Typical manifestations of Hürthle cell adenoma of the thyroi
A 63-year-old woman presented with increasing neck swelling over the past 10 years. She showed no symptoms of palpitation or hidrosis, pain or pressure, hoarseness, or fatigue and had no family history of thyroid cancer. She appeared very healthy, with no features of thyrotoxicity or hypothyroidism on examination. Her pulse was normal, and her blood pressure was moderately high. Her neck swelling showed a cystic and firm mass with a medium texture and a clear border that moved up and down with her swallowing. The swelling measured approximately 8 × 6 cm in size in the left lobe of the thyroid gland, and a cystic and firm mass with the same property measuring approximately 1.0 × 1.5 cm in size was felt in the right lobe of the thyroid gland. No regional lymph nodes were palpated, and significant tracheal deviation was observed to the right. Laboratory indices showed a low thyroid-stimulating hormone (TSH) level. Other biochemical indexes were normal.

Thyroid color Doppler ultrasonography showed that both lobes were significantly enlarged, the surface was not smooth, and the left lobe was more pronounced. The normal tissue of the left lobe was replaced by a hypoechoic mass of approximately 8.1 cm × 5.6 cm that was visible at the border of the hypoechoic mass and comprised multiple nodules, with a small number of cystic echoes. Sixty-four spiral contrast-enhanced CT (GE Medical Systems LightSpeed VCT, Hino-Shi, Tokyo, Japan) was used. The CT scanning parameters were as follows: for 64 detector rows, a beam collimation of 40 mm, a pitch of 0.984, a slice thickness of 2.5 mm, reconstruction intervals of 2.5 mm, a tube voltage of 120 kV, and a tube current of 150 mA. Contrast-enhanced CT scans were performed with patient in a supine position, scanning range from basis cranii to aortic arch level. The patient received intravenous contrast agent iopromide (300 mgI/mL) 80 mL as a bolus at the rate of 3 mL/s, and the CT images were obtained during arterial and venous phases at 25 and 60 seconds after contrast material injection, respectively. The results showed that the patient had a huge heterogeneously enhancing mass (8.5 cm × 7.5 cm) in the left lobe of the thyroid. But the enhancement degree of the mass was lower than thyroid gland and adjacent blood vessels.

There was no enhanced necrotic area in the center. Radiation-like, low-density scarring was seen in the lesion. Intact capsule enhancement was observed around the lesion, the venous lesions continued to strengthen, and the trachea was compressed to the right side. After general anesthesia, left thyroidectomy, and partial right thyroidectomy, the postoperative pathological results revealed left thyroid eosinophilic adenoma and a right thyroid nodular goiter. Microscopically, the tumor capsule was intact, the tumor cells comprised numerous eosinophils and were arranged in a cord, beam, or interconnected network, showing a papillary structure, which meet the diagnostic criteria of HCA of the thyroid. The patient was discharged 1 week after surgery. She was followed up for 12 months and was in good health without recurrence.

Source: Medicine: May 2019 - Volume 98 - Issue 22 - p e15866

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