magnetic resonance imaging with contrast, performed to delineate the anatomy, revealed the lesion in the left neck, deep to the left clavicle, that extended superiorly into the supraclavicular fossa. Complete surgical removal of the lesion was successfully performed, with immunophenotyping confirming the initial diagnosis of CFP. We present a case report of cervical CFP, discuss the approach to neck masses, and review the recent literature on this rare, benign entity.

scholarly journals Intrathyroidal Parathyroid Cyst: An Unusual Neck Mass

2017 ◽  
Vol 10 ◽  
pp. 117955141769813 ◽  
Author(s):  
Maswood M Ahmad ◽  
Mohammed Almohaya ◽  
Mussa H Almalki ◽  
Naji Aljohani
Keyword(s):  
Thyroid Tissue ◽  
Parathyroid Tissue ◽  
Rare Condition ◽  
Needle Aspiration ◽  
Neck Mass ◽  
Maximum Diameter ◽  
High Concentration ◽  
Clear Fluid ◽  
Parathyroid Cyst ◽  
Parathyroid Dysfunction

Parathyroid cyst (PC) is a very rare condition. A case of intrathyroidal PC is being reported here in a 53-year-old woman who presented to the endocrine clinic with slowly progressive painless left anterior neck swelling for 1 year with no symptoms of thyroid or parathyroid dysfunction and no compressive symptoms. Ultrasound of the thyroid showed a well-defined cystic lesion measuring 4.7 × 3.6 cm in maximum diameter with internal echoes within the cyst located in the left lobe of the thyroid gland. Fine needle aspiration revealed colorless clear fluid with a high concentration of parathyroid hormone. The patient underwent left hemithyroidectomy at her request. Histopathology revealed parathyroid tissue with unilocular cyst and thyroid tissue with goitrous changes. She was in remission, and there was no evidence of thyroid or parathyroid dysfunction after surgery.

scholarly journals Thyroid Swelling and Thyroiditis in the Setting of Recent hCG Injections and Fine Needle Aspiration

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Elizabeth M. Lamos ◽  
Kashif M. Munir
Keyword(s):  
Thyroid Nodule ◽  
Fine Needle Aspiration ◽  
Needle Aspiration ◽  
Neck Mass ◽  
Cross Reactivity ◽  
Follicular Epithelium ◽  
Fine Needle ◽  
Thyroid Fine Needle Aspiration ◽  
Thyroid Swelling

A 60-year-old woman presented with a neck mass and underwent fine needle aspiration of a left thyroid nodule. During this time, she had been injected with hCG for weight loss. Soon after, she developed rapid diffuse thyroid growth with pain. She was ultimately diagnosed with thyrotoxicosis due to postaspiration subacute thyroiditis and subsequently became hypothyroid. This condition is rare in the nonpregnant state in noncystic nodules with a smaller needle gauge approach. The incidence of thyroid nodule discovery and evaluation is increasing. As more procedures are undertaken, understanding of potential complications is important. This case highlights potential complications of thyroid fine needle aspiration including diffuse thyroid swelling and thyroiditis. The role of hCG injections is speculated to have potentially stimulated thyroid follicular epithelium via cross-reactivity with the TSH receptor and contributed to the acute inflammatory response after fine needle aspiration.

scholarly journals Clavicular Metastasis as an Initial Presentation of Papillary Thyroid Cancer

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Russell Fung ◽  
Madeline Fasen ◽  
Firas Warda ◽  
Patrick Natter ◽  
Stacey Nedrud ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Carcinoma ◽  
Needle Aspiration ◽  
Neck Mass ◽  
Pathology Report ◽  
X Rays ◽  
Papillary Thyroid ◽  
Cancer Specific Survival ◽  
Cell Variant ◽  
The Right

Objective. We present the case of a 44-year-old man with a large neck mass to highlight the unique presentation of papillary thyroid carcinoma (PTC) metastatic to the clavicle. Methods. We reviewed the medical record for a detailed history and physical examination findings. Our radiology colleagues examined the diagnostic imaging studies performed. The pathology team reviewed the neck mass biopsy and the confirmatory surgical pathology after total resection of the mass. Results. A 44-year-old man presented with an enlarging neck mass. Initial X-rays revealed a large soft tissue density mass that extended to the midline of the right clavicle. A neck ultrasound established a 5.4 × 3.6 cm mass with increased vascularity and calcification extending from the thyroid. A CT scan noted the extension of the mass into the adjacent sternoclavicular junction with osteolysis of the middle third of the clavicle and the superior aspect of the sternal body. Fine-needle aspiration revealed a thyroid neoplasm with follicular features and positive immunostaining consistent with thyroid carcinoma. The patient underwent a composite resection of the tumor, including a segmental osteotomy of approximately two-thirds of the medial clavicle. The pathology report confirmed PTC with extrathyroidal extension and clavicle involvement (staged pT4a pN0), with further genomic findings showing positive KRAS mutation. Conclusion. Clavicular metastasis from differentiated thyroid cancer is rare. While the prognosis is generally favorable, various factors, including age greater than 45 years, poor differentiation, follicular thyroid carcinoma, Hurthle cell variant, and extrapulmonary metastasis, have typically been associated with poorer cancer-specific survival.

