Journal of Cytology
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Year : 2016  |  Volume : 33  |  Issue : 4  |  Page : 239-240
Colloid goiter in ectopic thyroid tissue presenting as submandibular swelling with a coexisting functional orthotopic thyroid gland in a pregnant female


Department of Pathology, Pt. B.D. Sharma PGIMS Rohtak, Haryana, India

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Date of Web Publication13-Sep-2016
 

How to cite this article:
Verma R, Gupta S, Kalra R, Sen R, Samal S, Sharma J, Malik S. Colloid goiter in ectopic thyroid tissue presenting as submandibular swelling with a coexisting functional orthotopic thyroid gland in a pregnant female. J Cytol 2016;33:239-40

How to cite this URL:
Verma R, Gupta S, Kalra R, Sen R, Samal S, Sharma J, Malik S. Colloid goiter in ectopic thyroid tissue presenting as submandibular swelling with a coexisting functional orthotopic thyroid gland in a pregnant female. J Cytol [serial online] 2016 [cited 2020 Jun 2];33:239-40. Available from: http://www.jcytol.org/text.asp?2016/33/4/239/190452


Sir,

The thyroid tissue is defined as ectopic when not located in the pretracheal region between the second and the fourth tracheal cartilages. The ectopic thyroid gland is very rare, with a prevalence of approximately one in 100, 000 to 300, 000 in the population, with a female to male ratio of about 4:1, the age ranging from 5 months to 40 years but is usually seen in adolescence, pregnancy, and menopause due to increased physiological demand of thyroid hormones and marked endocrine activity. Most of the patients of ectopic thyroid are asymptomatic.[1],[2] Lingual endotracheal tube (ETT) is the most common site, accounting for more than 90% of cases, and patients usually have hypothyroidism. The simultaneous finding of the submandibular ectopic thyroid tissue and a functional orthotopic thyroid gland is an extremely rare event.[3] As in many cases, the ectopic thyroid gland is the only functioning thyroid. The incidence of malignancy arising in ETT is approximately 1%.[1]

A 19-year-old pregnant female presented with a firm, nontender swelling measuring 2.0 cm × 1.5 cm in the right submandibular region [Figure 1]a. The thyroid gland was not enlarged. Ultrasonography revealed a hypoechoic lesion measuring 2.4 cm × 1.4 cm in the right submandibular region with cystic changes, separate from submandibular gland anterior to bifurcation of the common carotid artery [Figure 1]b. No significant lymphadenopathy was seen. Sonography features were in favor of the ectopic thyroid tissue. Thyroid function tests were normal; thyroid-stimulating hormone (TSH) level was 2.0 mU/L (normal range 0.3-4.5), FT4 1.5 ng/dL (0.8-2), FT3 4.5 pg/mL (1.8-5). Calcitonin, calcium, and parathyroid hormone (PTH) levels were normal. Because of pregnancy, Tc99m pertechnetate scan and computed tomography (CT) scan were not performed.
Figure 1: (a) Firm, nontender swelling measuring 2.0 cm × 1.5 cm in right submandibular region (b) Ultrasonography revealed a hypoechoic lesion measuring 2.4 cm × 1.4 cm with cystic changes (c) A few follicular epithelial cells revealing involutional changes alongwith abundant foamy and pigment-laden macrophages in a background of thin colloid and RBCs. (Giemsa stain, ×200)

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Fine needle aspiration yielded blood mixed colloid, smears prepared showed abundant thin colloid over a background of blood. A few follicular epithelial cells arranged in micro and macro follicles, revealed involutional and hyperplastic changes, with no features of malignancy. Abundant foamy and pigment-laden macrophages and multinucleated giant cells were additionally seen along with a few lymphocytes [Figure 1]c. Cytological findings suggested ectopic thyroid tissue with colloid goiter with cystic change.{Figure 1}

Cases of ectopic thyroid, though rare, should be considered as a differential diagnosis of the submandibular mass. An ultrasound and fine needle aspiration cytology (FNAC) will help in confirming the thyroid tissue and diagnosing any existing pathology. Hence, the present study illustrates the potential for rare sites of ectopic thyroid gland lateral to the midline that enters into the differential diagnosis of metastasis from well-differentiated thyroid cancers.

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Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Ibrahim NA, Fadeyibi IO. Ectopic thyroid: Etiology, pathology and management. Hormones (Athens) 2011;10:261-9.  Back to cited text no. 1
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2.
Noussios G, Anagnostis P, Goulis DG, Lappas D, Natsis K. Ectopic thyroid tissue: Anatomical, clinical, and surgical implications of a rare entity. Eur J Endocrinol 2011;165:375-82.  Back to cited text no. 2
[PUBMED]    
3.
Piantanida E, Compri E, Lai A, Lombardi V, Mule ID, Gandolfo M, et al. Ectopic submandibular thyroid tissue with a coexisting normally located multinodular goitre: Case report and review of the literature. BMJ Case Rep 2009;2009. pii: bcr07.2009.2136.  Back to cited text no. 3
    

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Correspondence Address:
Dr. Renuka Verma
H. No. 138-L, Model Town, Rohtak, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9371.190452

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