Dignosis and Treatment of Primary Malignant Lymphoma of the Thyroid Gland

Primary malignant lymphoma of the thyroid gland is a rare disease comprising about 1%–3% of the thyroid malignancies, and this uncommon lymphoma represent less than 1% of all non-Hodgkinlymphomas (NHL). According to the modified Ann-Arbor-Classification primary thyroid lymphoma by definition is a lymphoma that is restricted to the thyroid gland (stage I E ) or involves the thyroid gland and supradiaphragmatic predominantly adjacent thyroid lymph nodes (stage II E ). Primary thyroid lymphoma is a heterogenous disease encompassing a wide variety of lymphoma entities. The diagnosis and treatment of this lymphoma are emphasis of this article. Key words thyroid gland - lymphoma - diagnosis - treatment

Extrapleural solitary fibrous tumor of the thyroid gland: A case report and review of literature

BACKGROUND Solitary fibrous tumor(SFT)is an uncommon mesenchymal neoplasm that arises from the pleura.A few SFTs have also been described in extrapleural sites.However,SFT of the thyroid gland is rare.Here,we report a case of extrapleural SFT on the thyroid gland,in addition to a literature review.CASE SUMMARY A 59-year-old man visited our hospital in July 2017 complaining of a large mass in his neck.His thyroid function test results,including antibody levels,were within the normal limits.Ultrasonography showed a 4.7 cm×4.0 cm×3.2 cm solitary mass of intermediate suspicion in the left thyroid lobe.A fine-needle aspiration biopsy was subsequently performed.The pathologist reported a benign follicular lesion.However,the size of this nodule increased to 5.5 cm×5.0 cm×3.4 cm by April 2018.After a multidisciplinary discussion,a left lobectomy was performed in May 2018.The specimen showed a well-demarcated,partly encapsulated,soft nodule of whitish and tan/brown color on the cut surface.Light microscopy revealed high cellularity with moderate cytologic atypia.The mitotic count was 5/10 high-power fields.There was no tumor necrosis or lymphovascular invasion.The tumor was CD34-positive and signal transducer and activator of transcription 6-positive.Neither thyroid transcription factor-1 nor cytokeratin expression was detected.The Ki-67 showed intermediate proliferative activity.The final diagnosis was extrapleural SFT of the thyroid gland with a clear resection margin.The patient was discharged without complication three days after the surgery.CONCLUSION In the literature,extrapleural SFT of the thyroid gland has been reported to behave indolently with the capacity for recurrence and rare metastasis,although surgical resection is the treatment of choice.Understanding this disease entity is important for accurate diagnosis and proper management.

Metastasis to the thyroid gland from primary breast cancer presenting as diffuse goiter:A case report and review of literature

BACKGROUND Metastasis to the thyroid gland(TM)from primary breast cancer is uncommon and usually presents as thyroid nodules;however,diffuse goiter without thyroid nodules is the first sign of TM in rare cases.Skip metastases(SMs)to the lymph nodes in breast cancer,defined as discontiguous higher-level metastases in the absence of lower levels of contiguous metastases,have been reported in the contralateral cervical area of the primary tumor site in rare cases.CASE SUMMARY A 49-year-old previously healthy Chinese woman was diagnosed with right lateral invasive ductal carcinoma and underwent neoadjuvant chemotherapy treatment and bilateral mastectomy with axillary lymph node dissection.No malignancy of the left breast or axillary or distant metastases were identified preoperatively.However,enlarged left cervical lymph nodes were detected 36 mo after surgery,and rapidly enlarging thyroid glands without nodules were detected 42 mo after surgery.Fine-needle aspiration cytology was performed on the left cervical lymph nodes and left lobe of the thyroid,which were both revealed to contain metastases from the primary breast cancer.Additionally,the immunostaining profiles changed in the process of metastases.The patient was discharged with the NP(vinorelbine and cisplatin)regimen for subsequent treatment,and stable disease was determined when the curative effect was evaluated.CONCLUSION Diffuse goiter may be the first sign of TM,and enlarged lymph nodes in the contralateral cervical area may be SMs of primary breast cancer.

