Large intrathyroidal lipoma with radioiodine uptake
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Large intrathyroidal lipoma with radioiodine uptake Angelo Ghidini1 Cecilia Botti1,2 Silvia Vezzani3 Simonetta Piana ●
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Andrea Frasoldati3
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Received: 31 March 2020 / Accepted: 16 April 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
A 70-year-old man with a 5-year history of type II insulindependent diabetes mellitus and a recent diagnosis of hyperthyroidism presented with a visible lump located in the left paramedian portion of the anterior neck, slowly growing over the years. The patient did not show voice hoarseness, dysphagia, or dyspnea. In the last 8 months he had been complaining of weight loss, tachycardia, and asthenia. The blood tests show overt hyperthyroidism: TSH < 0.01 microIU/ml and fT4 65.8 pg/ml. Serum antithyroid peroxidase antibodies (TPO-ab) were positive, while TSHreceptor antibodies (TRAb) were negative. Ultrasound (US) examination showed a hypoechoic solid mass (Fig. 1a). US fine-needle aspiration (FNA), repeated twice, consisted of blood, stromal fragments, and rare epithelial cells and provided a nondiagnostic result. A subsequent US-guided core biopsy showed some normal fat tissue and few thyroid follicles, which were insufficient for a definite diagnosis. Thyroid scintigraphy showed increased and inhomogeneous uptake in the left thyroid lobe (Fig. 1b), while the computed tomography scan and the subsequent magnetic resonance imaging (MRI), performed for an accurate morphological definition, confirmed the intrathyroidal location of a well-defined solid mass, 56 × 40 × 50 mm (Fig. 1c, d), consistent with a lipoma.
* Simonetta Piana [email protected] 1
Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Reggio Emilia, Italy
3
Endocrinology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
4
Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
A total thyroidectomy was performed uneventfully with preservation of the recurrent laryngeal nerves and parathyroid glands bilaterally. Grossly, the nodule was 55 mm along its greatest axis, and it was soft, yellow, capsulated, and localized inside the thyroid capsule, compressing the left lobe. Upon histological examination, the lesion was mainly composed of mature fat tissue, including discrete islands of hyperplastic thyroid follicles (Fig. 1e). The follicles were often dilated, contained abundant thick colloid, and were bordered by flattened thyrocytes. A diagnosis of intrathyroid lipoma was made. The thyroid gland normally harbors a small amount of adipose tissue adjacent to the capsule, around the vessels or in the connective tissue septa of the gland. Adipose lesions that may develop within the thyroid gland can be either intrathyroidal fat-containing epithelial lesions, such as nodular hyperplasia, ectopic tissue or other rare pathologic entities with a 1.2% prevalence, or purely fa
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