Primary thyroid hemangioma, a rare diagnosis in a patient with a painless neck mass

Abstract

The aim of this case report is to demonstrate a case of primary thyroid hemangioma in a 62-year-old female who presented with a painless neck mass, treated with right hemithyroidectomy and diagnosed by surgical biopsy. Thyroid hemangiomas are rare, benign lesions which present a diagnostic challenge given the lack of specific imaging findings and clinical manifestations associated with them. However, accurate recognition of these lesions is important and can facilitate conservative, rather than surgical, management strategies. In this report, we discuss a case in a patient whose laboratory assessment raised concern for a thyroid paraganglioma, leading to surgical resection of what was ultimately a benign thyroid hemangioma. We also review the pathophysiology, clinical manifestations, differential diagnostic considerations, and imaging characteristics of thyroid hemangiomas across multiple modalities and discuss strategies for accurately diagnosing these lesions.

Keywords: Head and neck radiology; Hemangioma; Neuroradiology; PET/CT; Primary thyroid hemangioma; Thyroid mass; Thyroid ultrasound.

Fig. 1

Axial (A-C), coronal (D), and sagittal-reformatted (E) contrast-enhanced CT images demonstrate a well-circumscribed, highly vascular, hypodense lesion centered in the superior aspect of the right thyroid gland (arrows) with a prominent vein traversing through the central portion of the lesion and subsequently draining into the right internal jugular vein (arrowhead on C).

Fig. 2

Color Doppler ultrasound image in a transverse plane of the right thyroid lobe performed before fine needle aspiration shows a well-circumscribed hypoechoic thyroid nodule with increased internal vascularity (arrow).

Fig. 3

Axial (A) and coronal-reformatted (B) Gallium-68 Dotatate PET/CT images show no significant uptake within the lesion in the superior right thyroid lobe (arrows), against a background of mild uptake by the normal thyroid tissue (arrowhead on B). The lesion was therefore not compatible with a somatostatin-rich neoplasm, such as paraganglioma, for which this exam is felt to have roughly 93% sensitivity .

Fig. 4

(A) Histopathologic features of thyroid hemangioma. Hematoxylin and eosin (H&E) staining (2×) of the lesion reveals normal thyroid parenchyma (arrow) with numerous intermingled thick and thin-walled blood vessels (arrowheads). (B) Histopathologic features of thyroid hemangioma. Hematoxylin and eosin (H&E) staining (4×) of the lesion reveals thick and thin walled blood vessels (arrows), in a vague lobular pattern with surrounding lymphoid aggregates (arrowheads).