Document Detail

Thyroid paragangliomas are locally aggressive.
MedLine Citation:
PMID:  22168229     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Thyroid paraganglioma (TP) is a very rare neoplasm that can be misdiagnosed. We evaluated the clinical and pathologic characteristics of three patients with TP.
PATIENT FINDINGS: The records of all patients from 1981 to 2008 who had thyroidectomy with a final histologic diagnosis of TP were retrieved, and histology was reviewed by a single pathologist. Head and neck paragangliomas arising outside of the thyroid were excluded. TP accounted for 3 of all 6782 (0.04%) patients undergoing thyroidectomy during three decades. One patient has been previously reported and will not be discussed. In the remaining two patients and a surgical pathology consult case that we also describe herein, the mean age at diagnosis was 56 years (40-67) and two patients were men. Presenting features were indicative of advanced local invasion, including stridor, tracheal invasion, compression of the great vessels, and hemoptysis. The diagnosis of TP was not suspected preoperatively; in two patients, fine-needle aspiration (FNA) cytology was inadequate for diagnosis because of excessive blood. Intraoperative frozen section analysis suggested medullary thyroid cancer in two patients and oncocytic (Hurthle) cell carcinoma in one patient. Local invasion was common, requiring concurrent tracheal resection in two of three patients, and present histologically in all three patients. In all three cases, immunohistochemical analysis was negative for cytokeratin AE1/3, calcitonin, and thyroglobulin but positive for S100, highlighting sustentacular cells. After resection of a large TP with tracheal and vascular invasion, a 67-year-old woman experienced a 7-year disease-free interval.
CONCLUSIONS: Primary TP is indeed rare. It does occur in men, frequently presents with compressive symptoms, and is typically locally aggressive, but does not appear to cause symptoms suggestive of catecholamine excess. Despite invasion of adjacent structures, aggressive resection can achieve a long disease-free interval.
Michaele J Armstrong; Simon I Chiosea; Sally E Carty; Steven P Hodak; Linwah Yip
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2011-12-14
Journal Detail:
Title:  Thyroid : official journal of the American Thyroid Association     Volume:  22     ISSN:  1557-9077     ISO Abbreviation:  Thyroid     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-01-05     Completed Date:  2012-05-08     Revised Date:  2012-09-10    
Medline Journal Info:
Nlm Unique ID:  9104317     Medline TA:  Thyroid     Country:  United States    
Other Details:
Languages:  eng     Pagination:  88-93     Citation Subset:  IM    
Division of Endocrine Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
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MeSH Terms
Biopsy, Needle
Middle Aged
Neoplasm Invasiveness
Paraganglioma / diagnosis*,  pathology*
Retrospective Studies
Thyroid Neoplasms / diagnosis*,  pathology*

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