Case report: - A case report on the management of symptomatic Lingual throid.

INTRODUCTION: The lingual thyroid gland refers to ectopic thyroid tissue situated at the base of the tongue. This rare condition occurs when the thyroid gland fails to descend to its usual position in the pre-tracheal area during embryonic development. CASE PRESENTATION: We present a case of a 23-year-old female who presented with throat discomfort and progressive difficulty of swallowing upon examination there was a mass at the level of the base of the tongue. She was investigated with a thyroid function test, neck ultrasound, at the tongue's base, and head and neck CT scan. With a diagnosed lingual thyroid she was managed initially with suppression therapy followed by elective surgical removal. The work has been reported in line with the SCARE criteria. CLINICAL DISCUSSION: The incidence of lingual thyroid is reported to be 1 in 100,000, with a higher prevalence among females, in a ratio of 3:1 compared to males. Symptoms can vary and may include difficulty swallowing (dysphagia), voice changes (dysphonia), upper airway obstruction, or occasional bleeding, and can manifest from infancy to adulthood. CONCLUSION: Lingual thyroid is a rare clinical anomaly treatment depending on the severity of symptoms, size of the lesion, sex and age of the patient, and thyroid function.

Coexistence of Eutopic Thyroid Gland and Ectopic Thyroid Tissue: Rare but Not Uncommon.

Ectopic thyroid tissue is very rare, but the coexistence of ectopic and eutopic thyroid glands is even more rare. The recognition of this diagnosis is important in patients who are being treated for thyrotoxicosis, but it is also crucial to exclude other associated serious disease conditions. In this article, we report three different cases that showed ectopic thyroid tissue with the coexisting presence of an eutopic thyroid gland. All three cases showed different outcomes. The recognition of this condition is of great importance because it alerts the referring physicians to this rare, yet possible occurrence and the potential pathological conditions associated with it. The first case showed how imaging could help outline even small ectopic thyroid tissue outside of the neck region even in cases where histopathological confirmation is difficult. The second case was very rare as thyroid carcinoma originated in ectopic thyroid tissue. In the last case, the initial imaging was misleading as it mimicked greatly ectopic thyroid tissue, and only detailed history and careful inspection of the images could lead to the correct interpretation of the findings.

Ectopic thyroid in the hepatoduodenal ligament: a case report and literature review.

Ectopic thyroid arises from abnormal development of thyroid primordial tissues as it migrates to the lower interstitium during the embryonic period, which can occur at various locations during the descent process. However, ectopic thyroid in the subdiaphragmatic area is extremely rare. In this case, we report a case of ectopic thyroid located in the hepatoduodenal ligament. The 60-year-old female patient was admitted to hospital with gallbladder stones and cholecystitis. Preoperative imaging showed a mass in the hepatoduodenal ligament. As the patient declined a needle biopsy of the mass, the nature of the mass remained unclear prior to surgery. The patient subsequently underwent laparoscopic cholecystectomy and exploratory resection of the mass. The histopathology of the resected mass showed the characteristics of ectopic thyroid, and immunohistochemical staining revealed positive expression of thyroid transcription factor-1 and thyroglobulin. The diagnosis of ectopic thyroid was established. Upon confirming the diagnosis, comprehensive neck examination revealed the presence of a normally functioning thyroid gland. Throughout the four-year follow-up period, the patient's thyroid ultrasonography and thyroid function tests indicated no abnormalities. Ectopic thyroid in the hepatoduodenal ligament and surrounding areas is an extremely rare clinical abnormality, achieving a clear diagnosis before initiating treatment offers diagnostic and treatment insights and clues for clinicians when differentiating masses within this region.

Computed tomographic findings in canine and feline heart base tumors (25 cases).

