Ectopic Thyroid Cancer Research Articles

Research progress of ectopic thyroid cancer in thyroglossal duct cyst: A case report and literature review.

Thyroglossal duct carcinoma, a rare clinical condition characterized by ectopic thyroid adenocarcinoma within thyroglossal duct cysts (TGDCs), typically confirmed through intraoperative rapid pathology, this condition generally has a favorable prognosis. Nevertheless, comprehensive treatment guidelines across all disease stages are lacking, the purpose of this study is to report 1 case of the disease and propose the treatment plan for each stage of the disease. A patient presented with thyroid swelling, classified as C-TIRADS 4A following a physical examination. Preoperative thyroid puncture identified papillary thyroid carcinoma, and genetic testing revealed a BRAF gene exon 15-point mutation. Ancillary tests showed a slightly decreased thyroid stimulating hormone (TSH) level (0.172) with no other significant abnormalities. Preoperative fine-needle aspiration cytology (FNAC) confirmed right-side thyroid cancer. Intraoperative exploration uncovered a TGDC and intraoperative rapid pathology confirmed thyroglossal duct carcinoma. A Sistrunk operation and ipsilateral thyroidectomy were performed. Postoperative recovery was satisfactory. Thyroglossal duct carcinoma is a rare disease affecting the neck. Due to limited clinical cases and the favorable prognosis associated with this condition, there is currently no established set of diagnostic and treatment guidelines. According to tumor size, lymph node metastasis, thyroid status and other factors, the corresponding treatment methods were established for each stage of thyroglossal duct cancer, which laid the foundation for the subsequent treatment development of this disease.

Ectopic thyroid cancer with a normal thyroid gland

Introduction: Ectopic thyroid tissue may appear in any location along the trajectory of the thyroglossal duct from the foramen cecum to the mediastinum, as either a lingual thyroid or a thyroglossal duct cyst. In rare cases, aberrant migration of the gland can result in lateral ectopic thyroid tissue. As for native thyroid gland, ectopic tissues are subject to malignant transformation. Case Report: A 40-year-old female patient presented with a right-sided neck swelling. She had a history of treated Hodgkin’s lymphoma at the age of 16 years. She has hypothyroidism and on thyroxine and is known to have benign small thyroid nodules for the last 7 years. The neck swelling was suspicious for papillary thyroid carcinoma upon cytological examination. She underwent surgery (total thyroidectomy with central and right lateral selective neck dissection) that confirmed the presence of papillary thyroid cancer in the neck but the thyroid gland was devoid of any cancer. The patient had post-operative radioiodine ablation. She is free of any recurrence or residual disease after one-year post-treatment. Conclusion: This case highlights the unusual presentation of thyroid carcinoma arising within an ectopic thyroid tissue in an otherwise cancer-free thyroid gland. The management of this case followed the standard treatment of metastatic thyroid cancer; however, it raises the question of whether these rare cases should receive de-escalation of standard management.

ODP494 Mediastinal Ectopic Thyroid Papillary Carcinoma with NTRK3 Fusion, Presenting with Thoracic Spine Metastasis

Abstract Background Ectopic thyroid tissue may be encountered anywhere from the base of the skull to the lower neck. It is rarely seen in the mediastinum. Thyroid cancer in ectopic thyroid tissue is a very rare entity. We report a patient with papillary thyroid cancer arising from upper mediastinal ectopic thyroid tissue. The patient presented with thoracic spine metastasis with cord compression. Molecular testing showed SQSTM1-NTRK3chromosomal rearrangement. Case Presentation The patient is a 67 -year-old female, presented with upper back pain. She reported no weakness or sensory changes. MRI showed suspected metastatic disease to the second and third thoracic vertebrae (T2 and T3). Therewasepidural extension of tumor with cord compression and severe stenosis at T2. She underwent laminectomy and decompression surgeryat T1-T3 level. Final pathology report showed Metastatic thyroid carcinoma with papillary features. She underwent external beam radiation to the affected spines. CT chest abdomen and pelvis showed 3. 0×2.8×2.3 cm soft tissue mass in the left superior mediastinum extending into the supraclavicular region. FDG-PET scan showedHypermetabolic foci in the upper mediastinum with SUV max of 25. Fine needle Aspiration (FNA) of the upper mediastinal mass was consistent with papillary thyroid cancer. Molecular testing from the FNA sample using Thyroseq V3 showed SQSTM1-NTRK3 chromosomal rearrangement. Total thyroidectomy was performed; however, the upper mediastinal mass was not resected due to proximity to vascular and neuronal structures. Pathology of the resected thyroid was benign. Recombinant TSH stimulatedI-123 scan showed intense uptake in the neck area, most likely represents remnant thyroid tissue. No clear uptake in the mediastinal mass or spine metastasis. She underwent removal of the upper mediastinal mass with lymph node dissection at a referral center. Pathology showed soft tissue involved by papillary thyroid carcinoma with focal tall cell features, forming a 4×2.5×2.5 cm mass. Surgery was followed by ablation with 100 mci of radioactive iodine (I-131). Thyroglobulin level decreased from a baseline of 15272 ng/ml to 1857 ng/ml, post-surgery, external beam radiation and radioactive iodine ablation. Conclusion This case highlights the possibility of developing thyroid cancer in ectopic thyroid tissue and the unique challenges in the diagnosis and management of such rare disease. Our patient has very aggressive disease presentation that required multimodality treatment including thoracic spine decompression, total thyroidectomy, mediastinal ectopic thyroid cancer resection, external beam radiation to the affectedspine area, and high dose radioactive iodine treatment. The use of molecular diagnostics is very important to improve the outcome in such patient. The tumor has SQSTM1-NTRK3 chromosomal rearrangement. This rearrangement causesconstitutive activation of the NTRK3 in the Ras-Raf-MEK-ERK Pathway. This fusioncan be targeted by medications like Larotrectinib and Endtrectinib. Presentation: No date and time listed

