672334
research-article2016
IJSXXX10.1177/1066896916672334International Journal of Surgical PathologyCampora et al
Images in Pathology
A Never Ending Journey: Ectopic Thyroid
International Journal of Surgical Pathology 2017, Vol. 25(3) 241–242 © The Author(s) 2016 Reprints and permissions: sagepub.com/journalsPermissions.nav https://doi.org/10.1177/1066896916672334 DOI: 10.1177/1066896916672334 journals.sagepub.com/home/ijs
Michela Campora, MD1,2, Chiara Trambaiolo Antonelli, MD1,2, Luca Mastracci, MD1,2, Simona Pigozzi, BSc1,2, and Federica Grillo, MD1,2
Figure 1. (A, C, E) Hematoxylin and eosin–stained sections (magnification 2×, 10×, 60×) of the gallbladder wall on the left side and the focus of ectopic thyroid in the lower right. Magnifications show follicle formation and colloid production. (B, D, F) TTF-1 nuclear staining in ectopic thyroid (magnification 2×, 10×, 60×). Immunohistochemistry performed on sequential section.
242 A 76-year-old man presented to San Martino University Emergency Department with nausea, right upper quadrant pain, and fever. Ultrasound examination revealed the presence of cholelithiasis and sludge, gallbladder wall thickening, and pericholecystic fluid, in combination with the sonographic Murphy sign. Laboratory exams showed leukocytosis and elevated alkaline phosphatase, while blood culture revealed the presence of Citrobacter, an aerobic gram-negative bacillus from the Enterobacteriaceae family. Diagnosis of acute cholecystitis was promptly made and surgical approach considered mandatory. Laparoscopic cholecystectomy was performed within 48 hours from symptom onset; the specimen was sent for histological evaluation. At gross examination we observed a 10-cm long, distended gallbladder, with thickened wall, congested surface vessels, and serosal fibrino-inflammatory deposits. Contents were of blood clots and multiple millimetric gallstones, mixed with pus and bile. Microscopic examination showed several mucosal erosions with neutrophils, abscess formation, and transmural necrosis associated with acute peritonitis. Furthermore, on the serosal aspect of the gall bladder, a 2-mm nodular area was seen. This area proved to be composed of follicles lined by flattened and cuboidal epithelium, with small basally oriented nucleus, filled with eosinophilic and homogeneous material attributable to colloid. No cellular or architectural atypia was noted (Figure 1). At immunohistochemistry, strong expression of thyroid transcription factor-1 (TTF-1) was seen, while thyroglobulin (TGB) was negative. Periodic acid-Schiff stain was also performed to detect the possible presence of mucins, and the result was negative. On the basis of morphology and TTF-1 positivity, a diagnosis of ectopic
International Journal of Surgical Pathology 25(3) thyroid localization was made. TGB expression is usually 100% in normal thyroid with lower percentages in neoplasms of different types; little is known on its expression in ectopic tissues.1 A complete checkup of the patient was carried out to exclude a primary tumor in the thyroid or the presence of other similar foci elsewhere. Ectopic thyroid is a well-known disontogenetic lesion, and although most cases occur along the normal migration path of the developing thyroid from the base of the tongue to the inferior margin of the cricoid cartilage, intra-abdominal localizations have been observed. Nevertheless, only 3 cases of ectopic thyroid have been described in gallbladder from 1969,2 and only one in its fibrofatty-adjacent tissue.3 Pathogenesis of ectopic thyroid in abdominal organs is unknown; the most quoted interpretation refers to a common precursor cell from the foregut endoderm. References 1. Liu H, Lin F. Application of immunohistochemistry in thyroid pathology. Arch Pathol Lab Med. 2015;139:67-82. 2. Cassol CA, Noria D, Asa SL. Ectopic thyroid tissue within the gall bladder: case report and brief review of the literature. Endocr Pathol. 2010;21:263-265. 3. Harach HR. Ectopic thyroid tissue adjacent to the gallbladder. Histopathology. 1998;32:90-91.