scholarly journals Chronic thyroiditis in lateral ectopic thyroid mimicking cervical metastasis of thyroid cancer

2021 ◽  
Vol 2021 ◽  
Author(s):  
Simone Pederzoli ◽  
Tiziana Salviato ◽  
Francesco Mattioli ◽  
Gianluca Di Massa ◽  
Giulia Brigante
Keyword(s):  
Fine Needle Aspiration Biopsy ◽  
Frozen Section ◽  
Thyroid Tissue ◽  
Needle Aspiration ◽  
Neck Mass ◽  
Ectopic Thyroid ◽  
Ultrasound Guided ◽  
Chronic Thyroiditis ◽  
Cervical Mass ◽  
Ectopic Thyroid Tissue

Summary We present the case of a 45-year-old Caucasian woman who attended the Endocrinology Unit for a left cervical mass discovered during follow-up for autoimmune chronic thyroiditis. The ultrasound-guided fine-needle aspiration biopsy of the lesion was consistent with a metastasis of follicular thyroid carcinoma. The sonographic neck evaluation revealed no thyroid nodules but three markedly hypoechoic and highly vascularized areas, with irregular margins and hyperechoic spots. In the clinical suspicion of primary thyroid neoplasm, ultrasound-guided fine-needle aspiration biopsy of two of the three areas was performed, but both cytological reports were non-diagnostic, revealing only colloid and blood. Subsequently, the patient underwent surgical removal of the cervical mass, with the intra-operatory consultation with frozen section examination suggesting follicular-like neoplasia. For this reason, thyroidectomy with both central and lateral neck dissection was performed. Surprisingly, the final histologic examination revealed chronic thyroiditis in the thyroid specimen and no evidence of metastasis in the left neck mass. Consequently, the pathological revision of the frozen section assessment led to the final diagnosis of chronic thyroiditis on the lateral ectopic thyroid. This case represents an uncommon example of lateral ectopic thyroid tissue with coexisting normally located thyroid tissue both affected by chronic thyroiditis. Learning points Ectopic thyroid must be considered in the diagnostic work-up of lateral neck mass. Even if rare, ectopic thyroid tissue can be found lateral to the carotid sheath and with coexisting normally located thyroid tissue. As the orthotopic tissue, lateral ectopic thyroid tissue can be affected by chronic thyroiditis, which may complicate the diagnosis both on ultrasound and cytology.

scholarly journals A case of papillary thyroid carcinoma in toxic adenoma: are hyperfunctioning nodules truly innocent all the times?

2017 ◽  
Vol 4 (3) ◽  
pp. 1093
Author(s):  
Banu Sarer Yurekli ◽  
Hatice Ozisik ◽  
Nilufer Ozdemir Kutbay ◽  
Ozer Makay ◽  
Gokhan Ozgen ◽  
...  
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Thyroid Tissue ◽  
Follicular Neoplasm ◽  
Pathology Report ◽  
Papillary Thyroid ◽  
Toxic Adenoma ◽  
Thyroid Lobectomy

Thyroid nodule is seen commonly in clinical practice. Thyroid scintigraphy should be performed for the evaluation of thyroid nodules in case of suppressed TSH. We would like to present a case of toxic adenoma with the diagnosis of papillary thyroid carcinoma. Forty-four-year-old female patient had applied to the hospital with the diagnosis of thyroid nodule. Thyroid fine needle aspiration biopsy (FNAB) was performed for the evaluation of thyroid nodule measured as 47x12 mm. This nodule was in mixed solid form bearing cystic components. FNAB revealed that the thyroid nodule was benign. Our ultrasonographic evaluation was consistent with a thyroid nodule located at right lobe with a diameter of 43x18x28 mm. The patient underwent right thyroid lobectomy. Pathology report revealed macrofollicular variant of papillary thyroid carcinoma. The tumor was 3.5 cm in diameter with regular margin and 0.2 cm away from the surgical border. The tumor didn’t spread out of the thyroid capsule. Second thyroid surgery was performed due to remaining thyroid tissue. After that ablative radioactive iodine therapy was applied. Guidelines in Endocrine literature report that hyperfunctioning nodules are almost always benign. However, the risk of malignancy was reported as a weighted rate of 3.1%. As follicular lesions are seen in high percentage in hot nodules, surgery should be recommended in case of the cytological results of a follicular neoplasm of a hyperfunctioning nodule. So, hyperfunctioning thyroid nodules warrants careful evaluation and appropriate therapy. We wanted to draw attention of the clinicians for this rare issue.

