Thyroid : official journal of the American Thyroid Association · 2008
A six-year-old boy with a suspicious thyroid nodule: intrathyroidal thymic tissue.
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Hernandez-Cassis Carlos, Poniecka Anna, Vogel Claudia K, McKenzie J Maxwell
Аннотация
BACKGROUND: Ectopic intrathyroidal thymus tissue that forms mass lesions as a consequence of aberrant thymic migration during embryogenesis is rarely reported in the literature.
METHODS: We present the case of a 6-year-old boy with a right thyroid nodule and bilateral cervical lymph nodes. Thyroid hormone, antibodies, and routine chemistry tests were normal. Real-time thyroid ultrasound showed a right calcified nodule measuring 8 x 5 x 7 mm and multiple bilateral cervical lymph nodes. I131 scan showed mild decreased uptake in the right upper lobe. On fine-needle aspiration biopsy we discovered an atypical lymphoid proliferation that was suspicious, although not diagnostic, of a lymphoma. Immunostain for calcitonin was negative. Flow cytometry of the thyroid nodule aspirate demonstrated an abnormal polyclonal T cell population with dual expression of CD4 and CD8, and a subpopulation of cells that expressed TdT suggesting the possibility of lymphoblastic lymphoma. DNA analysis, as well as polymerase chain reaction for T cell and B cell gene rearrangement, did not demonstrate changes in the gene for the heavy chain of immunoglobulin of B cells and gamma chain of the T cell receptor. Lymph node aspirate showed unremarkable T and B lymphoid cells.
MAIN OUTCOMES: The diagnosis of ectopic intrathyroidal thymus was made after the operation.
CONCLUSION: Ectopic thymus tissue should be considered in the differential diagnosis of thyroid masses, especially in children.
METHODS: We present the case of a 6-year-old boy with a right thyroid nodule and bilateral cervical lymph nodes. Thyroid hormone, antibodies, and routine chemistry tests were normal. Real-time thyroid ultrasound showed a right calcified nodule measuring 8 x 5 x 7 mm and multiple bilateral cervical lymph nodes. I131 scan showed mild decreased uptake in the right upper lobe. On fine-needle aspiration biopsy we discovered an atypical lymphoid proliferation that was suspicious, although not diagnostic, of a lymphoma. Immunostain for calcitonin was negative. Flow cytometry of the thyroid nodule aspirate demonstrated an abnormal polyclonal T cell population with dual expression of CD4 and CD8, and a subpopulation of cells that expressed TdT suggesting the possibility of lymphoblastic lymphoma. DNA analysis, as well as polymerase chain reaction for T cell and B cell gene rearrangement, did not demonstrate changes in the gene for the heavy chain of immunoglobulin of B cells and gamma chain of the T cell receptor. Lymph node aspirate showed unremarkable T and B lymphoid cells.
MAIN OUTCOMES: The diagnosis of ectopic intrathyroidal thymus was made after the operation.
CONCLUSION: Ectopic thymus tissue should be considered in the differential diagnosis of thyroid masses, especially in children.