Radiological insights of ectopic thyroid in the porta hepatis: A case report and review of the literature

BACKGROUND Ectopic thyroid is defined as a rare developmental anomaly where thyroid tissues are atypically found in locations other than its normal anatomical position:Anterolateral to the second,third,and fourth tracheal cartilages.An intemperate descent or a migration failure of the thyroid anlage results in sub-diaphragmatic thyroid ectopia,a sparse clinical entity.CASE SUMMARY This case portrays a 63-year-old female patient presenting with chronic abdominal discomfort at a local hospital whereby a computed tomography(CT)scan revealed a well-defined mass in the hepatic entrance.For further examination,the patient underwent a CT scan with contrast,magnetic resonance imaging(MRI),and CT-angiography(CTA)at our department.The CT scan showed a welldefined and high attenuated mass measuring 43 mm×38 mm in the hepatic entrance with calcification.The CTA revealed an additional finding:Blood supply to the mass from the right hepatic artery.MRI of the upper abdomen demonstrated a mass with mixed signal intensity on T1 and T2 weighted images in the hepatic entrance.The patient underwent surgery with resection of the mass which was sent for histopathology.Ectopic thyroid at the level of porta hepatis with nodules was the definitive diagnosis since histopathological report revealed presence of thyroid tissue in the resected liver mass.CONCLUSION This case delivers a rare insight of pre-operative radiological imaging of an ectopic thyroid located in the liver.These findings can aid in narrowing down potential differential diagnosis when managing a patient with those subsequent findings.

Multiple ectopic goiter in the retroperitoneum,abdominal wall,liver,and diaphragm:A case report and review of literature

BACKGROUND Ectopic thyroid is a rare developmental disorder,typically found in lingual areas,and most distantly in the abdomen.Thyroid ectopia in multiple regions is extremely rare.To date,there are no reports of ectopic goiter in four regions of the abdominal cavity in a single patient.CASE SUMMARY We present a case of thyroid ectopia in four areas of the abdomen,comprising normal orthotopic thyroid tissue.A 36-year-old woman,who underwent ovarian teratoma resection 10 years previously due to symptomatic ovarian teratoma,was referred to our hospital for treatment of an incidental hepatic mass.Magnetic resonance imaging and computed tomography(CT)of the abdomen showed a heterogeneously enhanced lobulated lesion in the sixth and seventh hepatic segment adjacent to the diaphragm.The mass was surgically excised,and histologic examination determined an ectopic nodular goiter.At the one-year follow-up,the abdominal CT scan,whole-body radionuclide I131 examination,and abdominal wall biopsy showed similar lesions in the left renal fascia and anterior abdominal wall.CONCLUSION Multiple para-ectopic thyroid is often misdiagnosed,owing to its extremely rare incidence and non-specific clinical manifestations and imaging features.A combination of multiple examinations is necessary for diagnostic accuracy.

Rare primary mature teratoma of the liver:A case report

BACKGROUND Primary liver teratoma is an extremely rare tumor usually affecting children under the age of 3 years.Specific signs of teratoma on ultrasound,computed tomography(CT)or magnetic resonance imaging are lacking,which makes morphology the only diagnostic tool.Misdiagnosis of a mature teratoma may lead to excessive liver resection,whereas misdiagnosis of an immature teratoma may result in spread,causing a life-threatening condition.Consequently,a careful tumor examination is important,and the rarest types of tumors must be accounted for.CASE SUMMARY We describe a 52 years old female who presented with a solid mass in the left liver lobe.Contrast-enhanced CT and magnetic resonance imaging(MRI)revealed a round,heterogeneous lesion containing a number of fluid areas and areas of calcification in the middle,and the provisional diagnosis was cholangiocarcinoma.The patient underwent resection of liver segment I.Immunohistochemistry analysis of the resected lesion indicated thyroid follicular epithelium;however,the thyroid gland was intact.10 years prior to presentation the patient underwent a surgery due to mature teratoma of the right ovary,nevertheless the tumor was benign and could not spread to the liver,in addition teratoma of the liver was also benign.This led to the final diagnosis of primary mature liver teratoma.CONCLUSION Primary hepatic teratoma,including heterotopia of the thyroid gland in the liver,is an extremely rare condition in adults that needs to be considered in the differential diagnosis of solid-cystic neoplasms in the liver and cholangiocarcinoma.This case adds to the limited literature on the patient presentation,clinical workup and management of liver teratomas.