Division of Diabetes, Endocrinology, and Metabolism, Duke University Hospital, Durham, NC 27710, USA.
Thyroid. 2011 Sep;21(9):1033-8. doi: 10.1089/thy.2010.0390. Epub 2011 Aug 11.
Ectopic thyroid tissue is a rare finding but has been reported in many thoracic and abdominal locations. It is usually an incidental pathologic finding after an unrelated surgical intervention. When thyroid tissue is found outside the thyroid bed, it is important to rule out thyroid cancer metastasis.
We present a case of a 61-year-old African American woman who was incidentally found to have concomitant ectopic thyroid tissue in the adrenal gland and a papillary thyroid microcarcinoma (PTMC) in the right lobe of the thyroid.
The concurrent finding of ectopic thyroid tissue and PTMC posed the diagnostic dilemma of whether the extrathyroidal tissue was metastasis or metaplasia, with very different treatment implications. Although many of these incidental micropapillary cancers are indolent, some patients do experience local or distant metastasis. Therefore, it is important to delineate which of these microtumors are likely to metastasize. Some tumor markers and gene mutations have been proposed to help differentiate the more benign tumors from the more aggressive tumors, but there is currently no standard method for determination of metastatic potential.
Here we present the seventh known case of ectopic thyroid tissue in the adrenal gland and the first case of concomitant incidental PTMC in the setting of this ectopic tissue finding. Using this case, we discuss the diagnostic and therapeutic challenges faced and propose the use of biomarkers to help determine the metastatic potential of these tumors.
异位甲状腺组织是一种罕见的发现，但已在许多胸部和腹部位置报道过。它通常是在无关的手术干预后偶然发现的病理发现。当甲状腺组织在甲状腺床外发现时，重要的是要排除甲状腺癌转移。
我们报告了一例 61 岁的非裔美国妇女的病例，她偶然发现同时存在异位甲状腺组织在肾上腺和甲状腺右叶的甲状腺微小乳头状癌（PTMC）。
异位甲状腺组织和 PTMC 的同时发现提出了诊断难题，即甲状腺外组织是转移还是化生，这具有非常不同的治疗意义。尽管这些偶然的微乳头状癌中的许多是惰性的，但有些患者确实会发生局部或远处转移。因此，重要的是要确定哪些微肿瘤可能转移。已经提出了一些肿瘤标志物和基因突变来帮助区分更良性的肿瘤和更具侵袭性的肿瘤，但目前尚无确定转移潜力的标准方法。
在这里，我们提出了第七个已知的异位甲状腺组织在肾上腺的病例，也是第一个同时存在异位组织的偶然 PTMC 的病例。通过使用这个病例，我们讨论了所面临的诊断和治疗挑战，并提出使用生物标志物来帮助确定这些肿瘤的转移潜力。