Tumors located at the heart base are rare in dogs and cats and aortic body tumors (chemodectoma/paraganglioma), hemangiosarcoma, ectopic thyroid carcinoma, lymphoma, and other uncommon neoplasia can be found at that location. The objective of this retrospective case series was to describe the CT characteristics of canine and feline heart base tumors. CT studies of 21 dogs and four cats with histologically or cytologically confirmed heart base tumors were reviewed for size, location, shape, margination, contrast enhancement, adjacent neovascularization, invasion, mass effect, cavitary effusions, and metastasis. Neuroendocrine tumors (15 aortic body tumors, three ectopic thyroid carcinoma, and three nonspecific neuroendocrine) were more commonly observed than hemangiosarcoma (4) and were frequently located between the cranial vena cava and aortic arch (12/21; 57%) and or dorsal to the pulmonary trunk bifurcation/pulmonary arteries (10/21; 48%). Hemangiosarcoma was more commonly found cranioventral to the aortic arch and cranial to the right auricular appendage (3/4; 75%). Mediastinal and peritumoral neovascularization was associated with 16/21 (76%) neuroendocrine tumors but none of the hemangiosarcoma. Median postcontrast attenuation in Hounsfield units (HU) was higher in neuroendocrine (110 HU) than in hemangiosarcoma (51 HU). Pericardial effusion was frequently observed with hemangiosarcoma (3/4; 75%) and infrequently in neuroendocrine (3/21; 14%). In four cases (all neuroendocrine), concurrent cranial mediastinal masses were present. CT provides useful information regarding the characteristics of heart base tumors, indicating differences between the appearance of neuroendocrine tumors and hemangiosarcoma. However, no differences were found between aortic body tumors and ectopic thyroid carcinoma.

Two Cases of Adrenal Cysts Lined by Thyroid Follicular Epithelium: Addressing Cellular Origin and Malignancy Concerns.

Adrenal cysts lined by thyroid follicular epithelium are rare, with only 14 reported cases of "ectopic thyroid tissue" to date. While the primary consideration for differential diagnosis is thyroid carcinoma metastasis, exclusion of metastases is determined based on the absence of a primary thyroid lesion, serological euthyroidism, lack of thyroglobulin elevation, and absence of epithelial atypia. Herein, we report 2 cases of adrenal cysts lined by thyroid follicular epithelium. Case 1 was a 60-year-old woman with a right adrenal cyst. Case 2 was a 51-year-old man with a left adrenal cyst. Over time, both cysts became larger, necessitating an adrenalectomy. Cystic epithelia were lined with thyroid follicular epithelium, exhibiting moderate atypia. Human bone marrow endothelial cell marker-1 and galectin-3 were focally positive; CK19 was positive in Case 1, and all 3 markers were positive in Case 2, previously reported as an immunophenotype of thyroid carcinoma. CD56 expression was positive in both cases. Targeted next-generation sequencing revealed several low-frequency mutations; however, no major driver alterations for thyroid cancer were detected. Adrenal cysts can be lined by thyroid follicular epithelium. Challenges arise in determining the malignant or benign nature of adrenal cysts.

Primary Intrathoracic Ectopic Papillary Thyroid Carcinoma, Presenting With Thoracic Spine Metastasis: A Case Presentation and Literature Review.

Thyroid cancer in ectopic thyroid tissue is a very rare entity. We report a patient with papillary thyroid cancer arising from upper mediastinal ectopic thyroid tissue. The patient presented with thoracic spine metastasis with cord compression. The patient was a 67-year-old woman, who presented with upper back pain. Magnetic resonance imaging (MRI) showed suspected metastatic disease in the second and third thoracic vertebrae (T2 and T3). She underwent laminectomy and decompression surgery at the T1-T3 level. The final pathology report showed metastatic thyroid carcinoma with papillary features. She underwent external beam radiation to the affected spine. Computerized tomography (CT) scan of the chest, abdomen, and pelvis showed a 3.0 × 2.8 × 2.3 cm soft-tissue mass in the left superior mediastinum extending into the supraclavicular region. Fluorodeoxyglucose-positron emission tomography (FDG-PET) scan showed hypermetabolic foci in the upper mediastinum. Fine needle aspiration (FNA) of the upper mediastinal mass was consistent with papillary thyroid cancer. Molecular testing from the FNA sample using Thyroseq V3 showed SQSTM1NTRK3 chromosomal rearrangement. A total thyroidectomy was performed. Pathology of the resected thyroid was benign. Pathology of the mediastinal mass showed a papillary thyroid carcinoma with focal tall cell features, forming a 4 × 2.5 × 2.5 cm mass. Surgery was followed by ablation with 100 millicuries (mci) of radioactive iodine (I-131) and external beam radiation. This case highlights the presentation of primary intrathoracic papillary thyroid cancer with SQSTM1-NTRK3 chromosomal rearrangement and the challenges in the diagnosis and management of this unique case. This patient had a very aggressive disease presentation that required multimodal treatment, including thoracic spine decompression, total thyroidectomy, primary intrathoracic goiter resection, high-dose radioactive iodine treatment, and external beam radiation to the affected spine area. SQSTM1-NTRK3 chromosomal rearrangement can be targeted by medications such as larotrectinib and endtrectinib.

