Endocrine Abstracts

Section 1:: 25 year old lady presented in 2014 with subacute submental midline neck swelling. Ultrasound neck: thyroid glands noted to be normal in size, shape and echotexture. No foci/nodules/mass lesion noted with normal vascularity. Isthmus of thyroid also noted to be normal in size, shape and echotexture. Neck vessels seen normally. Few hypoechoic lesions noted in submental region with echogenic area within it, on application of color doppler flow showing blood flow in echogenic area (differential ?enlarged lymph node), no evidence of calcification. FNAC only revealed foamy histiocytes and acute inflammatory infiltrate. Normal routine bloods including thyroid function tests except slight increase in CRP therefore diagnosed as inflammatory cyst. Patient started on antibiotics and discharged. Lost to follow up. Represented to ENT 3 years later for cosmetic removal of persisting swelling. Noted to have a 3*3 cm submental swelling, surface noted to be irregular moving with swallowing. Overlying skin normal. Suspected thyroglossal cyst vs lymph node. Planned for sistrunk operation under GA as per patient request.

Section 2:: Specimens sent to pathology – received 4.5*2*2 cm three grey white nodular soft tissue masses measuring together 4.5*2*2 cms. C/S showed 4 cysts with papillary projections arising from the wall projecting into lumen. Microscopically well differentiated papilliferous lesion lying within a cystic space. Incomplete fibrous capsule capsule, closely packed papillae have a core of fibrovascular connective tissue lined by single layer of cuboidal to low columnar epithelial cells. Eosinophilic secretions presented within cysts. Pale staining nuclei with prominent nucleoli. Endocrinology involved retrospectively full thyroid screen (post op), thyroglobulin levels, autoimmune antibodies negative. Asuragen and thyroseq3 testing negative. Patient Discussion Plan made for active surveillance rather than thyroidectomy as patient denied same. Ultrasound/CT thyroid done serially for 3 years negative. FDG PET scan done 1 and 3 years post op negative

Conclusions/Points for Discussion: Rare case of ectopic thyroid papillary cancer developing in prolonged swelling. No evidence of malignancy in thyroid gland. Authors vary in offering management in patients with thyroglossal cyst carcinoma (or ectopic papillary thyroid cancer) / microscopic papillary thyroid cancer with total thyroidectomy vs active surveillance. Involvement of endocrine is essential in such cases as we may be able to offer patient with a better information background in case the option of thyroidectomy is to be broached. Perhaps, in this case early endocrine consultation and reassurance may have helped in achieving thyroidectomy if needed.