Blunt injury to the thyroid gland: A case of delayed surgical emergency

Blunt trauma to the thyroid gland is a possibly life- threatening condition known for years. However, only few cases have been reported in the English-language literature, so that no consensus has emerged as to its workup or management.

Colorectal cancer metastases to the thyroid gland:A case report

BACKGROUND Secondary malignancies of the thyroid gland are a rare finding in clinical practice.In addition,colorectal metastasis to the thyroid(CMT)is even more infrequently diagnosed.The source of the primary tumor follows demographic and ethnic patterns,which reflects the most prevalent malignancies in the different populations.Colorectal cancer is one of the most common types of cancer worldwide;nevertheless,CMT is infrequently diagnosed.Most of them are identified during the follow-up of gastrointestinal primary malignancies.Due to the improvement of image techniques,oncological treatment,and follow-up,survival and consequent diagnosis of metastatic disease are more frequent.Those facts make this entity a diagnostic and therapeutic challenge,due to the lack of information and the difficulties performing clinical trials and research.CASE SUMMARY Here,we present a case report of a patient diagnosed with CMT of adenocarcinoma of the rectum evidenced during follow-up,4 years after neoadjuvant chemoradiotherapy,who had subsequent curative surgical treatment of the primary tumor and inter-current lung bilateral metastases.CONCLUSION Thyroid metastases of extra-thyroid origin are an uncommon finding,even rarer in cases of CMT.The diagnostic process,as well as survival of oncologic patients is improving,and consequently the number of metastases to the thyroid gland is increasing.

Metastasis of esophageal squamous cell carcinoma to the thyroid gland with widespread nodal involvement: A case report

BACKGROUND Esophageal cancer is one of the most common causes of cancer-related death.Some patients with esophageal cancer have distant metastases at the time of diagnosis,but metastasis to the thyroid gland(MTG)and multifocal thyroid lesions alone are extremely rare.CASE SUMMARY In this case report,we present a case of a 69-year-old male with esophageal MTG.The patient visited our hospital for a routine body check-up,which revealed multifocal nodules in his thyroid lobes and enlarged cervical lymph nodes.A fine needle aspiration biopsy showed malignancies in both thyroid lesions and lymph nodes.The patient was initially diagnosed with primary bilateral thyroid cancer that spread to his lymph nodes,and a total thyroidectomy was performed.The histology showed MTG and therefore,a diagnostic work-up was implemented to determine the primary tumor.A fluorine-18-deoxyglucose positron emission tomography scan showed that the lower part of the esophagus and the lymph nodes in the neck,chest,and abdomen were involved.An esophagogastroscopy and corresponding pathology revealed distal esophageal squamous cell carcinoma.The esophageal MTG diagnosis was confirmed with pathological immunohistochemistry.CONCLUSION This case report highlights the difficulty in diagnosing esophageal MTG.Patients may have no malignancy history and be asymptomatic.Further diagnostic procedures are necessary after MTG is confirmed by cytology or histology,and the final diagnosis should be made according to the identification of the primary malignancy combined with pathological immunohistochemistry findings.

A Case Report of Thyroid Gland Squamous Carcinoma with Multiple Metastases

The patient was a female, 65 years to feel intermittent discomfort in old. Early in 1996, she began her neck, accompanied with hoarseness. In June, 2000, when she entered our hospital and accepted a physical examination, we found a 3 cm×2 cm tumor at the lower pole of the thyroid gland. Neck CT showed that the mass was located at the inferiorposterior right part of the thyroid gland with a diffuse boundary. MRI showed that the right thyroid cartilage wall was incomplete. Fine-needle aspiration cytology indicated a suspected papillary tumor.

The Comparison of Entrance Surface Radiation Dose to the Thyroid Gland Region in Different Dental Panoramic Radiography

Introduction:The proven radio sensitivity and the position of the thyroid gland make it a significant organ during the dental radiography exposure.Objectives:This study compared the surface radiation dose to the thyroid gland region during two different techniques of two dimensional(2D)conventional orthopantomography(OPG)and three dimensional(3D)OPG reconstructed from cone beam computed tomography(CBCT).Methods:The entrance surface dose to the thyroid region of the patients was evaluated using a personal dosimeter in a sample of 156 patients who prescribed for an OPG examination.Results:The obtained mean dose values for conventional OPG and reconstructed OPG from CBCT are 7.47μSv and 28.65μSv,respectively.Further a significant difference(p<0.05)was observed between those two doses.Conclusions:A significant amount of dose reduction to the thyroid gland region can be obtained when using conventional OPG compared to the CBCT.

Mobile Phone Use and Risk of Thyroid Gland Lesions Detected by Ultrasonography

In recent years, widespread use of mobile phones has led to a public debate about possible harmful effects on human health. A lot of researchers studied the possible effect of radiofrequency energy (RFE) emitted from cell phones on the human body. Up to our knowledge no one studied the effect of these waves on the thyroid gland by Ultrasonography (US). Our aim was to investigate the possible effects of EMR arising from cell phones on the thyroid gland using US. A prospective study was done on 180 participants, 110 females and 70 males, ranging in age from 15 to 65. A constructed questionnaire was distributed among them before performing US of the neck. Demographic data along with US findings were collected and statistically analyzed. A total of 46.7% of our participants had abnormal findings of the thyroid gland more in non smart phone users and more in females. The commonest abnormality was multinodular goiter (54%). Expanded researches are still needed to answer the question about the hazards of RFE on human health. All efforts should be made to encourage users of cellular phone to follow mobile device recommendations of manufacturers and avoid its possible hazards as possible.

Migrating fish bone piercing the common carotid artery,thyroid gland and causing deep neck abscess

Foreign body(FB) ingestion is very common in Malaysian population.The most commonly ingested FB is fish bone.Common presenting symptoms include FB sensation,odynophagia and or sharp pricking pain during swallowing.A careful history and physical examination is very important.Despite negative laryngoscopy and rigid esophagoscopy,persistent symptoms warrants further radiographic imaging studies.The FB can migrate extraluminally and involve other important adjacent structures of the neck and along the digestive tract.We report 3 cases of extraluminal migration of fish bone and their complications,which were successfully managed.One case with vascular complication which involve common carotid artery and the other two cases with neck abscess formation involving thyroid gland,retropharyngeal and parapharyngeal abscess.

The Ultrastructural Changes of Adult Porcine Thyroid Glands Following TSH Stimulation in Organ Culture

A culture technique had been developed by which the normal mor-phological integrity of the porcine thyroid tissue was well preserved. Few ultra-strvctural changes following TSE stimulation could be detected compared withthe control group. Parafollicular cells were detected after being cultured for 96h in the presence of TSH. For the first time, we used scanning electron micro-scope to study the ultrastructural changes of organ cultured thyroid gland.

Interferon-induced progression of autoimmune thyroiditis with enlarged thyroid glands in gynecological patient: A case report and literature review

A case report presents a progression of autoimmune thyroiditis with an abnormal enlargement of the thyroid glands and increased thyreotropin hormone concentration-associated with interferon treatment in human papillomavirus infected patient with the autoimmune thyroiditis and a daily L-thyroxin hormone replacement therapy background. Observation was supplemented with a brief review of literature and discussion. On the basis of this observation and a brief review of literature authors suggested that the potential adverse effects of interferon therapy are overbalanced than its benefits for gynecological patients, therefore any interferon treatment should be recommended with strict indications as well as after screening of conditions and functions of thyroid glands and other interferon target organs to avoid interferon treatment side effects. Practitioners especially gynecologists should inform their patients about pleiotropic interferon effects and its high frequent and wide range side effects before to start such kind of treatment.

