Abstract
Thyroid nodules with ultrasound (US) cancer risk features and extra-thyroid lesions suggesting malignant lymph nodes, require prompt diagnosis, especially in children. The US pattern of intrathyroidal ectopic thymus (IET) can strongly suggest papillary thyroid carcinoma (PTC). The extra-thyroid ectopic thymic tissue (EET) can mimic pathological lymph nodes in US. The aim of the study has been to demonstrate US features and diagnostic methods, allowing finally to confirm the presence of IET and EET in children. The US and elastographic features of 16 ectopic thymic tissue (ET) lesions were analyzed so as to describe the typical characteristics of ET and to define the best method to differentiate ET and malignant lesions. Among 16 analyzed lesions, 11 lesions were IET, and 5 were EET adjacent to the thyroid connective tissue capsule. Most of IET were located in the middle part of the right lobe and were fusiform or oval in shape. All the lesions were solid, hypoechoic, and heterogeneous with bright internal echoes. Among IET, 73% of lesions had well- or very well-defined margins. In strain elastography of IET lesions, the strain ratio was similar in all lesions, and its value ranged from 0.95 to 1.09. Despite the low prevalence of IET and cervical EET, clinicians and radiologists should be aware of US characteristics of such lesions. The confirmation of their benign character is absolutely required. Elastography is a useful tool to initially differentiate PTC and IET. However, due to high risk of malignancy in thyroid lesions in children, similarity of US features of PTC and IET, and due to the possibility of malignancy in ET, only cytological evaluation provides definitive diagnosis.
Highlights
Ultrasonography (US) is an accurate non-invasive diagnostic method commonly used in neck imaging
There are a few reports on the prevalence and ultrasound characteristics of intrathyroidal ectopic thymus (IET), which were carried out on large groups of patients, but the presence of IET was confirmed in them only on the basis of US imagery without cytological evaluation [4, 5]
To the best of our knowledge, this is the first study in which elastography was used in the diagnosis of IET, and the first study that demonstrated the usefulness of this method in the initial evaluation of IET-like lesions
Summary
Ultrasonography (US) is an accurate non-invasive diagnostic method commonly used in neck imaging This is the first line tool in the diagnosis of thyroid gland nodules. Sonographic features suggesting malignant thyroid lesion include solid and hypoechoic tumor pattern, irregular tumor margins, tumor shape (taller than wide), presence of microcalcifications, and increased tumor vascularization. The US pattern of intrathyroidal ectopic thymus (IET) can strongly suggest papillary thyroid carcinoma (PTC), which is the most common thyroid cancer in children. Such features suggest PTC and require precise differential diagnosis. The aim of the study has been to present US features and diagnostic methods that will allow for confirmation of the presence of ET in children who were referred to our center in order to definitively diagnose suspicious thyroid nodules. Most of the presented children had already been scheduled for thyroid surgery in other centers
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