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Ectopic thyroid tissue is defined as thyroid tissue that is present at a location other than its normal anatomical location. It can have any pathological condition that could impact the orthotopic thyroid gland. However, ectopic thyroid tissue seldom becomes malignant, and the occurrence of a follicular variant of papillary carcinoma in ectopic thyroid is much more unusual. We report a rare case of ectopic follicular variant of papillary carcinoma in a 73-year-old female with a normal orthotopic thyroid gland. Despite a few reports on ectopic papillary carcinoma thyroid (PTC) in submental, thyroglossal duct cysts, and bronchial cleft cysts with normal pathologic examinations of orthotopic thyroid, only one case of PTC in the anterior neck region without any neoplastic involvement of the orthotopic thyroid gland has been reported. Ectopic thyroid carcinoma should be taken into account in the differential diagnosis of a mass lesion in the front of the neck even in the presence of a normal thyroid gland which will aid in early diagnosis and treatment of such cases.

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Ectopic thyroid tissue is rare in the general population and more prevalent in people who have existing thyroid disease. Common anatomical sites of ectopic thyroid tissue include the lateral cervical region, thyroglossal duct, mediastinum, lingual, sublingual, and submandibular region. Intrathymic ectopic thyroid tissue is exceedingly rare. The purpose of this report is to describe one such case in a 52-year-old African-American female with Graves' disease. The patient presented for a physical exam and follow-up. During the exam, an incidental mediastinal mass was discovered, which was evaluated by imaging studies and subsequently was resected. Histologically, the mass was composed of variable-sized thyroid follicles lined by a monolayer of cuboidal to columnar follicular epithelial cells and filled with eosinophilic colloid, surrounded by a rim of unremarkable compressed thymic tissue.

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Background/Objective: Follicular thyroid cancer without an intrathyroidal primary cancer is rare. We present a patient with multifocal pulmonary metastatic follicular thyroid cancer without apparent cancer within her thyroid. Case Report: A 44-year-old woman was referred to the thyroid cancer clinic via telemedicine for evaluation of intrapulmonary thyroid tissue. Her past medical history included Roux-en-Y gastric bypass and hysterectomy with bilateral oophorectomy. Six months prior, abdominal computed tomography (CT) showed incidental bilateral lung nodules. Chest CT demonstrated 4 solid left and 1 solid right lung nodules. Lung nodule core biopsy revealed benign thyroid tissue. Thyroid ultrasound showed bilateral subcentimeter anechoic nodules. Chest CT 6 months after initial CT demonstrated stable lung nodules. The levels of thyroid-stimulating hormone, serum thyroglobulin, and thyroglobulin antibody were 1.63 mIU/L (reference range, 0.3-5.5 mIU/L), 40.9 ng/mL (reference range, 0-35 ng/mL), and <1 IU/mL (reference range, <4), respectively. Positron emission tomography/CT showed fluorodeoxyglucose-avid lung lesions measuring 1.5, 1.1, and 2.2 cm and other subcentimeter pulmonary nodules. Repeat lung core biopsy showed thyroid tissue with microfollicular architecture, favoring metastatic follicular carcinoma with neuroblastoma-RAS gene (NRAS) mutation. Total thyroidectomy performed showed multinodular hyperplasia without thyroid cancer. Her postoperative radioiodine scan demonstrated bilateral iodine-avid pulmonary nodules, a serum thyroglobulin level of 179.8 ng/mL, a thyroid-stimulating hormone level of 151.3 mIU/L, and undetectable serum thyroglobulin antibody. She received 261 mCi of radioactive iodine. Fourteen months later, chest CT revealed decreased lung nodules and a serum thyroglobulin level of 0.7 ng/mL. Discussion: Approximately 2 cases of multifocal pulmonary follicular thyroid cancer without a primary source and no other site of metastasis have been reported. Conclusion: Pulmonary follicular thyroid cancer without a primary source and no other site of metastasis is extremely rare.