Esthesioneuroblastoma, Thyroid Gland Carcinoma and Gastrointestinal Stromal Carcinoma

Olfactory neuroblastoma (esthesioneuroblastoma, ЕNB) is a rare tumor arising from the olfactory neuroepithelium. We report a case of ЕNB located in inferior nasal concha, combined with thyroid gland carcinoma and gastrointestinal stromal carcinoma in a 77-year-old man. The tumor was resected endonasally. When the final diagnosis of olfactory neuroblastoma was confirmed by histopathologic examination and immunohistochemical staining, the PET/CT examination was performed. The imaging revealed a small focus of a moderately increased cancer activity in the thyroid region. A gastrointestinal stromal carcinoma was detected one year after the resection of the thyroid gland. We discuss the clinical appearance of ENB, staging systems, diagnosis and management. During the endonasal surgery, ENB was removed entirely. Seven days after operation, in order to monitor the postoperative result, PET/CT was performed and a papillary thyroid cancer was detected. One year after the thyroid surgery, gastroendoscopy showed a neoplastic formation in the stomach. In conclusion, we state that when identified as aggressive tumors such as ENB, it is necessary to provide regular examinations in order to detect distant ENB metastases or other neoplastic localisations.

Tuberculosis of Thyroid Gland: A Case Report with Review of Articles

Objective: Tuberculosis of thyroid gland is encountered in only 0.1% - 0.4% thyroid biopsies. We are presenting a case to emphasize inclusion of this rare disorder as a potential differential diagnosis during the assessment of thyroid lesions. Case report: 38-year female presented with a cystic nodule of left lobe of thyroid. Guided aspiration yielded only necrosed material. Biopsy revealed caseating granuloma with giant cells. Tuberculosis etiology was confirmed by PCR examination. Conclusion: Thyroid tuberculosis should always be considered as a probability during assessment of any midline cervical mass. Pre-operative diagnosis can avoid unnecessary surgery.

Factors influencing postoperative anxiety and depression following Iodine-131 treatment in patients with differentiated thyroid cancer:A cross-sectional study

BACKGROUND Differentiated thyroid cancer(DTC)often seriously impacts patients’lives.Radionuclide Iodine-131(131I)is widely used in treating patients with DTC.However,most patients know little about radionuclide therapy,and the treatment needs to be performed in a special isolation ward,which can cause anxiety and depression.AIM To explore anxiety and depression status and their influencing factors after 131I treatment in patients with DTC.METHODS A questionnaire survey was conducted among postoperative patients with DTC who received 131I treatment at our hospital from June 2020 to December 2022.General patient data were collected using a self-administered demographic characteristics questionnaire.The self-rating depression scale and self-rating anxiety scale were used to determine whether patients were worried about their symptoms and the degree of anxiety and depression.The patients were categorized into anxiety,non-anxiety,depression,and non-depression groups.Singlevariable and multiple-variable analyses were used to determine the risk factors for anxiety and depression in patients with thyroid cancer after surgery.RESULTS A total of 144 patients were included in this study.The baseline mean score of self-rating anxiety and depression scales were 50.06±16.10 and 50.96±16.55,respectively.Notably,48.62%(70/144)had anxiety and 47.22%(68/144)of the patients had depression.Sex,age,education level,marital status,household income,underlying diseases,and medication compliance significantly differed among groups(P<0.05).Furthermore,multivariate logistic regression analysis showed that education level,per capita monthly household income,and medication compliance level affected anxiety(P=0.015,0.001,and 0.001 respectively).Patient’s sex,marital status,and underlying diseases affected depression(P=0.007,0.001,and 0.009,respectively).CONCLUSION Nursing interventions aiming at reducing the risk of anxiety and depression should target unmarried female patients with low education level,low family income,underlying diseases,and poor adherence to medications.

Effects of Low Concentration Samarium Chloride on theUltrastructure and Function of Rat Thyroid Gland

The levels of thyroxine (T3, T4) and thyroid stimulating hormone (TSH) in rat serum were measured by radioimmunoassay, and also ultrastructure of the thyroid gland and adenohypophyseal cell were examined by transmission electronic microscopy (TEM) after low concentration (0. 05 mg/kg) of samarium chloride (SmCl3) administration by intraperitoneal, oral and tail intravenous routes. The results showed that the level of T4 in rat serum increased and the level of TSH unchanged by the intraperitoneal administration, and the levels of T3, T4 and TSH did not increase by the oral and tail intravenous administration. The evidences mentioned above were in accord with the morphological changes of thyroid follicular epithelial cells andadenohypophysis thyrotroph observed under electronic microscope in a sense.