Ectopic lingual thyroid with subclinical hypothyroidism in children.

OBJECTIVES: Lingual thyroid is a rare condition that affects approximately 1 in 100,000 individuals. Although it is usually detected in the pediatric population through newborn screening tests or evaluation of congenital hypothyroidism, there are cases in which it remains undetected until adulthood or until symptoms arise because of glandular enlargement. The possible symptoms of lingual thyroid include foreign body sensation in the throat, dysphagia, dyspnea, and hemorrhage. Several cases of lingual thyroid are asymptomatic and accompanied by subclinical hypothyroidism. Herein, we present three cases of lingual thyroid treated with thyroid hormone suppressive therapy. CASE PRESENTATION: The three patients sought medical attention because of a sore throat or foreign body sensation in the throat. Their newborn screening tests and developmental histories were normal. These patients exhibited subclinical hypothyroidism and were treated with hormone suppression therapy. CONCLUSIONS: Patients with lingual thyroid frequently exhibit subclinical hypothyroidism. Hormone treatment may help to reduce the size of the ectopic thyroid and improve symptoms. If an increase in size is noted during follow-up or symptoms do not improve, surgical treatments may be considered.

Ectopic colloid goiter in mediastinum with normal thyroid gland.

Ectopic thyroid tissue is a rare developmental abnormality involving aberrant embryogenesis of the thyroid gland during passage from the primitive foregut to the pretracheal position. The most frequent position is the base of the tongue (lingual thyroid); however, it has been described in other sites, such as the submandibular region, trachea, mediastinum, and subdiaphragmatic regions.Here, we report a case of an adenomatous goiter that developed in mediastinal thyroid tissue without any connection to the pretracheal thyroid gland.

Follicular adenoma with a papillary architecture originating from an ectopic thyroid gland: a case report.

BACKGROUND: Follicular adenomas with papillary architecture are rare tumors of thyroid origin and are composed of completely encapsulated follicular cells with a papillary architecture lacking the nuclear characteristics of papillary carcinoma. Herein, we present a case of follicular adenoma with papillary architecture originating from an ectopic thyroid gland, diagnosed from a mass in the submandibular region. CASE PRESENTATION: A 70-year-old woman was referred to our hospital with the chief complaint of a painless left submandibular mass that had been present for one year. The patient underwent left submandibular dissection for therapy and diagnosis. Microscopically, papillary lesions with fibrovascular cores were observed in the interior, and the epithelial cells were cylindrical in shape with eosinophilic cytoplasm, round or oval nuclei, with no pathological features, leading to a diagnosis of papillary carcinoma or follicular carcinoma. The mass was diagnosed as a follicular thyroid adenoma with papillary architecture. This is the first report of a follicular adenoma with a papillary architecture originating from an ectopic thyroid gland. CONCLUSION: This experience suggests that follicular adenoma should be included in the differential diagnosis of ectopic thyroid tumors.

Rare Coexistence of Aldosterone-producing Adrenocortical Adenoma Confirmed by an Immunohistochemical Analysis of Steroidogenic Enzymes with Adrenal Ectopic Thyroid Tissue: A Case Report and Literature Review.