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Ectopic thyroid tissue (ETT) is a rare finding on mediastinoscopy which could be attributed to a defect early in thyroid gland embryogenesis, as the glandular tissue makes its way to a pre-tracheal position. The more distal the location of the ectopic tissue from typically neighboring structures, such as the recurrent laryngeal nerves or the superior thyroid artery, the greater the likelihood for issues such as hyperthyroidism, compression of nearby neurovascular structures, and malignancy. Depending on the exact anatomical location and hormonal activity of the tissue, management can range from administration of iodine to surgical resection. This report discusses a case of ETT discovered during the resection of an anterior mediastinal mass, possible treatment, and management plans.

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Ectopic thyroid tissue is a rare congenital anomaly, with the presence of three simultaneous ectopic foci being exceedingly rare. We describe a case of a totally asymptomatic 26-year-old male discovered to have triple ectopic thyroid following incidental elevated thyroid-stimulating hormone (TSH) levels. Subsequent ultrasonography of the neck showed an absent thyroid gland in its conventional location. A Technetium-99m pertechnetate (Tc-99m) thyroid scan showed three distinct foci of radiotracer uptake in the upper cervical, lingual, and sublingual regions, corresponding to triple ectopic thyroid. An extensive review of the literature was conducted to provide a broader understanding and deeper insights into this uncommon condition. This case underscores the pivotal role of Technetium-99m thyroid scanning in diagnosing triple ectopic thyroid, particularly in instances where the orthotopic thyroid gland is absent. A comprehensive understanding of this rare entity is indispensable for radiologists and clinicians, enabling accurate diagnosis and informed decision-making regarding the appropriate therapeutic strategies.

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INTRODUCTION: The lingual thyroid gland refers to ectopic thyroid tissue situated at the base of the tongue. This rare condition occurs when the thyroid gland fails to descend to its usual position in the pre-tracheal area during embryonic development. CASE PRESENTATION: We present a case of a 23-year-old female who presented with throat discomfort and progressive difficulty of swallowing upon examination there was a mass at the level of the base of the tongue. She was investigated with a thyroid function test, neck ultrasound, at the tongue's base, and head and neck CT scan. With a diagnosed lingual thyroid she was managed initially with suppression therapy followed by elective surgical removal. The work has been reported in line with the SCARE criteria. CLINICAL DISCUSSION: The incidence of lingual thyroid is reported to be 1 in 100,000, with a higher prevalence among females, in a ratio of 3:1 compared to males. Symptoms can vary and may include difficulty swallowing (dysphagia), voice changes (dysphonia), upper airway obstruction, or occasional bleeding, and can manifest from infancy to adulthood. CONCLUSION: Lingual thyroid is a rare clinical anomaly treatment depending on the severity of symptoms, size of the lesion, sex and age of the patient, and thyroid function.

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BACKGROUND AND OBJECTIVES: Thyroid ectopy represents a rare disease with an incidence of 0.3-1/100,000. It occurs due to the defective embryological process of the thyroid gland development. The thyroid ectopic tissue may suffer malignant transformation. This review aims to shed light on the roles that I-131 SPECT/CT (radioiodine 131 single-photon emission tomography fused with computed tomography) and F-18 PET/CT (fluorodeoxyglucose F18 positron emission tomography fused with computer tomography) may play in managing patients with ectopic thyroid carcinoma. MATERIALS AND METHODS: A total number of 47 articles were identified on the PubMed and Google Scholar databases, and 3 other articles were selected from articles identified in the references cited in the retrieved articles. After refining the selection, the inclusion and exclusion criteria were applied, resulting in 10 articles that were included in the review. RESULTS: The cases of ectopy included in this review were localised as follows: four cases in the thyroglossal duct, two cases in the mediastinum, one case in the oesophagus, one case in the thorax, one case with a pre-tracheal location, and one case with a latero-cervical location. In all the cases, F-18 FDG PET/CT was used as a diagnostic tool. In one case, F-18 FDG PET/CT was combined with I-131 SPECT/CT and MRI (magnetic resonance imaging). In one case, it was combined with 68 Ga-FAPI PET/CT (Ga-68 radiolabelled FAP inhibitor positron emission tomography fused with computer tomography). The maximum SUVs (standardised uptake values) ranged from 5.5 to 25 g/mL. CONCLUSIONS: F-18 PET/CT and I-131 SPECT/CT hybrid nuclear imaging is of great value in assessing ectopic thyroid carcinoma. F-18 FDG PET/CT plays an important role in the primary tumour evaluation and distant disease detection. Ga-68 FAPIs are a promising alternative. I-131 SPECT/CT adds important information related to the anatomical characterization of primary and distant iodine-avid lesions.