Zenker Diverticulum: A Potential Pitfall in Thyroid Ultrasound Evaluation: A Case Report and Systematic Review of Literature

2019 ◽  
Vol 19 (1) ◽  
pp. 95-99 ◽  
Author(s):  
Gaetano Achille ◽  
Marco Castellana ◽  
Sabino Russo ◽  
Massimo Montepara ◽  
Vito Angelo Giagulli ◽  
...  
Keyword(s):  
Thyroid Nodule ◽  
Needle Aspiration ◽  
Neck Mass ◽  
Review Of Literature ◽  
Aspiration Cytology ◽  
Case Presentation ◽  
Zenker Diverticulum ◽  
Ultrasound Evaluation ◽  
Endoscopic Diverticulotomy ◽  
Needle Aspiration Cytology

Background and Objective: Zenker Diverticulum (ZD) can sometimes be misinterpreted as a thyroid nodule both at clinical evaluation and at Ultrasound (US). </P><P> Case Presentation: We reported the case of a 46-years-old woman complaining of a lump in the anterior left aspect of the neck. Following clinical examination and US evaluation, a thyroid nodule was initially diagnosed and the patient was referred to our institution to be submitted to a fine-needle aspiration cytology. </P><P> Management and Outcome: A ZD was suspected by US and diagnosed by gastrografin esophagram, thus an endoscopic diverticulotomy was requested. Conclusion: A correct US evaluation can be crucial for the appropriate management of a neck mass.

scholarly journals VANISHING PAPILLARY THYROID CARCINOMA: MORPHOLOGICAL CHANGES AFTER FINE-NEEDLE ASPIRATION

2019 ◽  
Vol 5 (5) ◽  
pp. e298-e301
Author(s):  
Maria Teresa Jose ◽  
Bryan Hunt ◽  
Steven B. Magill
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Nodule ◽  
Total Thyroidectomy ◽  
Fine Needle Aspiration ◽  
Morphological Changes ◽  
Needle Aspiration ◽  
Surrounding Tissue ◽  
Pathology Report ◽  
Papillary Thyroid ◽  
Fine Needle

Objective: Fine-needle aspiration (FNA) of a thyroid nodule is typically considered a benign procedure. Uncommonly, morphological changes can occur in the nodule or tissue after the procedure. These changes have been noted in tissues like thyroid, breast, lymph node, and prostate. The objective of this case report is to report the rare occurrence of thyroid cancer diagnosed on FNA, appearing as a necrotic mass after near total thyroidectomy and to emphasize the need for confirmation of diagnosis with histopathology. Methods: A 69-year-old man was seen for a self-discovered neck mass. Thyroid ultrasound demonstrated a thyroid nodule with suspicious features. Ultrasound-guided FNA of the nodule was performed with a 22-gauge needle without immediate complications. Results: The cytology was read as consistent with papillary thyroid cancer with a preoperative thyroglobulin level of 15,288 ng/mL (normal range is 1.6–55 ng/mL). After a near total thyroidectomy, histopathology revealed complete infarction of the tumor with no evidence of cancerous tissue remaining. Based on the pathology report, he was considered cured of the cancer and did not receive radioactive iodine therapy. Conclusion: The occurrence of tissue infarction following FNA of a thyroid nodule is rare, reportedly <2%. We conclude a review of the original cytology material and a thorough examination of remaining viable tissue be made. Complete evaluation for invasion of the capsule or surrounding tissue must be ascertained to decrease diagnostic errors.

scholarly journals A Report About a 23-year-old Young Mother Suffering From Rare Insular Thyroid Carcinoma

2020 ◽  
Author(s):  
haibin chen ◽  
zhongmin liu ◽  
xiaoyan liang ◽  
rui wu
Keyword(s):  
Thyroid Carcinoma ◽  
Elderly Women ◽  
Needle Aspiration ◽  
Neck Mass ◽  
Maximum Diameter ◽  
Young Mother ◽  
Left Neck ◽  
Poor Differentiation ◽  
Needle Aspiration Cytology ◽  
Histopathological Results

Abstract Background Insular carcinoma of thyroid (ICT) is a rare malignant tumor with poor differentiation of the thyroid , most patients are middle-aged and elderly women. Here is a report of a case involving a young woman suffering from insular thyroid carcinoma.Case report This report is about a 23-year-old young mother who already has three children of hers. she accidentally discovered a left neck mass with slight pain from local compression about half a year ago and did not seek medical treatment. She came to the hospital this time because the neck mass recently increased rapidly and she felt pressure on the trachea, affecting swallowing. Ultrasonography showed that the maximum diameter of the hypoechoic nodules was 61*46mm in the left and no lymph nodes enlargement were seen on both sides.The patient had a partial left thyroidectomy and histopathological results revealed ICT. Therefore, she completed total thyroidectomy and cervical lymph node dissection. The postoperative process was relatively smooth and the patient was successfully discharged.Conclusion：Not all patients with insular thyroid carcinoma have similar imaging findings, so Fine Needle Aspiration Cytology(FNAC)pathological diagnosis is necessary before surgery.

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