Primary cavernous hemangioma of thyroid gland

Abstract

We report a case of cavernous hemangioma presenting as a case of solitary nodule of thyroid.A 25-year-old male presented with a slowly growing solitary swelling in front of neck of 16 years duration. There was no history of pain over the swelling, change in voice or dyspnea. On clinical examination, a 6 × 4 cm irregular, hard, freely mobile swelling could be felt in the thyroid region. Ultrasonography (USG) showed a single hypoechogenic mass in the left lobe of the thyroid with coarse calcifications. X-ray of neck also showed coarse calcifications [Figure 1]. Computed tomography (CT) scan showed a heterogeneously enhancing mass of 4.9 × 4.4 cm diameter in the left lobe of the thyroid deviating the trachea to the right. Multiple dense calcific densities were noted in the nodule [Figure 2]. Fine needle aspiration cytology (FNAC) of the mass was attempted twice but was inconclusive and only blood could be aspirated. The patient was euthyroid and showed no signs of local spread or lymphadenopathy. Surgery in the form of left hemithyroidectomy was done. Peroperatively, tumor mass was found to be hard in consistency and well encapsulated. Gross pathology showed a well-circumscribed nodule with hemorrhagic and calcified areas. On histopathology, nodule was divided into multiple lobules with areas of hemorrhage, fibrosis, hyalinization and calcifications. Some of these calcifications were located in dilated vessels and classical cavernous vascular spaces could be seen [Figure 3]. A diagnosis of primary intrathyroid cavernous hemangioma was made.Lesions similar to hemangiomas secondary to FNAC have been reported. These have been ascribed to vascular proliferation in organized hematoma following the FNAC leading to a histological resemblance to cavernous hemangioma.