Metastasis of Merkel Cell Carcinoma to the Thyroid Gland: a Case Report

Kwangsoon Kim,Chan Kwon Jung,Ja Seong Bae,Jeong Soo Kim 대한갑상선-내분비외과학회 2021 The Koreran journal of Endocrine Surgery Vol.21 No.1

Merkel cell carcinoma (MCC) is an uncommon neuroendocrine cutaneous malignancy. The thyroid gland is an exceptionally rare site of metastasis for MCC. Thus, metastasis to the thyroid gland may entail diagnostic difficulties. An 82-year-old man presented with a palpable neck tumor in the right anterior neck. Computed tomography scan revealed a 3.4 cm, enhancing tumor in the right thyroid gland. The patient underwent fine needle aspiration, and cytologic and immunohistochemical findings revealed metastasis of MCC to thyroid gland. We decided to perform surgical excision of the right thyroid gland. The patient was discharged 2 days after surgery without any complications. Various immunohistochemical studies were performed with the surgical specimen. The tumor cells were positive for CK 20 and CD 56, but negative for thyroid transcription factor-1. Finally, the histopathologic diagnosis confirmed as metastasis of MCC to the thyroid gland. Here, we present an exceedingly rare metastasis of MCC to the thyroid gland and discuss its diagnosis and treatment. In patients with a known history of a primary malignancy, the differential diagnosis of any abnormal findings in the thyroid gland should always include possibility of potential metastasis.

하시모토 갑상선염에서 갑상선종양으로 발현한 갑상선 골수외 형질세포종

조은정,하동우,최진희,이경남,엄중섭,김미라,전윤경,김상수,김보현,김인주 대한내분비학회 2012 Endocrinology and metabolism Vol.27 No.1

Extramedullary plasmacytomas most commonly occur in the nasal cavity, nasopharynx, paranasal sinuses, and larynx. Solitary extramedullary plasmacytoma (SEP) of the thyroid gland is rare. The diagnosis of SEP of the thyroid by cytology is typically difficult before surgery, and the entity is often confused with different cytology findings. We report a case of a 59-year-old man with primary plasmacytoma of the thyroid presented as a rapidly enlarging thyroid gland with Hashimoto’s thyroiditis. He had been suffering from anterior neck swelling for 1 month. Several fine-needle aspiration biopsies yielded Hashimoto’s thyroiditis. During a follow-up period of 3 years, the size of the thyroid gland increased and a mass lesion in right thyroid gland was detected. A total thyroidectomy was performed based on a diagnosis of a thyroid tumor with Hashimoto’s thyroiditis. Permanent pathology identified the mass as an extramedullary plasmacytoma associated with Hashimoto’s thyroiditis. Skeletal survey and serum electrophoresis tests were normal, and a bone marrow biopsy yielded no evidence of multiple myeloma. The patient underwent definitive radiotherapy and remained free from any recurrences during follow-up.

Complex Variations of Double Pyramidal Lobe and Double Isthmus of the Thyroid Gland: A Case Report

황지원,이동혁,박은서,박광락 대한체질인류학회 2024 해부·생물인류학 (Anat Biol Anthropol) Vol.37 No.1

The thyroid gland (TG) is an endocrine organ located at the level of the 5th cervical vertebra to 1st thoracic vertebra. The TG consists of right and left lobe, and the left lobe and the right lobe, and these two lobes are connected by the isthmus. The superior thyroid artery (STA) and the inferior thyroid artery (ITA) supply blood to the thyroid gland. We aimed to report complex variations of double thyroid lobes, double isthmus, and double pyramidal lobes to provide basic anatomical data for understanding clinical and pathological mechanisms. Thyroid variations were discovered while dissecting a cadaver at the College of Korean Medicine. In this case, the thyroid lobes, the isthmus, and the pyramidal lobes were formed independently on both sides. The thyroid lobes were divided into right thyroid lobe (RTL) and left thyroid lobe (LTL). The right pyramidal lobe (RPL) was connected from the superior border of the right isthmus(RIS) to the distal portion of the thyroglossal duct, and the left pyramidal lobe (LPL) was also connected from the superior border of the left isthmus(LIS) to the distal portion of the thyroglossal duct. The lengths of RTL, LTL, RIS, LIS, RPL, and LPL were 47.5 mm, 47.1 mm, 9.8 mm, 17.2 mm, 14.2 mm, and 20.3 mm, respectively. And the widths of RTL, LTL, RIS, LIS, RPL, and LPL were 17.0 mm, 13.9 mm, 6.0 mm, 11.3 mm, 4.8 mm, and 6.1 mm, respectively. The STA and the ITA was in a normal anatomical form, but the collateral circulation connecting the right and left sides did not exist. Since these variations may clinically lead to the possibility of incomplete thyroidectomy, clinicians need to understand the various variations of the TG and apply them to diagnosis and treatment.

