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Cases reported "Goiter, Nodular"

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11/25. Sequential presentation of a case of hyperthyroidism with autonomously functioning nodules and Graves' disease in the presence of IgG thyroid stimulators.

    The rare occurrence of hyperthyroidism with an autonomously functioning nodule which following 131I therapy presented as toxic diffuse goitre (Graves' disease) is described in a 60 year old male. This progression was characterised by the presence of varying concentrations of IgG thyroid stimulators, thyroid stimulating immunoglobulins and thyroid growth stimulating immunoglobulins, as measured by cytochemical bioassay. It is postulated that the presence of the nodule and its associated hypersecretion of thyroid hormones may have protected the gland from the effects of IgG stimulators by bringing about inhibitory short-loop feedback on normal thyroid cells. It is further suggested that following therapeutic ablation of the nodule, normal thyroid cells became sensitive to the thyroid stimulators with the evolution of typical features of toxic diffuse goitre.
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12/25. Clinical application of 201Tl scintigraphy in patients with cold thyroid nodules.

    201Tl-chloride scintigraphy was performed in 45 patients with cold thyroid nodules. The 201Tl scintigram was positive in 17 of 18 thyroid patients with cancer (94.4%), 8 of 20 patients with an ademoma (40.0%), 1 of 2 adenomatous goiter patients (50.0%), and all of 5 cases of chronic thyroiditis (100.0%). When the cold nodule was demonstrated to be positive with 201Tl, the statistical chance of the lesion being a cellular one was 100.0% and a risk of its malignancy was 54.8%. On the other hand, the nodule with negative 201Tl concentration had a 14.3% chance of cellularity and a 7.1% risk of malignancy. Thus, 201Tl scintigraphy is of use in the differential diagnosis of the cold thyroid nodule.
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13/25. Translocation (5;19)(q13;q13) in a multinodular thyroid goiter.

    We describe the cytogenetics of a multinodular thyroid goiter where 90% of the analyzed cells showed a diploid karyotype with a balanced translocation between chromosomes 5 and 19: 46,XX,t(5;19)(q13;q13). This translocation has been previously described in cases of thyroid adenoma. Our case is the first report of this anomaly in nodular hyperplasia. We discuss its putative role in the neoplastic transformation of thyroid lesions.
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14/25. Intranodular reactive endothelial hyperplasia in adenomatous goitre.

    Endothelial hyperplasia has rarely been recognized in the thyroid. Ischaemic events or hemorrhage, sometimes as a result of fine needle aspiration procedures, have been regarded as possible causes. To clarify the morphological pattern and the clinical significance of this lesion, we studied a series of adenomatous goitres and selected 11 cases showing prominent endothelial hyperplasia in an individual nodule. Grossly, the parenchyma of the affected nodule was substituted by greyish, friable tissue surrounded by a fibrous capsule and by a thin rim of residual thyroid parenchyma. Microscopically, fibrinous and haemorrhagic material was crossed by intercommunicating vascular channels or papillary structures. These were lined by plump endothelial cells. In only one case had pre-operative fine needle aspiration biopsy been performed: smears yielded a haemorrhagic background, fibrin and numerous elongated cells; colloid and follicular cells were virtually absent. In both surgical and cytological specimens a differential diagnosis with a vascular neoplasm, a rare occurrence in the thyroid, was taken into consideration. We conclude that intranodular reactive endothelial hyperplasia is a relatively common occurrence (1.6%) in adenomatous goitre and is of diagnostic interest in both surgical and cytological specimens, since it can mimic vascular tumours and may lead to unnecessary treatment if misdiagnosed.
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15/25. Intrathyroid salivary gland-type tissue in multinodular goiter.

    We report a case of intrathyroid salivary gland tissue in a 66-year-old Caucasian female with multinodular goiter. Lobules of well differentiated seromucinous salivary glands were found in close relationship with cartilage and fat, and intimately associated with normal thyroid follicles and solid cell nests (SCN) of the thyroid gland. This is the first report of non-neoplastic intrathyroid salivary gland tissue. We conclude that this heterotopic tissue probably arises from the SCN as ultimobranchial vestigial structures.
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16/25. Preoperative localization of a parathyroid adenoma with Tc-99m sestamibi imaging in a patient with concomitant nontoxic multinodular goiter.

