Traveling together! - Intrathymic thyroid tissue in a patient with Graves’ disease

McCormick, Hugh Ellis; Khawar, Sidrah; Hamza, Ameer

doi:10.4322/acr.2024.506

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Clinical Case Report and Review • Autops. Case Rep. 14 • 2024 • https://doi.org/10.4322/acr.2024.506 copy

Traveling together! - Intrathymic thyroid tissue in a patient with Graves’ disease

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

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.

Keywords
Ectopic thyroid; Intrathymic thyroid; Thoracic intrathymic thyroid; Benign thymic nodule; Mediastinal mass; Graves’ disease

Ref	Age / Gender	Presenting Complaint	Physical Exam	Imaging	Pathology
²2 Spinner RJ, Moore KL, Gottfried MR, Lowe JE, Sabiston DC Jr. Thoracic intrathymic thyroid. Ann Surg. 1994;220(1):91-6. http://doi.org/10.1097/00000658-199407000-00013. PMid:8024364. http://doi.org/10.1097/00000658-19940700...	61	None	Normal	Anterior mediastinal mass on CT scan	Grossly large mass within the body of the thymus without evidence of invasion. Tissue samples consisted of thyroid tissue closely associated with atrophic thymic tissue.
²2 Spinner RJ, Moore KL, Gottfried MR, Lowe JE, Sabiston DC Jr. Thoracic intrathymic thyroid. Ann Surg. 1994;220(1):91-6. http://doi.org/10.1097/00000658-199407000-00013. PMid:8024364. http://doi.org/10.1097/00000658-19940700...	41	Substernal chest pain	Normal	Anterior mediastinal mass on CT scan	Grossly large mass within the body of the thymus without evidence of invasion. Tissue samples consisted of thyroid tissue closely associated with atrophic thymic tissue.
⁵5 Hwang I, Lee SK, Cho KJ, Kim KR. Heterotopic intrathymic thyroid tissue. Pathol Int. 2006;56(10):629-32. http://doi.org/10.1111/j.1440-1827.2006.02019.x. PMid:16984621. http://doi.org/10.1111/j.1440-1827.2006....	55	Metastatic papillary thyroid carcinoma	Palpable mass	No thymic / mediastinal imaging.	Neck dissection specimen contained involuting thymic tissue containing Hassall’s corpuscles. Within the thymic capsule were multiple cystically dilated thyroid follicles filled with colloidal fluid. The lining epithelium of the follicles was composed of flat cuboidal cells. The nuclei were uniformly small and ovoid. Intranuclear grooves or pseudoinclusions were not present.
⁶6 Tang AT, Johnson MJ, Addis B, Weeden DF. Thoracic intrathymic thyroid and cervical goiter: single-stage resection. Ann Thorac Surg. 2002;74(2):578-9. http://doi.org/10.1016/S0003-4975(02)03557-9. PMid:12173852. http://doi.org/10.1016/S0003-4975(02)035...	55	Visual disturbance and intermittent chest pain	Normal	Large cervical goiter and a solid contrast-enhancing mass in the left anterior mediastinum contiguous to the thymus.	Grossly, large mass measuring 9 × 7.5 × 6.5 cm was found in the left inferior pole of the thymus, which had no direct physical continuity with the cervical goiter. Histopathologically, the thymus contained a large, well-encapsulated irregular mass with multiple small cysts consisting of multinodular thyroid tissue in an otherwise normal thymus.
⁸8 Nakaya M, Ito A, Mori A, et al. Surgical treatment of substernal goiter: an analysis of 44 cases. Auris Nasus Larynx. 2017;44(1):111-5. http://doi.org/10.1016/j.anl.2016.02.016. PMid:26995097. http://doi.org/10.1016/j.anl.2016.02.016...	37	History of breast malignancy and concern for metastasis	Palpable mass	CT scan revealed a large calcified anterior mediastinal mass distinct from the existing cervical goiter.	Grossly, a large anterosuperior mediastinal, lobulated mass, firm in consistency separate from cervical goiter. Histologically, mature thyroid tissue composed of thyroid follicles containing colloids of varying sizes, surrounded by thymic tissue.

Hospital Universitário da Universidade de São Paulo Hospital Universitário da Universidade de São Paulo, Av. Prof. Lineu Prestes, 2565 - Cidade Universitária, 05508-000 - São Paulo - SP - Brasil, (16) 3307-2068, (16) 3307-2068 - São Paulo - SP - Brazil
E-mail: autopsy.hu@gmail.com

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[1] Authors’ contributions:

All authors contributed equally to the project.