1
University of Genoa, Genoa, Italy IRCCS AOU S. Martino-IST, Genoa, Italy
2
Corresponding Author: Federica Grillo, IRCCS AOU San Martino IST, Largo Rosanna Benzi 10, Genoa 16132 Italy. Email: [email protected]
research-article2016
IJSXXX10.1177/1066896916672334International Journal of Surgical PathologyCampora et al
Images in Pathology
A Never Ending Journey: Ectopic Thyroid
International Journal of Surgical Pathology 2017, Vol. 25(3) 241–242 © The Author(s) 2016 Reprints and permissions: sagepub.com/journalsPermissions.nav https://doi.org/10.1177/1066896916672334 DOI: 10.1177/1066896916672334 journals.sagepub.com/home/ijs
Michela Campora, MD1,2, Chiara Trambaiolo Antonelli, MD1,2, Luca Mastracci, MD1,2, Simona Pigozzi, BSc1,2, and Federica Grillo, MD1,2
Figure 1. (A, C, E) Hematoxylin and eosin–stained sections (magnification 2×, 10×, 60×) of the gallbladder wall on the left side and the focus of ectopic thyroid in the lower right. Magnifications show follicle formation and colloid production. (B, D, F) TTF-1 nuclear staining in ectopic thyroid (magnification 2×, 10×, 60×). Immunohistochemistry performed on sequential section.
242 A 76-year-old man presented to San Martino University Emergency Department with nausea, right upper quadrant pain, and fever. Ultrasound examination revealed the presence of cholelithiasis and sludge, gallbladder wall thickening, and pericholecystic fluid, in combination with the sonographic Murphy sign. Laboratory exams showed leukocytosis and elevated alkaline phosphatase, while blood culture revealed the presence of Citrobacter, an aerobic gram-negative bacillus from the Enterobacteriaceae family. Diagnosis of acute cholecystitis was promptly made and surgical approach considered mandatory. Laparoscopic cholecystectomy was performed within 48 hours from symptom onset; the specimen was sent for histological evaluation. At gross examination we observed a 10-cm long, distended gallbladder, with thickened wall, congested surface vessels, and serosal fibrino-inflammatory deposits. Contents were of blood clots and multiple millimetric gallstones, mixed with pus and bile. Microscopic examination showed several mucosal erosions with neutrophils, abscess formation, and transmural necrosis associated with acute peritonitis. Furthermore, on the serosal aspect of the gall bladder, a 2-mm nodular area was seen. This area proved to be composed of follicles lined by flattened and cuboidal epithelium, with small basally oriented nucleus, filled with eosinophilic and homogeneous material attributable to colloid. No cellular or architectural atypia was noted (Figure 1). At immunohistochemistry, strong expression of thyroid transcription factor-1 (TTF-1) was seen, while thyroglobulin (TGB) was negative. Periodic acid-Schiff stain was also performed to detect the possible presence of mucins, and the result was negative. On the basis of morphology and TTF-1 positivity, a diagnosis of ectopic
International Journal of Surgical Pathology 25(3) thyroid localization was made. TGB expression is usually 100% in normal thyroid with lower percentages in neoplasms of different types; little is known on its expression in ectopic tissues.1 A complete checkup of the patient was carried out to exclude a primary tumor in the thyroid or the presence of other similar foci elsewhere. Ectopic thyroid is a well-known disontogenetic lesion, and although most cases occur along the normal migration path of the developing thyroid from the base of the tongue to the inferior margin of the cricoid cartilage, intra-abdominal localizations have been observed. Nevertheless, only 3 cases of ectopic thyroid have been described in gallbladder from 1969,2 and only one in its fibrofatty-adjacent tissue.3 Pathogenesis of ectopic thyroid in abdominal organs is unknown; the most quoted interpretation refers to a common precursor cell from the foregut endoderm. References 1. Liu H, Lin F. Application of immunohistochemistry in thyroid pathology. Arch Pathol Lab Med. 2015;139:67-82. 2. Cassol CA, Noria D, Asa SL. Ectopic thyroid tissue within the gall bladder: case report and brief review of the literature. Endocr Pathol. 2010;21:263-265. 3. Harach HR. Ectopic thyroid tissue adjacent to the gallbladder. Histopathology. 1998;32:90-91.
1
University of Genoa, Genoa, Italy IRCCS AOU S. Martino-IST, Genoa, Italy
2
Corresponding Author: Federica Grillo, IRCCS AOU San Martino IST, Largo Rosanna Benzi 10, Genoa 16132 Italy. Email: [email protected]