    Preoperative localization of parathyroid adenomas is useful in patients undergoing parathyroidectomy. The authors report a patient with hyperparathyroidism and an associated nontoxic nodular goiter. technetium-99m sestamibi scintigraphy localized and differentiated the parathyroid adenoma from the multinodular goiter. Excellent correlation was found between preoperative radionuclide imaging and surgical pathology. technetium-99m sestamibi parathyroid imaging may be a simple and helpful test in the surgical management of parathyroid adenomas, particularly in patients with nontoxic multinodular goiter.
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17/25. Appearance of thyroid stimulating antibody and Graves' disease after radioiodine therapy for toxic nodular goitre.

    A patient with toxic nodular goitre is described in whom radioiodine (131I) therapy paradoxically induced typical Graves' disease. This patient had a goitre with two autonomously functioning nodules suppressing uptake by the remainder of the gland. Circulating thyroid peroxidase antibody indicated the coexistence of focal lymphocytic thyroiditis. Radioiodine therapy was followed by the development of severe and persistent Graves' hyperthyroidism associated with diffuse 131I uptake by the gland. A second administration of 131I produced a further worsening of hyperthyroidism, and the appearance of ophthalmopathy. TSH-receptor antibody and thyroid stimulating antibody were undetectable before 131I, appeared after the first administration of radioiodine, and showed a further increase after the second dose of 131I. We suggest that, in a patient genetically susceptible to thyroid autoimmunity, the release of TSH-receptor antigenic components from follicular cells damaged by radioiodine therapy triggered an autoimmune response to the TSH-receptor, thus turning a toxic nodular goitre into Graves' disease.
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18/25. thyroid gland metastasis from renal cell carcinoma masquerading as nodular goitre.

    Renal cell carcinoma metastasizing to the thyroid gland, in a 72 year old Japanese woman, is reported. The patient had undergone a left radical nephrectomy for renal cell carcinoma 3 months prior to the present operation. The patient noticed a nodular goitre but there was no evidence of any systemic spread of renal cell carcinoma. The histopathologic diagnosis, from a left lobectomy of the thyroid gland, was thyroid gland metastasis from renal cell carcinoma in adenomatous goitre. Clinical manifestation of thyroid gland metastasis from renal cell carcinoma, with no evidence of systemic involvement, is seen rarely. A case is reported and the condition discussed briefly.
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19/25. Solitary fibrous tumor of the thyroid.

    A case of solitary fibrous tumor (SFT) of the thyroid in a 43-year-old woman with a multinodular goiter is reported. This is the first case of SFT described in the thyroid. On histologic, immunohistochemical, and ultrastructural examination, the tumor was identical to SFT of the pleura and other organs. Despite its rarity, SFT should be included in the differential diagnosis of spindle-cell tumors of the thyroid, along with anaplastic carcinoma, spindle-cell medullary carcinoma, and several types of mesenchymal tumors.
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20/25. Langerhans cell histiocytosis presenting as a goitre: a case report.

    We report a case of Langerhans cell histiocytosis (histiocytosis X) in a 36-year-old female with an euthyroid nodular goitre as the rare initial presentation. She subsequently developed a pathological fracture of the lumbar spine which was initially thought to be due to malignant infiltration, possibly from metastatic thyroid carcinoma. Open vertebral biopsy and total thyroidectomy were performed. Histological features of histiocytic proliferation with erythrophagocytosis were found in both the thyroid gland and in the involved vertebral body. The diagnosis of histiocytosis X was made on the basis of the positive immunoperoxidase staining of the histiocytic cells with S-100 and peanut agglutinin (PNA) as well as the clinical picture. Despite systemic chemotherapy with low dose corticosteroids and vinblastine, diabetes insipidus with a suprasellar mass occurred three years post thyroidectomy. Successful management of this uncommon disease is difficult to conduct and evaluate at the present time.
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Last update: April 2009
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