Ultrasonographic Features and the Diagnostic Role of Core Needle Biopsy at Metastatic Breast Cancer in the Thyroid gland: A Case Report

이동현,윤라경,안진경,우정주 대한영상의학회 2020 대한영상의학회지 Vol.81 No.3

Metastases to the thyroid gland have rarely been reported in clinical settings, and the thyroid gland is an uncommon site for breast carcinoma metastasis. We report a case of a 64-year-old breast cancer patient diagnosed with metastatic breast carcinoma in the thyroid gland after performing ultrasonography (US)-guided core needle biopsy (CNB) and subsequent total thyroidectomy. On US, the thyroid lesion appeared to be mildly enlarged with multiple internal hypoechoic lines and a few microcalcifications without mass formation. Under US-guidance, CNB was performed by targeting the area with microcalcifications and subsequently diagnosed as metastatic breast carcinoma. Total thyroidectomy revealed that the patient had metastatic invasive ductal carcinoma of the breast with lymphatic spread involving both lobes and the isthmus of the thyroid gland. Although the thyroid gland is an uncommon metastatic site, the unusual features of thyroid metastasis can be observed on US; thus, US-guided CNB effectively aids the diagnosis of thyroid metastasis.

Insights from a Prospective Follow-up of Thyroid Function and Autoimmunity among COVID-19 Survivors

David Tak Wai Lui,Chi-Ho Lee,Wing-Sun Chow,Alan Chun Hong Lee,Anthony Raymond Tam,Carol Ho Yi Fong,Chun Yiu Law,Eunice Ka Hong Leung,Kelvin Kai Wang To,Kathryn Choon Beng Tan,Yu-Cho Woo,Ching Wan Lam 대한내분비학회 2021 Endocrinology and metabolism Vol.36 No.3

Background: The occurrence of Graves’ disease and Hashimoto thyroiditis after coronavirus disease 2019 (COVID-19) raised concerns that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may trigger thyroid autoimmunity. We aimed to address the current uncertainties regarding incident thyroid dysfunction and autoimmunity among COVID-19 survivors. Methods: We included consecutive adult COVID-19 patients without known thyroid disorders, who were admitted to Queen Mary Hospital from July 21 to September 21, 2020 and had serum levels of thyroid-stimulating hormone, free thyroxine, free triiodothyronine (fT3), and anti-thyroid antibodies measured both on admission and at 3 months. Results: In total, 122 patients were included. Among 20 patients with abnormal thyroid function tests (TFTs) on admission (mostly low fT3), 15 recovered. Among 102 patients with initial normal TFTs, two had new-onset abnormalities that could represent different phases of thyroiditis. Among 104 patients whose anti-thyroid antibody titers were reassessed, we observed increases in anti-thyroid peroxidase (TPO) (P<0.001) and anti-thyroglobulin (P<0.001), but not anti-thyroid stimulating hormone receptor titers (P=0.486). Of 82 patients with negative anti-TPO findings at baseline, 16 had a significant interval increase in anti-TPO titer by >12 U, and four became anti-TPO-positive. Worse baseline clinical severity (P=0.018), elevated C-reactive protein during hospitalization (P=0.033), and higher baseline anti-TPO titer (P=0.005) were associated with a significant increase in anti-TPO titer. Conclusion: Most patients with thyroid dysfunction on admission recovered during convalescence. Abnormal TFTs suggestive of thyroiditis occurred during convalescence, but infrequently. Importantly, our novel observation of an increase in anti-thyroid antibody titers post-COVID-19 warrants further follow-up for incident thyroid dysfunction among COVID-19 survivors.

동맥 색전술로 치료한 갑상선 세침 흡인술 후 발생한 미만성 갑상선 출혈 1예

김의영,김정민,김은희,정지윤,이상아,최지영,임지혜,이필형,김태용,송영기,김원배 대한내분비학회 2008 Endocrinology and metabolism Vol.23 No.3

Although hematoma formation after fine needle aspiration cytology fine needle aspiration cytology (FNAC) is a most common complication and most of these hematomas are self-limiting with minimal pain, a massive intra-thyroidal hemorrhage that produces acute airway obstruction had rarely been reported on.A 60-year old female underwent ultrasound-guided FNAC for evaluation of nodules that were in the right lobe (0.5 cm) and left lobe (3 cm) of her thyroid gland. Two hours later, the patient experienced swelling and progressive pain in the anterior neck. She visited an emergency room with dyspnea at 6 hours after FNAC. On the initial examination, her vital signs were stable and the oxygen saturation was 100%. On physical examination, her thyroid gland was tender and diffusely enlarged. Neck CT revealed diffuse enlargement of the thyroid gland with heterogeneous hyper-attenuated areas that were suspicious for intra-thyroidal hemorrhage and a highly enhanced area in the left lower lobe of the thyroid. No definite bleeding focus was identified on the angiography that was done through the carotid artery, but the left superior thyroid artery was severely congested and partial embolization was done. After embolization her neck pain and tenderness decreased over several days and the patient was discharged on the 6th hospital day. We report here on a case of diffuse hemorrhage into the thyroid gland after FNAC, and this was successfully treated with arterial embolization. (J Korean Endocr Soc 23:199~203, 2008)

