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Thursday, 28 November 2013

Thyroid disease: Thyroid adenoma – The Misdiagnosis

Thyroid is one of the largest endocrine glands found in the neck, below the Adam’s Apple with the function of regulating the body use of energy, make of proteins by producing its hormones as a result of the stimulation of thyroid-stimulating hormone (TSH) produced by the anterior pituitary.
Thyroid disease is defined as a condition of malfunction of thyroid.
Thyroid adenoma is a benign tumor started in the layer of cell lined the inner surface of the thyroid gland. The disease are relatively common among adults living in the United States. According to the study by the Mayo Clinic and Mayo Foundation, there is a report of 4 patients described in whom a follicular carcinoma developed following thyroidectomy for a benign follicular neoplasm. Most thyroid nodules are Thyroid adenoma.
D.1. Misdiagnosis
1. Hyalinizing trabecular tumors (HTT)
Hyalinizing trabecular tumors (HTT) are very rare thyroid tumors whose diagnosis is difficult, particularly in cytology. There is a report of two HTT cases which were initially diagnosed as papillary carcinoma, on the preoperative cytology and for which the patients underwent total thyroidectomy with lymph node dissection(18).
2. Totally cervical thymoma
Totally cervical thymoma is extremely rare and usually arises from ectopic thymic tissue. We report a case of a B1 thymoma localized in the neck, misdiagnosed for a decade as a thyroid nodule(19).
3. Papillary thyroid carcinoma (PTC)
There is a report of two cases diagnosed as papillary thyroid carcinoma (PTC) by FNA cytology, but histopathology reports indicated colloid goiters with infarcted nodules. Review of histopathologic material showed features of PTC in the viable tissue at the periphery of nodules. Immunohistochemical study for galectin-3 and CD44 in 1 of the cases supported the diagnosis of PTC(20).
4. Pharyngoesophageal diverticulum
A pharyngoesophageal diverticulum can be mistaken for a posteriorly placed “thyroid nodule” on ultrasound scan if the subtle differentiating signs are missed. An awareness of this condition is important to avoid unnecessary needle biopsies, according to the study by the Alexandra Hospital, Singapore(21).
5. Primary thyroid paraganglioma
There is a report of thyroid PG case to highlight importance of careful evaluation of clinical and pathological findings to correctly identify paragangliomas which anatomically mimic MTCs(22).
6. Anaplastic thyroid cancer
There is a report of a case of Riedel’s thyroiditis that had presented rapidly growing, hard, fixed, thyroid mass mimicking anaplastic thyroid cancer in a 41-year-old female patient with longstanding benign thyroid nodule for 6 years(23).
7. Hodgkin’s lymphoma
Hodgkin’s lymphoma of the thyroid is rare and can mimic a primary thyroid epithelial tumor or thyroiditis clinically(24).
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(18) http://www.ncbi.nlm.nih.gov/pubmed/21839358
(19) http://www.ncbi.nlm.nih.gov/pubmed/21766278
(20) http://www.ncbi.nlm.nih.gov/pubmed/19798886
(21) http://www.ncbi.nlm.nih.gov/pubmed/20665743
(22) http://www.ncbi.nlm.nih.gov/pubmed/19816814
(23) http://www.ncbi.nlm.nih.gov/pubmed/19059128
(24) http://www.ncbi.nlm.nih.gov/pubmed/16258502