A 56-year-old man presented with a history of hypertension; clinically, the patient had primary aldosteronism (PA) and a 4-cm left adrenal tumor. The left adrenal glands, resected by adrenalectomy, also contained ectopic thyroid tissue (ETT). An immunohistochemical analysis of steroid-converting enzymes revealed an aldosterone-producing adenoma (APA). Among 19 previously reported cases of adrenal ETT, 4 had adrenal hormonal abnormalities, all of which were PA. This is the first case of adrenal ETT coexisting with APA, confirmed by steroid-converting enzyme expression. Further analyses using cumulative case data are required to clarify the correlation between adrenal ETT and APA.

A case report of ectopic thyroid adenoma resection by transaxillary non-inflatable endoscopic surgery.

INTRODUCTION AND IMPORTANCE: The ectopic thyroid gland is a rare disease in which abnormal migration of the embryonic thyroid germ is thought to be the basis for the formation of the ectopic thyroid gland. CASE PRESENTATION: A 37 year old female sought medical attention due to feeling a sensation of swallowing foreign objects, without any other positive symptoms such as pain or difficulty breathing. Preoperative examination revealed a nodule in the left lobe of the thyroid gland and a nodule behind the left lobe. The patient ultimately underwent non-inflatable endoscopic surgery under the axilla to completely remove the tumor located in the suprasternal fossa. Postoperative pathological examination confirmed ectopic thyroid adenoma. The patient's postoperative thyroid function was normal. CLINICAL DISCUSSION: The diagnosis of ectopic thyroid is difficult due to its highly non-specific histological characteristics and positional changes. However, clinical diagnosis and treatment should not overlook the possibility of ectopic thyroid. On the basis of completely removing the lesion, the transaxillary non-inflatable endoscopic surgery also meets the patient's minimally invasive and aesthetic needs. CONCLUSION: The diagnosis of ectopic thyroid is difficult, and through transaxillary non-inflatable endoscopic surgery, the tumor can be completely removed and the patient's aesthetic needs can be met.

The clinicopathological features, treatment outcomes and follow-up results of 47 ectopic thyroid gland cases: a single-center retrospective study.

Background: Ectopic thyroid gland (ETG) is an uncommon clinical condition, presenting various challenges and limitations in its regulate diagnosis and treatment currently. This study aims to enhance our understanding of ETG and improve the strategies for its diagnosis and treatment. Methods: The retrospective single-center study was conducted, encompassing clinical data from ETG patients screened at our institution between 2013 and 2022. Patients were categorized based on the location of the disease, and follow-ups were performed on each. Results: This study included a total of 47 patients who were confirmed to hav confirmed to have ETG. Among them, we found 29 cases of accessory thyroid and 18 cases of aberrant thyroid. Furthermore, 42 cases exhibited the single ETG, while 5 cases displayed the double ETG. The distribution of the ETG was as follows: 20 were lingual, 10 were submandibular, 10 were lateral cervical, 4 were thoracic mediastinal, 1 was esophageal, and 7 were ovarian. Of these cases, 22 patients underwent surgery, 18 received thyroid hormone replacement therapy, and 7 were placed under observation. All patients were followed up for 59.4 (12-117) months. No significant abnormalities were detected at the conclusion of the follow-up period. Conclusion: ETG is frequently observed in the head and neck, particularly in lingual. Accessory thyroid glands are commonly reported, with most cases being single ETG. Notably, these glands usually do not manifest specific clinical symptoms. Therefore, the appropriate and comprehensive examinations during the initial diagnosis are crucial to avoid misdiagnosis. Treatment should be individualized, and long-term follow-up is essential for managing ETG effectively.

Pancreatic ectopic thyroid tissue: A case report and analysis of literature.

