1/6. Massive squamous metaplasia of the thyroid gland-- report of three cases.Three cases of massive squamous cell metaplasia in Hashimoto's thyroiditis are reported. The patients were two men and one woman aged 24, 52, and 55 years, respectively. In all three patients, the glandular parenchyma was replaced by hypocellular fibrous tissue with scattered chronic inflammatory infiltrate. Follicular cells were almost absent; the majority of residual epithelial cells formed squamous nests that were partly solid and partly cystic. There were three types of epithelial cells - squamous, basaloid, and follicular, with oncocytic differentiation. The squamous and basaloid cells showed strong positivity high molecular weight (HMW) cytokeratin, moderate to strong expression of galectin-3 (2/3), and nuclear expression of p63 protein (2/3). The staining pattern of p63 was identical to that of HMW, with predominant positivity at the periphery of cell nests. In one case, weak but unequivocal positivity of thyroid transcription factor-1 also was present. We believe that metaplasia was caused by Hashimoto's thyroiditis. The cases presented here are extremely rare, and only two convincing similar cases have been reported in the English literature so far. They may represent a diagnostic pitfall and should not be misdiagnosed as a malignancy, in particular as squamous cell or mucoepidermoid carcinoma.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
2/6. Combined occurrence of hyperthyroid Graves' and Hashimoto's thyroiditis.A 40 years old, married Govt. servant from Sadar upazila, Mymensingh was admitted in Mymensingh Medical College Hospital on 9(th) February, 2005 with the complaints of excessive sweating for 1 year, gradual loss of weight for 6 months, swelling in front of the neck for 1(1/2) months, and hoarseness of voice for 1 month. He was nervous, irritable, emotionally labile. thyroid gland was symmetrically enlarged, firm in consistency with scalloped surface. Palms were warm and sweaty with fine tremor in outstretched hands. Lid lag, lid retraction and proptosis were the occular manifestations. All the reflexes were exaggerated. Radioactive iodine uptake showed enlarged gland with homogenously increased radiotracer concentration, ultrasonogram findings were enlarged gland with hypoechoic parenchyma with fibrous septa, T(3), T(4), TSH values were 6.56 nmol/L, 241.09 nmol/L and 0.14 mIU/L respectively. Thyroid microsomal antibody level was 32.87%. Thyroid FNAC findings were sheets of regular follicular cells, some large cells with granular basophilic cytoplasm, macrophages, a few inflammatory cells and giant cells. All the above findings were in favour of a diagnosis of hyperthyroid Graves' with Hashimoto's thyroiditis.- - - - - - - - - - ranking = 0.6keywords = gland (Clic here for more details about this article) |
3/6. Ectopic lingual thyroid tissue and acquired hypothyroidism: case report.Ectopic thyroid tissue with thyroid gland in its normal location is an extremely rare phenomenon. We present a case of a 38-year-old woman who was referred to our hospital with symptoms of hypothyroidism. Thyroid hormone measurement revealed clinical hypothyroidism with elevated anti-thyroid antibodies, neck ultrasonography showed a small tissue with the characteristic of Hashimoto thyroiditis, while the scintigraphy demonstrated only a lingual thyroid. Treatment consisted in L-thyroxine replacement to the euthyroid state. We reviewed the literature with respect to the embryological background and the clinical management of such cases.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
4/6. Hashimoto's thyroiditis in a patient with non-Hodgkin's thyroid lymphoma of B cell type and originated from mucosa-associated lymphoid tissue (MALT): A case report.This is a rare case report of Hashimoto's thyroiditis in a patient with MALT thyroid lymphomas. The patient presented with an enlarged neck mass over the past 10 years and had rapidly enlarged neck mass with compressive symptoms for about 2 months. Examination by an endocrinologist found that the size of the thyroid gland was 120 gm with firm consistency and with no tenderness. She had clinical hypothyroidism and no abnormality of neither lymphadenopathy nor any masses. She was diagnosed with Hashimoto's thyroiditis because her thyroids function lest showed primary hypothyroidism [(FT4 = 0.76 ng/dl (0.93-1.71), FT3 = 1.76 pg/ml (1.8-4.6), TSH = 8.24 mIU/L (0.27-4.21)] with antimicrosomal antibody positive titers (> 1:409,600): diagnosis of primary thyroid lymphoma was diagnosed by FNA and total thyroidectomy was performed. About 1 day after total thyroidectomy, she developed clinical hypocalcemia and the laboratory showed that calcium was = 6.2 ng/dl (8.5-10.1), phosphorus = 6.4 mg/dl (2.5-4.9). After 10% calcium gluconate replacement, her hypocalcemic symptoms didn't appear and she received oral replacement of calcium carbonate and vitamin d before discharge. During OPD follow up, her pathological report from Maha Chakri Sirinthorn Medical Center was a diagnosis of Non Hodgkin's lymphoma, low grade and the latter 1 week immunohistochemically staining of tumor markers indicated B-cell type (CD20) with MALT (AE1/AE3) lymphoma. Staging of the disease was stage IE and she received one course of CHOP (cyclophosphamide, doxorubicin, vincristin and prednisolone). After one course of CHOP regimen, she was healthy and the hematologist ordered two courses of CHOP and external radiation.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
5/6. Autoimmune thyroid encephalopathy presenting with epilepsia partialis continua.We report the first case of an autoimmune thyroid encephalopathy presenting with multifocal motor status epilepticus. A 37-year-old female patient was admitted with multifocal motor seizures intractable to intravenous status epilepticus treatments, asymmetrical quadriparesis, truncal ataxia and continuous semi-rhythmical jerks. Pathological signal alterations were detected in both precentral cortices in MRI examination. Autoimmune thyroiditis was diagnosed after radiological examinations of the thyroid gland and thyroid function tests. seizures promptly ceased following intravenous steroid treatment. immunohistochemistry studies showed mild to moderate neuronal staining with the plasma and CSF samples. Remarkably, autoimmune thyroiditis may present with migrating focal motor status epilepticus. We recommend anti-thyroid antibody screening for multifocal motor status epilepticus cases of unspecified cause.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
6/6. Primary squamous cell carcinoma of the thyroid arising in Hashimoto's thyroiditis in an adolescent.Squamous cell carcinoma is a rare thyroid neoplasm that has been described exclusively in adults. We report what appears to be the first example of a primary squamous cell carcinoma of the thyroid gland arising in a background of Hashimoto's thyroiditis in an adolescent female. The tumor was well demarcated, confined to the right thyroid lobe, and did not metastasize, although follow up has been limited. The squamous cell carcinoma was well to moderately differentiated, and the stroma contained an abundant inflammatory infiltrate rich in lymphocytes and eosinophils. The lack of goblet cells, extracellular mucin, and extensive stromal sclerosis excluded the diagnosis of sclerosing mucoepidermoid carcinoma with eosinophilia. Immunohistochemical staining revealed focal expression of cytokeratin 7 and diffuse labeling with cytokeratin AE1/AE3. The squamous cell carcinoma overexpressed p53 protein and showed increased proliferative activity, as evidenced by the high MIB-1 labeling index. In contrast, the tumor did not show immunoreactivity for thyroglobulin or thyroid transcription factor 1.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |