Uchida Naotaka, Yoshida Manabu
Department of Breast, Endocrine and Thoracic Surgery, Matsue City Hospital, 32-1, Noshira-cho, Matsue, Shimane, 690-8509, Japan.
Department of pathology, Matsue City Hospital, 32-1, Noshira-cho, Matsue, Shimane, 690-8509, Japan.
Surg Case Rep. 2020 May 11;6(1):97. doi: 10.1186/s40792-020-00857-2.
Normally located in the neck, ectopic mediastinal thyroid tissue consists of very rare ectopic thyroid tissue that does not connect to the thyroid gland. A patient with mucosa-associated lymphoid tissue (MALT) lymphoma that has developed in mediastinal thyroid tissue, to our best knowledge, has not been previously reported.
A 67-year-old woman presented with a superior mediastinal mass that was revealed by chest computed tomography (CT), an optional examination she hoped, during a medical checkup. Contrast-enhanced CT scan performed in our hospital for close examination confirmed the presence of a 2 × 1.3 cm poorly enhanced mass anterior to the trachea during the arterial phase. Magnetic resonance imaging depicted low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. I-131 meta-iodobenzylguanidine did not accumulate in the mass. Serum levels of interleukin-2 receptor, catecholamine, and anti-acetylcholine receptor antibody were within the normal range. The mass was resected through a transverse neck incision for the diagnosis and treatment. The histopathological diagnosis of the specimen was ectopic mediastinal thyroid tissue associated with MALT lymphoma and chronic thyroiditis. Immunoglobulin heavy chain class switch recombination was identified. Fine-needle aspiration biopsy of the cervical thyroid showed chronic thyroiditis but not lymphoma. The patient's postoperative thyroid function was normal. To date, the patient's recovery has been uneventful, and she is being monitored without further treatment.
We treated the patient with MALT lymphoma that developed in ectopic mediastinal thyroid tissue. This novel case illustrates a new differential diagnosis associated with ectopic mediastinal thyroid tissue.
异位纵隔甲状腺组织通常位于颈部,由非常罕见的不与甲状腺相连的异位甲状腺组织构成。据我们所知,此前尚未有纵隔甲状腺组织中发生黏膜相关淋巴组织(MALT)淋巴瘤的患者的报道。
一名67岁女性在体检时进行了胸部计算机断层扫描(CT),这是她希望进行的一项检查,结果发现上纵隔有一个肿块。我院进行的增强CT扫描以进行仔细检查,在动脉期证实气管前方存在一个2×1.3 cm强化不佳的肿块。磁共振成像显示在T1加权图像上为低信号强度,在T2加权图像上为高信号强度。I-131间碘苄胍未在肿块中积聚。白细胞介素-2受体、儿茶酚胺和抗乙酰胆碱受体抗体的血清水平在正常范围内。通过颈部横向切口切除肿块以进行诊断和治疗。标本的组织病理学诊断为与MALT淋巴瘤和慢性甲状腺炎相关的异位纵隔甲状腺组织。发现了免疫球蛋白重链类别转换重组。颈部甲状腺细针穿刺活检显示为慢性甲状腺炎而非淋巴瘤。患者术后甲状腺功能正常。迄今为止,患者恢复顺利,正在接受监测且无需进一步治疗。
我们治疗了一名在异位纵隔甲状腺组织中发生MALT淋巴瘤的患者。这个新病例说明了与异位纵隔甲状腺组织相关的一种新的鉴别诊断。