Ectopic thyroid is a rare malformation induced by a migration defect in the developing gland during embryogenesis. In 90% of cases, the ectopic thyroid is located in the lingual region, whereas it is extremely rare in the abdominal cavity, particularly in the pancreas. A 50-year-old female patient presented to the Taizhou First People's Hospital with a complaint of recurrent mid-lower abdominal pain and diarrhea for approximately a month. The abdominal computed tomography scan revealed a space-occupying lesion with abundant blood supply in the head of the pancreas during the consultation. This led to the suspicion of a neuroendocrine tumor. The doctor considered that this lesion in the head of the pancreas could be responsible for the patient's incontinence. A laparoscopic pancreaticoduodenectomy was performed after relevant tests were undertaken and contraindications were ruled out. The patient was diagnosed with ectopic thyroid of the pancreas through postoperative pathology. Ectopic thyroid can be considered in middle-aged and elderly women who present with a mass with abundant blood supply and an unknown diagnosis. Subsequent treatments should be decided after fine-needle aspiration cytology.

High survival simultaneous occurrence of papillary thyroid carcinoma and ectopic thyroid with medullary thyroid carcinoma; case report and literature review.

Thyroid cancer is usually treated with surgical intervention followed by ablative radiotherapy if indicated to eliminate any metastases. Five-year survival rates are 99% for papillary thyroid carcinoma (PTC) and 82% for medullary thyroid carcinoma (MTC). The chances of survival decrease significantly with two simultaneous types of cancers and with male gender. PTC and MTC present as different entities. The coexistence of different types of thyroid carcinoma in a patient is a rare event. We report the case of a 45-year-old Saudi male with a rare synchronous occurrence of PTC in the thyroid gland, along with ectopic MTC with a unique prognosis over the years. Our case adds data to the literature supporting the coincidental coexistence of PTC and MTC.

En bloc resection of pararectal ectopic thyroid tissue: a case report.

A pararectal mass' specific diagnosis can be challenging as a broad range of both benign and malignant tumors are possible. Many of these lesions are congenital and do not require treatment, if asymptomatic. Special attention is to be paid when imaging findings are not typical. In such cases, definitive diagnostic can require surgical excision. To this day, ectopic thyroid tissue was not part of known differential diagnosis. This is the first reported case of thyroid adenoma found in the perirectal area. Ectopic thyroid gland can progress over time and include malignant transformation, although rare. It needs to be considered when managing these cases, especially in unusual locations. This case report offers a systematic approach to the atypical pararectal tumor. It shares new specific clinical experience in managing a case  of pararectal ectopic thyroid adenoma, from both a surgical and a histopathological point of view.

Parapharyngeal space ectopic thyroid with eutopic papillary thyroid cancer: A case report.

BACKGROUND: Ectopic thyroid is a rare condition. Here we report an extremely rare case of parapharyngeal space ectopic thyroid, which has simultaneously found the papillary thyroid carcinoma of the eutopic thyroid. CASE PRESENTATION: A 54-year-old woman was admitted to our hospital for a thyroid tumor and neck lymph nodes. CT and MR imaging revealed the presence of a thyroid right node, as well as a right parapharyngeal mass with a diameter of 2.5 × 2.3 cm. PET-CT was also performed to diagnose further, revealing that the suv metric of the PPS mass was 4.03. Considering that the mass was asymptomatic, we did not handle it at the first thyroid surgery. However, when the patient underwent a radioactive iodine scan before the radioactive iodine treatment, the imaging showed that the mass could intake the iodine. So, we arranged the second surgery for this mass, and the postoperative pathological examination confirmed the mass was well-differentiated thyroid tissue. CONCLUSION: Parapharyngeal ectopic thyroid with eutopic thyroid cancer is extremely rare. Preoperative imaging examination can significantly avoid the missed diagnosis of this disease. Surgical resection is recommended for the ectopic thyroid while the eutopic thyroid is found to be malignant.

An unusual ectopic thyroid tissue location & review of literature.

Ectopic thyroid is well-known pathology for several decades. Many locations have been described. Nowadays, only three cases of skull base location have been described in literature. In our case, we reported a single case of a 39-year-old male presenting with a supra-sellar and suprachiasmatic location. He presented no clinical symptoms, no endocrine alteration on biology and no skull base invasion which make this case unique compared to actual literature. Such diagnosis should always be an exclusion diagnosis as secondary neoplastic should be first ruled out.