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Case Reports
. 2017:2017:4592783.
doi: 10.1155/2017/4592783. Epub 2017 Nov 27.

Thyroid Carcinoma on the Side of the Absent Lobe in a Patient with Thyroid Hemiagenesis

Hiroki Sato  1 , Kiyoaki Tsukahara  1 , Ray Motohashi  1 , Midori Wakiya  2 , Hiromi Serizawa  2 , Atsushi Kurata  3
Affiliations
Case Reports

Thyroid Carcinoma on the Side of the Absent Lobe in a Patient with Thyroid Hemiagenesis

Hiroki Sato et al. Case Rep Otolaryngol. 2017.

Abstract

Background: Thyroid carcinoma complicated by hemiagenesis is very rare, and previous reports have not described this cancer on the side of the absent lobe.

Methods and results: We report the case of a 64-year-old woman in whom left thyroid hemiagenesis was discovered incidentally during investigations of abnormal sensation during swallowing. A tumorous 1.4 cm lesion was also found on the side of the absent lobe, left of the isthmus. Fine-needle aspiration biopsy revealed class V papillary carcinoma, but no lymph node metastases. Total thyroidectomy was performed for stage cT1bN0M0 carcinoma. Histopathology revealed normal thyroid tissues in the right lobe and isthmus, while the left lobe was absent. The mostly papillary carcinoma was adjacent to the truncated thyroid tissue, with a portion histologically consistent with poorly differentiated carcinoma.

Conclusions: All previously reported cases of thyroid cancer complicated by hemiagenesis have represented carcinoma occurring within the present lobe. This case is extremely rare.

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Figures

Figure 1
Figure 1
Findings from ultrasonography and computed tomography. The right thyroid lobe and thyroid isthmus are present, while the left lobe of the thyroid is absent. A nodule measuring 0.7 × 0.8 × 1.4 cm is seen on the left side of the thyroid isthmus. On cervical ultrasonography, the periphery of the tumor is nonuniform, small calcifications are detected in the interior, and the posterior echo is attenuated. Arrows indicate the tumor. No cervical lymph node swelling is detected.
Figure 2
Figure 2
Surgical findings. The left lobe of the thyroid is absent. Tumor is observed on the side of the absent thyroid and has invaded the lateral branch of the recurrent laryngeal nerve. No abnormalities in the path of the recurrent laryngeal nerve are observed. Arrowheads indicate tumor; arrow indicates craniad.
Figure 3
Figure 3
Tumor histopathology. Although the right thyroid lobe and isthmus were evident, left lobe tissue was absent. Most of the tumor represented papillary carcinoma, with a minority portion comprising poorly differentiated carcinoma. No thyroid tissue was observed in the absent portion. Arrow indicates right side. Hematoxylin and eosin staining, ×1.
Figure 4
Figure 4
Histopathology of Section A in Figure 3. Clear demarcation is evident between the thyroid tissue and tumor. Dotted line delineates normal thyroid tissue truncating at the isthmus. Arrowheads point to the tumor site. Hematoxylin and eosin staining, ×1.25.
Figure 5
Figure 5
Histopathological (hematoxylin and eosin) and immunohistochemical findings for Sections B and C in Figure 3. Images (a), (c), and (d) are from Section B (thyroid papillary carcinoma), while images (b) and (d) are from Section C (poorly differentiated carcinoma) in Figure 3. (a) The tumor shows a ductal structure with funicular and microfollicular shapes, consistent with thyroid papillary carcinoma. (b) A honeycomb structure and necrosis are observed, with marked differences in nucleus sizes; these findings suggest poorly differentiated carcinoma. (c, d) Both papillary carcinoma and poorly differentiated carcinoma sites are thyroid transcription factor-1-positive. (e) Nuclear grooves under high magnification.
Figure 6
Figure 6
Three hypotheses for tumorigenesis in the present case. (a) Hypoplasia of the left thyroid lobe plus thyroid cancer occurring on the hypoplastic side, with tumor replacing the hypoplastic tissue. (b) Thyroid hemiagenesis plus thyroid microcancer plus lymph node metastasis. (c) Thyroid hemiagenesis plus ectopic thyroid on the side of the absent gland plus ectopic thyroid carcinoma.
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References

    1. Mikosch P., Gallowitsch H. J., Kresnik E., Molnar M., Gomez I., Lind P. Thyroid hemiagenesis in an endemic goiter area diagnosed by ultrasonography: report of sixteen patients. Thyroid. 1999;9(11):1075–1084. doi: 10.1089/thy.1999.9.1075. - DOI - PubMed
    1. Shabana W., Dealnge F., Freson M., Osteaux M., De Schepper J. Prevalence of thyroid hemiagenesis: ultrasound screening in normal children. European Journal of Pediatrics. 2000;159(6):456–458. doi: 10.1007/s004310051307. - DOI - PubMed
    1. Henle J. Handbuck der Systematischen Anatomie des Menschen. Vol. 2. Braunschwerg, Germany: Verlag von Friedrich Vieweg and Sohn; 1866. p. p. 538.
    1. Sadler T. W. Langman’s Medical Embryology. 6th edition. Baltimore, MD, USA: The Williams and Wilkins Company; 1990. pp. 297–327.
    1. Hsu C. Y., Wang S. J. Thyroid hemiagenesis accompanying an ectopic sublingual thyroid. Clinical Nuclear Medicine. 1994;19(6):p. 546. doi: 10.1097/00003072-199406000-00019. - DOI - PubMed

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