Endocrine Abstracts

Case of 33 years old male patient with an unremarkable past medical history, who after a car accident, a cystic nodular right neck mass was incidentally found by MRI of cervical spine. Physical examination revealed a mildly tender right neck mass. He was clinically and biochemically euthyroid. Denied history of neck irradiation. No family history of thyroid disease or thyroid cancer. Excisional biopsy of right neck mass showed metastasic well differentiated papillary carcinoma of thyroid gland at lymph node. Total thyroidectomy with right modified neck dissection was performed. Histopathological report disclosed no evidence of malignant tumor within the thyroid gland (papillary cancer) as well as 16 right lymph nodes obtained from surgery. One month after surgery, thyroglobulin levels were elevated, 133.61 ng/ml (nv: 5–25 ng/ml) with negative anti-thyroglobulin antibodies (thyroglobulin antibodies: 11.8 μU/ml nv: 0–4.11). Thyroid scan and whole-body scan showed evidence of functional thyroid tissue remnants; this appears to be a right thyroid lobe. Also, a faint visualization of a smaller focus in the left thyroid bed region was seen. Thyroid ultrasound showed two right medial neck nodules. Fine needle aspiration biopsy of neck nodules were reported positive for metastasic thyroid papillary carcinoma. Radioidine ablation therapy was given.

Ectopic thyroid gland is defined as thyroid tissue not located anterolaterally in the second to fourth tracheal cartilages. Ectopic Thyroid tissue is a rare entity with an incidence of 1 in 300.000. An ectopic thyroid gland in the region of the submandibular gland, intra-trachea or laterally is very rare. Malignant transformation of ectopic thyroid tissue is an uncommon event; only 43 cases have been reported. Only 10 of those cases were papillary carcinoma.