A Case of Mediastinal Ectopic Thyroid Cancer with a Normal Thyroid Gland

A Case of Mediastinal Ectopic Thyroid Cancer with a Normal Thyroid Gland

A Rare Case of Aggressive Ectopic Thyroid Cancer in a Patient With Graves Disease

Background: Ectopic thyroid tissue is a rare entity with a prevalence of 1 per 300,000 persons. Malignancy in ectopic thyroid tissue is reported in <1% of these cases.[1] We report a case of aggressive papillary carcinoma in ectopic thyroid gland in a patient with Graves’ disease. Case: A 65-year old woman was incidentally found to have a 3.1 cm mass with coarse calcifications in the superior mediastinum on CT scan of chest. Ultrasound confirmed the presence of hypoechoic mass which was separate from thyroid. Additionally, a 0.5cm TI-Rad 4 left thyroid lobe nodule was found. FNA of the mediastinal mass was suspicious for follicular thyroid neoplasm. Thyramir testing was positive for BRAF V600E and TERT c-124C>T mutations. Thyroid function tests showed frank hyperthyroidism and elevated thyroid stimulating immunoglobulins. Thyroid uptake and scan showed diffuse uptake of 67% at 24 hours.The patient underwent simultaneous excision of mediastinal mass and total thyroidectomy. The pathology of mediastinal mass showed papillary thyroid cancer with tall and sclerosis features with one involved lymph node. The pathology of thyroid gland did not show any malignancy. She was treated with 100 mCi I-131. Post treatment Whole Body Nuclear Scan after treatment revealed metastatic disease in left lower lung area.Discussion: Ectopic thyroid gland is usually found anywhere between forman caecum and mediastinum. It is rare to find ectopic thyroid tissue in the presence of eutopic thyroid gland which can create a diagnostic dilemma. Only a very few case reports of thyroid cancer arising from ectopic thyroid tissue have been reported. Our case is unique as the eutopic thyroid gland had Graves’ disease with no malignancy but the ectopic thyroid tissue developed aggressive papillary thyroid cancer. There are no specific guidelines for the management of carcinoma in ectopic thyroid glands, possibly due to the rarity of the condition. Our case has a clear metastasis to the lungs. However, it is important to differentiate ectopic thyroid tissue with carcinoma from thyroid cancer metastasis which can be difficult at times. Without specific guidelines for the management of cancer in ectopic thyroids, an individualised approach can be taken using the same therapeutic principals used in the management of eutopic thyroid cancer. Additionally, a finding of a normal thyroid gland or a benign condition in the thyroid gland should not exclude the diagnosis of malignancy in ectopic thyroid tissues.1) Vázquez, Oscar R., et al. “Ectopic papillary thyroid cancer with distant metastasis.” Case reports in endocrinology 2018 (2018).

Lingual Papillary Thyroid Carcinoma with Bilateral Neck Node Metastasis

ABSTRACT Incidence of ectopic thyroid tissue is 1 in every 100,000 to 300,000 in general population and lingual thyroid is the most common ectopic site (90%). The number of reported neoplasms occurring in this tissue seems disproportionately small when compared with the frequency of tumor formation in the normally placed thyroid. Till now only 51 cases of lingual thyroid cancer have been reported in the literature. We are reporting a case of lingual thyroid carcinoma with bilateral cervical metastasis and absent orthotopic thyroid gland. In our case we approach the tumor via midline lip splitting with lateral mandibulotomy approach which provides us a good exposure of the entire oropharynx (tumor). We have managed the tumor according to the guidelines of differentiated thyroid cancer because of non availability of guidelines for ectopic thyroid cancer. After surgical excision of lingual thyroid and neck dissection radioiodine therapy was given. The surgical approach to a lingual thyroid cancer as well as adjuvant therapy and natural history remains to be ascertained due to the rarity of the disease. Lip splitting with lateral mandibulotomy and swing approach appears to give adequate exposure to lingual thyroid. How to cite this article Singh SP, Das S, Jain DK. Lingual Papillary Thyroid Carcinoma with Bilateral Neck Node Metastasis. World J Endoc Surg 2017;9(2):68-71.

Ectopic Cervical Thyroid Carcinoma—Review of the Literature with Illustrative Case Series

More than 99% of thyroid cancers arise eutopically within the thyroid gland. The most frequent sites of ectopic thyroid tissue are lingual, sublingual, thyroglossal, laryngotracheal, and lateral cervical. Thyroid tissue can also be found in remote structures that were associated with the thyroid anlage during development, including the esophagus, mediastinum, heart, aorta, adrenal, pancreas, gallbladder, and skin. Ectopic thyroid tissue can be subject to the same pathological processes as normal eutopic thyroid tissue such as inflammation, hyperplasia, and tumorigenesis. The aim of this review is to describe aspects of thyroid cancer arising from the ectopic thyroid tissue in the neck in regard to epidemiology, diagnosis, and treatment and to present an illustrative series of cases of ectopic thyroid cancer. We have searched the PubMed database for articles including the keywords "ectopic thyroid cancer" published between January 1, 1960, and January 1, 2011. As references, we used clinical case series, case reports, review articles, and practical guidelines focused on ectopic thyroid cancer confined to the neck region. The possibility of an ectopic thyroid cancer should be considered in the differential diagnosis of a pathological mass in the neck. Treatment of ectopic cervical thyroid cancer is based predominantly on the surgical excision of the malignant lesion. Management strategies, including performance of total thyroidectomy, neck dissection, and treatment with radioiodine, should be based on individualized risk stratification.