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Ectopic thyroid tissue is very rare, but the coexistence of ectopic and eutopic thyroid glands is even more rare. The recognition of this diagnosis is important in patients who are being treated for thyrotoxicosis, but it is also crucial to exclude other associated serious disease conditions. In this article, we report three different cases that showed ectopic thyroid tissue with the coexisting presence of an eutopic thyroid gland. All three cases showed different outcomes. The recognition of this condition is of great importance because it alerts the referring physicians to this rare, yet possible occurrence and the potential pathological conditions associated with it. The first case showed how imaging could help outline even small ectopic thyroid tissue outside of the neck region even in cases where histopathological confirmation is difficult. The second case was very rare as thyroid carcinoma originated in ectopic thyroid tissue. In the last case, the initial imaging was misleading as it mimicked greatly ectopic thyroid tissue, and only detailed history and careful inspection of the images could lead to the correct interpretation of the findings.

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Ectopic thyroid arises from abnormal development of thyroid primordial tissues as it migrates to the lower interstitium during the embryonic period, which can occur at various locations during the descent process. However, ectopic thyroid in the subdiaphragmatic area is extremely rare. In this case, we report a case of ectopic thyroid located in the hepatoduodenal ligament. The 60-year-old female patient was admitted to hospital with gallbladder stones and cholecystitis. Preoperative imaging showed a mass in the hepatoduodenal ligament. As the patient declined a needle biopsy of the mass, the nature of the mass remained unclear prior to surgery. The patient subsequently underwent laparoscopic cholecystectomy and exploratory resection of the mass. The histopathology of the resected mass showed the characteristics of ectopic thyroid, and immunohistochemical staining revealed positive expression of thyroid transcription factor-1 and thyroglobulin. The diagnosis of ectopic thyroid was established. Upon confirming the diagnosis, comprehensive neck examination revealed the presence of a normally functioning thyroid gland. Throughout the four-year follow-up period, the patient's thyroid ultrasonography and thyroid function tests indicated no abnormalities. Ectopic thyroid in the hepatoduodenal ligament and surrounding areas is an extremely rare clinical abnormality, achieving a clear diagnosis before initiating treatment offers diagnostic and treatment insights and clues for clinicians when differentiating masses within this region.

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Tumors located at the heart base are rare in dogs and cats and aortic body tumors (chemodectoma/paraganglioma), hemangiosarcoma, ectopic thyroid carcinoma, lymphoma, and other uncommon neoplasia can be found at that location. The objective of this retrospective case series was to describe the CT characteristics of canine and feline heart base tumors. CT studies of 21 dogs and four cats with histologically or cytologically confirmed heart base tumors were reviewed for size, location, shape, margination, contrast enhancement, adjacent neovascularization, invasion, mass effect, cavitary effusions, and metastasis. Neuroendocrine tumors (15 aortic body tumors, three ectopic thyroid carcinoma, and three nonspecific neuroendocrine) were more commonly observed than hemangiosarcoma (4) and were frequently located between the cranial vena cava and aortic arch (12/21; 57%) and or dorsal to the pulmonary trunk bifurcation/pulmonary arteries (10/21; 48%). Hemangiosarcoma was more commonly found cranioventral to the aortic arch and cranial to the right auricular appendage (3/4; 75%). Mediastinal and peritumoral neovascularization was associated with 16/21 (76%) neuroendocrine tumors but none of the hemangiosarcoma. Median postcontrast attenuation in Hounsfield units (HU) was higher in neuroendocrine (110 HU) than in hemangiosarcoma (51 HU). Pericardial effusion was frequently observed with hemangiosarcoma (3/4; 75%) and infrequently in neuroendocrine (3/21; 14%). In four cases (all neuroendocrine), concurrent cranial mediastinal masses were present. CT provides useful information regarding the characteristics of heart base tumors, indicating differences between the appearance of neuroendocrine tumors and hemangiosarcoma. However, no differences were found between aortic body tumors and ectopic thyroid carcinoma.

