|IMAGES IN ONCOLOGY
|Year : 2021 | Volume
| Issue : 2 | Page : 294-295
An unusual case of ectopic thyroid tissue in an adrenal gland presenting as a cyst
Shreya Bramhe1, Shashi Dhawan1, Neeraj Dhamija2
1 Department of Histopathology, Sir Gangaram Hospital, New Delhi, India
2 Department of General and Laparoscopic Surgery, Sir Gangaram Hospital, New Delhi, India
|Date of Submission||07-Mar-2020|
|Date of Decision||26-Dec-2020|
|Date of Acceptance||07-Feb-2021|
|Date of Web Publication||11-May-2021|
Department of Histopathology, Sir Gangaram Hospital, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bramhe S, Dhawan S, Dhamija N. An unusual case of ectopic thyroid tissue in an adrenal gland presenting as a cyst. Indian J Cancer 2021;58:294-5
Most of the ectopic thyroids are confined to the migration pathway of the normal thyroid gland. The presence of ectopic thyroid outside this pathway is rare. A few case reports of ectopic thyroid in adrenal are available. The ectopic thyroid undergoes the same pathological changes as that of the normal orthotopic thyroid gland. We present an ectopic thyroid tissue in the adrenal gland in an Indian girl.
An 18-year-old girl presented with dull aching pain in the abdomen since 2 months. Ultrasonography (USG) revealed a cystic lesion (66 mm × 63 mm × 55 mm) with internal echogenic content in linorenal ligament abutting the upper pole of the left kidney and tail of the pancreas. Computerized tomography (CT) scan confirmed this cystic lesion in the left adrenal region. Fluid from the cyst showed normal level of amylase and lipase. The lesion was excised. On gross examination, one surface was smooth, and the other was irregular. Wall thickness was 0.1–0.3 cm. Periphery of the cyst wall showed normal adrenal tissue.
Microscopically the cyst had no definite lining. The wall showed follicles of varying sizes, filled with eosinophilic colloid-like material, which resembled normal thyroid follicles [Figure 1]. No cellular atypia or nuclear features of papillary carcinoma (ground glass nuclei, nuclear grooves, intranuclear inclusions, or psammoma bodies) were seen. Folliclular cells were positive for TTF-1, thyroglobulin, and CK19 and were negative for galectin 3 and HBME1 establishing thyroid origin and benign nature of the thyroid follicles [Figure 2].
|Figure 1: (a) Thyroid follicles within the adrenal gland (H and E 100×) (b) Higher power view (H and E 200×)|
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|Figure 2: Follicular epithelial cells are positive for TTF1 (a) and Thyroglobulin (b). Adrenal cortical cells are positive for Inhibin (c) and Calretinin (d). All images are in 100×|
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A few explanations were given to answer the presence of ectopic thyroid in the adrenal gland which includes metastasis, teratoma, metaplasia heterotopia (choriostoma), and over descent of the thyroglossal duct remnant. Presence of thyroid in the ovaries (struma ovarii) is considered as monodermal teratoma.
Malignant transformation of ectopic thyroid is rare. The ectopic thyroid must always be distinguished from the metastasis of occult thyroid carcinoma. Immunohistochemistry (IHC) is helpful to rule out metastasis. Thyroid should also be evaluated for the presence of any malignancy before labeling thyroid ectopic because metastasis is more frequent than ectopic thyroid.
In conclusion, an ectopic thyroid in the adrenal is rare but well documented. It mostly occurs in women and is present as a cystic lesion. The microscopic features are the same as that of the orthotopic thyroid and can be easily distinguished from the normal adrenal. IHC helps to confirm or rule out any metastasis. Clinicians and pathologists should be aware of ectopic thyroid in the adrenal, to avoid misdiagnosis.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]