선천성 갑상선 저하증을 보인 신생아의 이중 이소성 갑상선 1례

조혜진,이혜영,박신애 대한소아내분비학회 2012 Annals of Pediatirc Endocrinology & Metabolism Vol.17 No.1

저자들은 신생아 선별 검사상 갑상선 기능저하증을 보인 신생아에서 경부초음파검사, 방사선 동위원소 스캔을 통하여이중 이소성 갑상선을 진단하고, L-thyroxine을 투여하여 정상발육하고 있는 1례를 경험하였기에 보고하는 바이다. An ectopic thyroid occurs when thyroid tissue has not properly migrated from the foramen cecum to the fourth tracheal ring along the midline of the ventral portion of the neck, but instead is located elsewhere. There are some cases of dual-site ectopic thyroid glands, usually involving adolescents or adults. Cases of neonatal dual ectopic thyroid glands are even rarer. We report a case of a dual ectopic thyroid with congenital hypothyroidism found during a neonatal screening of the lingual and upper cervical regions of a patient . The patient had no airway obstruction symptoms, such as dysphagia or grunting. The thyroxine (T4) level was 2.49 μg/dL (normal value: 6.2-22.0 μg/dL)and the thyroid-stimulating hormone (TSH) level was 217.85 μIU/mL (normal value: 1.7-9.1 μIU/mL). A dual ectopic thyroid was diagnosed based on a Tc-99m thyroid scan. After receiving thyroid hormone replacement therapy, the child has developed normally

미만성 대세포성 B세포 림프종과 MALT 림프종이 혼재된 갑상선 림프종 1예

신향애 ( Hyang Ae Shin ),한재호 ( Jae Ho Han ),이종주 ( Jong Joo Lee ),김철호 ( Chul-ho Kim ) 대한갑상선학회 2008 International Journal of Thyroidology Vol.1 No.1

Primary thyroid lymphoma is a rare thyroid tumor, representing approximately 2∼3% of all non-Hodgkin's lymphoma (NHL) and 2∼8% of all thyroid malignancies. Thyroid lymphomas typically occur in middle- to older-aged women. Pathologically, most thyroid lymphomas are non-Hodgkin's lymphomas of B-cell origin whereas Hodgkin's and T-cell thyroid lymphomas occur rarely. Diffuse large B-cell lymphoma (DLBCL) is the most common histologic type followed by mucosa-associated lymphoid tissue (MALT) lymphoma. MALT lymphomas classically arise in a background of longstanding autoimmune thyroiditis. We report a case of mixed diffuse large B-cell lymphoma and MALT lymphoma of the thyroid gland accompanied by Hashimoto's thyroiditis with a review of the literature.

한국 성인집단에서 촬영한 통상적인 경부 전산화 단층촬영 영상에서의 정상 갑상선의 크기와 연령, 성별, 체구와의 관계

이동희,조광재,전범조,황성재,김동기,김민식,조승호 대한이비인후과학회 2004 대한이비인후과학회지 두경부외과학 Vol.47 No.11

Background and Objectives:on routine neck computed tomography in the Korean population. Also, this study investigated the posible influence of some physical factors. Materials and Method:Neck computed tomography scans of 100 adults were reviewed retrospectively to measure the size of the thyroid gland and to evaluate its relationship to the trachea and cervical vertebra. The width, thickness, and length of each thyroid lobes, as wel as the estimated volume of the thyroid gland were measured. The cros-sectional areas ing to diferent body size. Results:The mean widths were 15.7 mm (right) and 15.2 m (left). The mean thicknesses were 20.9 mm (right) and 18.9 mm (left). The mean lengths were 61.8 m (right) and 58.5 mm (left). The mean estimated volumes of each lobe were 8.8 cm3 (right) and 7.6 cm3 (left). The mean volume of total thyroid glands (including isthmus) was 17.5 cm3. There was no significant diference between the total study group and normal thyroid function group. The dimensions of right lobe was significantly larger that of the left. There was no significant diference between males and females. The results of the multiple regresion analysis suported the likelihood that the influence of the body weight was most pronounced. Conclusion:it values of normal thyroid glands.

좌측의 갑상선 무형성 및 우측의 갑상선종과 동반된 설갑상선 1예

이상헌,양윤수,홍기환,오정기 대한이비인후과학회 2005 대한이비인후과학회지 두경부외과학 Vol.48 No.2

Ectopic thyroid is an uncommon embryological aberration characterized by the presence of thyroid tissue in sites other than in its usual pretracheal region. Lingual thyroid, although it is the most common manifestation of benign ectopic thyroid tissue, is still a rare clinical entity. Thyroid hemiagenesis is also a very rare abnormality, in which one thyroid lobe fails to develop. We report a case of left thyroid hemiagenesis and goiter in the right lobe of a 26-year-old female patient with ectopic lingual thyroid.