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Adrenal cysts lined by thyroid follicular epithelium are rare, with only 14 reported cases of "ectopic thyroid tissue" to date. While the primary consideration for differential diagnosis is thyroid carcinoma metastasis, exclusion of metastases is determined based on the absence of a primary thyroid lesion, serological euthyroidism, lack of thyroglobulin elevation, and absence of epithelial atypia. Herein, we report 2 cases of adrenal cysts lined by thyroid follicular epithelium. Case 1 was a 60-year-old woman with a right adrenal cyst. Case 2 was a 51-year-old man with a left adrenal cyst. Over time, both cysts became larger, necessitating an adrenalectomy. Cystic epithelia were lined with thyroid follicular epithelium, exhibiting moderate atypia. Human bone marrow endothelial cell marker-1 and galectin-3 were focally positive; CK19 was positive in Case 1, and all 3 markers were positive in Case 2, previously reported as an immunophenotype of thyroid carcinoma. CD56 expression was positive in both cases. Targeted next-generation sequencing revealed several low-frequency mutations; however, no major driver alterations for thyroid cancer were detected. Adrenal cysts can be lined by thyroid follicular epithelium. Challenges arise in determining the malignant or benign nature of adrenal cysts.

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Thyroid cancer in ectopic thyroid tissue is a very rare entity. We report a patient with papillary thyroid cancer arising from upper mediastinal ectopic thyroid tissue. The patient presented with thoracic spine metastasis with cord compression. The patient was a 67-year-old woman, who presented with upper back pain. Magnetic resonance imaging (MRI) showed suspected metastatic disease in the second and third thoracic vertebrae (T2 and T3). She underwent laminectomy and decompression surgery at the T1-T3 level. The final pathology report showed metastatic thyroid carcinoma with papillary features. She underwent external beam radiation to the affected spine. Computerized tomography (CT) scan of the chest, abdomen, and pelvis showed a 3.0 × 2.8 × 2.3 cm soft-tissue mass in the left superior mediastinum extending into the supraclavicular region. Fluorodeoxyglucose-positron emission tomography (FDG-PET) scan showed hypermetabolic foci in the upper mediastinum. Fine needle aspiration (FNA) of the upper mediastinal mass was consistent with papillary thyroid cancer. Molecular testing from the FNA sample using Thyroseq V3 showed SQSTM1NTRK3 chromosomal rearrangement. A total thyroidectomy was performed. Pathology of the resected thyroid was benign. Pathology of the mediastinal mass showed a papillary thyroid carcinoma with focal tall cell features, forming a 4 × 2.5 × 2.5 cm mass. Surgery was followed by ablation with 100 millicuries (mci) of radioactive iodine (I-131) and external beam radiation. This case highlights the presentation of primary intrathoracic papillary thyroid cancer with SQSTM1-NTRK3 chromosomal rearrangement and the challenges in the diagnosis and management of this unique case. This patient had a very aggressive disease presentation that required multimodal treatment, including thoracic spine decompression, total thyroidectomy, primary intrathoracic goiter resection, high-dose radioactive iodine treatment, and external beam radiation to the affected spine area. SQSTM1-NTRK3 chromosomal rearrangement can be targeted by medications such as larotrectinib and endtrectinib.

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OBJECTIVES: Lingual thyroid is a rare condition that affects approximately 1 in 100,000 individuals. Although it is usually detected in the pediatric population through newborn screening tests or evaluation of congenital hypothyroidism, there are cases in which it remains undetected until adulthood or until symptoms arise because of glandular enlargement. The possible symptoms of lingual thyroid include foreign body sensation in the throat, dysphagia, dyspnea, and hemorrhage. Several cases of lingual thyroid are asymptomatic and accompanied by subclinical hypothyroidism. Herein, we present three cases of lingual thyroid treated with thyroid hormone suppressive therapy. CASE PRESENTATION: The three patients sought medical attention because of a sore throat or foreign body sensation in the throat. Their newborn screening tests and developmental histories were normal. These patients exhibited subclinical hypothyroidism and were treated with hormone suppression therapy. CONCLUSIONS: Patients with lingual thyroid frequently exhibit subclinical hypothyroidism. Hormone treatment may help to reduce the size of the ectopic thyroid and improve symptoms. If an increase in size is noted during follow-up or symptoms do not improve, surgical treatments may be considered.

