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LETTER TO THE EDITOR - DOCUMENTING A CASE
Year : 2011  |  Volume : 7  |  Issue : 3  |  Page : 385-387

Primary paraganglioma of thyroid presenting as solitary thyroid mass


1 Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, Parel, Mumbai, India
2 Department of Pathology, Tata Memorial Hospital, Mumbai, India

Date of Web Publication2-Nov-2011

Correspondence Address:
Sandip Basu
Radiation Medicine Centre, Bhabha Atomic Research Centre,Tata Memorial Hospital Annexe, Jerbai Wadia Road, Parel, Mumbai - 400 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.87028

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How to cite this article:
Basu S, Viswanathan S. Primary paraganglioma of thyroid presenting as solitary thyroid mass. J Can Res Ther 2011;7:385-7

How to cite this URL:
Basu S, Viswanathan S. Primary paraganglioma of thyroid presenting as solitary thyroid mass. J Can Res Ther [serial online] 2011 [cited 2019 Sep 20];7:385-7. Available from: http://www.cancerjournal.net/text.asp?2011/7/3/385/87028

Sir,

We herein report a case of primary thyroid paraganglioma, an extremely rare clinical entity, with follow-up data of 1 year after surgery. The patient, a 70-year-old woman presented with a solitary thyroid nodule involving the right lobe of thyroid and isthmus of around 3.5 × 1.5 cm in dimension. On ultrasonography (USG) of the neck, the nodule appeared well-defined hyperechoic and solid and demonstrated increased vascularity on color Doppler USG. Computed tomography with contrast [Figure 1]a-d revealed a brightly enhancing noncalcific soft tissue density lesion of 4.2 × 4.6 × 2.7 cm extending from the level of infrahyoid sections to reach the upper tracheal sections inferiorly, appearing as an exophytic growth from thyroid. She had undergone complete excision of the thyroid nodule. On cut section, the tissue was uniformly grey brown. Sections showed a well-circumscribed neoplasm with rich vascularity and focal organoid Zell-Ballen pattern [Figure 2]. On immunohistochemistry, S100 had highlighted sustentacular cells [Figure 3]a and b. Tumor cells were positive for chromogranin [Figure 4], NSE, CD56, focally for synaptophysin and negative for calcitonin [Figure 5]. Overall features were consistent with primary thyroid paraganglioma. She was not subjected to further surgery and followed-up based on age and associated cardiac morbidity. At 1-year follow-up, the patient is alive without evidence of recurrence elsewhere in the body. A whole body 131 I-MIBG scan was within normal limits 6 months after surgery and the 24 h urinary VMA level was also normal at that time.
Figure 1 (a-d): CT with contrast showing brightly enhancing noncalcifi c soft tissue density lesion of 4.2 × 4.6 × 2.7 cm. The lesion extended from the level of infrahyoid sections to reach the upper tracheal sections inferiorly and appeared as an exophytic growth from the right lobe of the thyroid

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Figure 2: Section of paraganglioma showing tumor cells in nests separated by sustentacular cells (H and E, ×200)

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Figure 3: S100 protein highlighting the sustentacular cells,(a) ABC, ×100, (b) H and E, ×200

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Figure 4: Chromogranin stain highlighting the tumor cells (ABC, ×100)

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Figure 5: Negative staining for calcitonin proving that the tumor is not a medullary carcinoma (ABC, ×100)

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Primary thyroid paraganglioma is a rare entity with around 25 cases reported in the literature till date. [1] Overall it runs a benign course with complete removal of the disease after surgery. It is also important to know that paraganglioma is usually detected as a hypoechoic thyroid nodule on USG, although in this case the nodule appeared hyperechoic. In a systematic review published recently, there was no evidence of metastases in the reported cases and was associated with bilateral or monolateral carotid body tumors in some cases. [2],[3] Surgery in the form of hemithyroidectomy appears adequate with long-term follow-up. External radiation therapy is advocated only when there is suspicion of inadequate removal of the disease.

 
 > References Top

1.Ferri E, Manconi R, Armato E, Ianniello F. Primary paraganglioma of thyroid gland: A clinicopathologic and immunohistochemical study with review of the literature. Acta Otorhinolaryngol Ital 2009;29:97-102.  Back to cited text no. 1
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2.Hughes JH, El-Mofty S, Sessions D, Liapis H. Primary intrathyroidal paraganglioma with metachronous carotid body tumour: Report of a case and review of literature. Pathol Res Pract 1997;193:791-6.  Back to cited text no. 2
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3.LaGuette J, Matias-Guiu X, Rosai J. Thyroid paraganglioma: A clinicopathologic and immunohistochemical study of three cases. Am J Surg Pathol 1997;2:748-53.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]


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