Comprehensive Review of Thyroid Embryology,Anatomy,Histology,and Physiology for Surgeons

Emil Theodor Kocher and Theodor Billroth pioneered the surgical management of thyroid disease. Their surgical techniques, knowledge of thyroid anatomy, embryology, histology, physiology, and antisepsis practices transitioned a life-threatening operation to one with acceptable morbidity. The modern head and neck surgeon should have a meticulous surgical technique, combined with a thorough understanding of thyroid embryology and anatomy that is central to the understanding and treatment of the different disease processes of the thyroid gland and the consequences of thyroid gland surgery. In this manuscript we will be examining thyroid gland embryology, anatomy, histology, and physiology that is essential to the practicing thyroid surgeon.

Protirelin(thyrotropin-releasing hormone)in thyroid gland:possible involvement in regulation of thyroid status

AIM:To establish the presence of the hypothalamic hormone protirelin(thyrotropin-releasing hormone,TRH)in human thyroid and to investigate whether the concentration of this peptide in the thyroid gland is sensitive to thyroid status.METHODS:A procedure has been developed for the determination of TRH in the thyroid gland,distinct from TRH-like peptides which also react with TRH-antibody.RESULTS:Human thyroid was shown to contain both authentic TRH and TRH-like peptides,a similar pattern was seen in a range of animal thyroids.The concentrations of TRH in non-active goiter thyroids were substantial(41.6-248 pmol·g-1);in contrast the thyroids from hyperthyroid patients contained very little TRH(0.01-2.52 pmol·g-1).CONCLUSION:The physiologic role of TRH in the thyroid is not known but the large difference between the concentrations of this hormone in non-active and hyperactive thyroids suggests that thyroidal TRH may be involved in the regulation of thyroid status.

多模态超声诊断甲状腺肿瘤

超声是诊断甲状腺疾病首选的影像学工具。基于常规超声的甲状腺影像报告和数据系统的建立在甲状腺肿瘤诊断中发挥着举足轻重的作用。近年来,弹性成像、超微血流成像、超声造影及人工智能等新技术广泛应用于甲状腺疾病超声诊断。多模态超声技术的应用大幅度提升了甲状腺恶性肿瘤的诊断准确度,为甲状腺癌患者个体化诊疗方案的制订提供了理论依据。

甲状腺木乃伊结节和甲状腺乳头状癌的超声表现分析

目的探讨甲状腺木乃伊结节和甲状腺乳头状癌(PTC)的超声表现,以期更准确地诊断甲状腺木乃伊结节,从而减少不必要的甲状腺穿刺活检或外科手术治疗。方法回顾性收集2016年1月至2023年7月间首都医科大学附属北京友谊医院收治的具有可疑超声征象的甲状腺结节患者80例作为研究对象。经甲状腺细针抽吸活检证实为甲状腺木乃伊结节40例,PTC 40例,分别作为木乃伊结节组、PTC组。对两组患者结节的二维超声特征(包括大小、回声、形态、边界、钙化、黑白双层晕环征、血流信号等)及其超声造影表现进行比较分析。结果木乃伊结节组结节的边界清晰、形态规则、无钙化、有黑白双层晕环征超声特征的患者比例分别为57.5%、60.0%、55.0%、37.5%,均高于PTC组(25.0%、22.5%、17.5%、0),差异均有统计学意义(P<0.05);两组间纵横比比较,差异无统计学意义(P>0.05)。两组间在结节回声构成上比较差异有统计学意义(P<0.05),木乃伊结节和PTC均更容易表现为低回声。而在血流方面比较,木乃伊结节更多表现为周边和内部无血流信号,两组间在血流分布上比较,差异有统计学意义(P<0.05)。木乃伊结节组与PTC组患者行超声造影,两组间造影特点比较,差异有统计学意义(P<0.05)。木乃伊结节多表现为整体无增强,而PTC多表现为低或等增强。结论PTC更容易出现点样钙化、边界模糊,而黑白双层晕环征易出现在甲状腺木乃伊结节中,结节内部无血流,超声造影无增强等超声特征,将有助于提高甲状腺木乃伊结节的诊断,从而避免过度诊断及不必要的穿刺活检。