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Ectopic thyroid tissue is a rare developmental abnormality involving aberrant embryogenesis of the thyroid gland during passage from the primitive foregut to the pretracheal position. The most frequent position is the base of the tongue (lingual thyroid); however, it has been described in other sites, such as the submandibular region, trachea, mediastinum, and subdiaphragmatic regions.Here, we report a case of an adenomatous goiter that developed in mediastinal thyroid tissue without any connection to the pretracheal thyroid gland.

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Introducción: La glándula tiroides tiene su origen embriológico en la base de la lengua, desde donde desciende al cuello. Este proceso migratorio puede detenerse o continuar más allá, dando diferentes cuadros de tiroides ectópica. El quiste tirogloso es la alteración embriológica más frecuente en el cuello, pudiendo desarrollar cáncer como una complicación rara. Caso clínico: Paciente de 21 años con aumento de volumen cervical, se diagnostica quiste tirogloso, la biopsia identifica cáncer papilar en el quiste. Se decide completar tiroidectomía, se objetiva agenesia de glándula. Ante respuesta bioquímica incompleta se realiza cintigrama que identifica nódulo retrolingual, el cual es resecado. Discusión: La resección del quiste tirogloso se debe realizar según la descripción de Sistrunk para evitar recidivas. La historia natural del cáncer en quiste tirogloso es bastante menos conocida y podría tener un peor pronóstico que el cáncer tiroideo habitual. Existen grupos que defienden la necesidad de completar tiroidectomía y, eventualmente, realizar disecciones cervicales como parte de su manejo. Conclusión: El cáncer de quiste tirogloso es una patología infrecuente, Existen diferentes lineas de manejo que se discuten en la literatura. Aún el análisis individualizado de los pacientes en comités multidisciplinario de expertos es la conducta sugerida.

Introduction: The thyroid gland has its embryological origin from the base of the tongue, where it descends to the neck. This migratory process can stop early or continue beyond, giving rise to differents cases of ectopic thyroid. The thyroglossal cyst is the most frequent embryological alteration in the neck, and it can develop cancer as a rare complication. Clinical case: A 21 year old patient with a cervical volume increase is diagnosed a thyroglossal cyst. Biopsy identifies papilary cancer in the cyst. It is decided to complete de thyroidectomy, and agenesis of the gland is observed. Due to incomplete biochemical response, a scintigram is performed, wich identifies a retrolingual nodule that is resected. Discussion: The resection of the thyroglossus cyst should be performed according to the description of Sistrunk to avoid recurrence. The natural history of cancer in the thyroglossal cyst is much less known and could have a worst prognosis than usual thyroid cancer. Some groups advocate for the need to complete a thyroidectomy and eventually perform cervical dissections as part of its management. Conclusion: The cancer on a thyroglossal cyst is a rare pathology. There are diferents management approaches that are discussed in the literature. However, an individualized analysis of patients in multidisciplinary expert committees it still the suggested aproach.

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BACKGROUND: Follicular adenomas with papillary architecture are rare tumors of thyroid origin and are composed of completely encapsulated follicular cells with a papillary architecture lacking the nuclear characteristics of papillary carcinoma. Herein, we present a case of follicular adenoma with papillary architecture originating from an ectopic thyroid gland, diagnosed from a mass in the submandibular region. CASE PRESENTATION: A 70-year-old woman was referred to our hospital with the chief complaint of a painless left submandibular mass that had been present for one year. The patient underwent left submandibular dissection for therapy and diagnosis. Microscopically, papillary lesions with fibrovascular cores were observed in the interior, and the epithelial cells were cylindrical in shape with eosinophilic cytoplasm, round or oval nuclei, with no pathological features, leading to a diagnosis of papillary carcinoma or follicular carcinoma. The mass was diagnosed as a follicular thyroid adenoma with papillary architecture. This is the first report of a follicular adenoma with a papillary architecture originating from an ectopic thyroid gland. CONCLUSION: This experience suggests that follicular adenoma should be included in the differential diagnosis of ectopic thyroid tumors.

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