Ectopic intrapulmonary follicular adenoma diagnosed by surgical resection
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CASE REPORT
Ectopic intrapulmonary follicular adenoma diagnosed by surgical resection Ryusuke Sumiya1 · Keigo Sekihara1 · Aya Sugimura1 · Hideki Miyazaki2 · Toru Igari2 · Takeshi Ikeda1 · Satoshi Nagasaka1 Received: 9 June 2020 / Accepted: 4 September 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Ectopic intrapulmonary thyroid tissue is extremely rare and considerably difficult to diagnose without surgery. Ectopic thyroid tissue, described as a mediastinal tumor, and intrapulmonary lesions are infrequent. An abnormal shadow was detected upon chest X-ray in a 60-year old woman with a history of benign thyroid goiter. A computed tomography scan revealed a solitary nodule measuring 27 mm in diameter in the left lower lobe, the diameter of which had increased by 5 mm since initial observation eight years ago. A thoracoscopic wedge resection was performed and the lesion was determined to be a non-invasive, soft-tissue tumor. It was pathologically diagnosed as an ectopic thyroid follicular adenoma. The course of the tumor was uneventful. A diagnosis of ectopic intrapulmonary thyroid should be made cautiously and only after ruling out metastasis of a follicular adenoma or thyroid carcinoma. This diagnosis of ectopic thyroid tissue was made possible by the surgical approach. Keywords Ectopic thyroid tissue · Lung · Goiter · Follicular adenoma · Thoracoscopic surgery
Introduction
Case
Ectopic thyroid tissue is a rare clinical condition that occurs due to aberrant embryogenesis of the thyroid gland. Some cases have been reported with intrathoracic lesions, the vast majority of which are located in the mediastinum [1]. Ectopic intrapulmonary thyroid tissue is extremely rare and considerably difficult to diagnose without surgery. Because solid pulmonary nodules have various differential diagnoses, clinical information and radiological findings should be considered as references to distinguish between malignant neoplasm and benign tumor. However, many cases need surgical resection to determine the histological diagnosis. Herein, we report a case of ectopic intrapulmonary thyroid tissue.
An abnormal shadow was detected upon chest radiography in a 60-year-old non-smoking woman with a history of ovarian cysts and benign thyroid goiter (Fig. 1), who underwent left total thyroid lobectomy at age 34. It was pathologically diagnosed as a benign thyroid follicular adenoma without vascular invasion. She was asymptomatic at first presentation. A chest computed tomography (CT) scan demonstrated a solitary nodule of 22 mm diameter in the left segment 10, with a smooth and uniformly enhanced surface. Benign tumor or low-grade malignancy was suspected. Although surgical resection for diagnosis was recommended, she did not wish to undergo surgical resection. Eight years later, chest CT scan revealed that the tumor had enlarged to 27 mm (Fig. 2). She also reported a dry cough at that time. She was euthyroid with serum thyroid stimulating hormone of 3.08 uTU/ml (normal limit: 0.30–4.94), FT3 of 2.95 pg/ ml (1.71–3.
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