Abstract
We describe the case of a 46-yr-old euthyroid woman, who was submitted to right lobectomy plus isthmusectomy because of a 30 mm large, rapidly growing thyroid nodule. Two cytological examinations of fine needle aspiration biopsy (FNAB) specimens were not diagnostic. Histology showed a neoplasm composed of nests of chief cells, almost completely replacing thyroid parenchyma, infiltrating the capsule and surgical resection margins, and invading perithyroid tissues. Immunohistochemical analysis revealed that the tumor stained positively to chromogranin, synaptophysin, NSE, S-100 protein and tyrosine hydroxylase, whereas no immunoreactivity was detected against cytokeratin, thyroglobulin, TTF-1, calcitonin and CEA. A diagnosis of thyroid paraganglioma (PG) was finally made. No complications developed following operation. Laboratory analysis and imaging study excluded multicentric disease, metastases to neck or extra-cervical organs, and multiple endocrine neoplasia (MEN). We report this unusual case, underscore its clinical and immunohistochemical features and discuss differential diagnosis.
Similar content being viewed by others
References
Buss DH, Marshall RB, Baird FG, Myers RT. Paraganglioma of the thyroid gland. Am J Surg Pathol 1980, 4: 589–93.
Lack EE. Pathology of adrenal and extra-adrenal paraganglia. Major problems in pathology. Philadelphia: WB Saunders 1994.
Zak FG, Lawson W. Glomic (paraganglionic) tissue in the larynx and capsule of the thyroid gland. Mt Sinai J Med 1972, 39: 82–90.
Kay S, Montague JW, Dodd RW. Nonchromaffin paraganglioma (chemodectoma) of thyroid region. Cancer 1975, 36: 582–5.
Kronz JD, Argani P, Udelsman R, Silverberg L, Westra WH. Paraganglioma of the thyroid: two cases that clarify and expand the clinical spectrum. Head Neck 2000, 22: 621–5.
Hughes JH, El-Mofty S, Sessions D, Liapis H. Primary intrathyroidal paraganglioma with metachronous carotid body tumor: report of a case and review of the literature. Pathol Res Pract 1997, 193: 791–6.
Skiadas PK, Kakavoulis TN, Gikonti IJ. Normalisation of blood pressure and heart rate after excision of a thyroid paraganglioma. Eur J Surg 2001, 167: 392–4.
Vodovnik A. Fine needle aspiration cytology of primary thyroid paraganglioma. Report of a case versus cytologic, histologic and immunohistochemical features and differential diagnostic considerations. Acta Cytol 2002, 46: 1133–7.
McNichol AM. Differential diagnosis of pheocromocytomas and paragangliomas. Endocr Pathol 2001, 12: 407–15.
Huss LJ, Mendelsohn G. Medullary carcinoma of the thyroid gland: an encapsulated variant resembling the hyalinizing trabecular (paraganglioma-like) adenoma of the thyroid. Mod Pathol 1990, 3: 581–5.
Rosai J, Carcangiu ML, DeLellis RA. Tumors of the thyroid gland. AFIP Atlas 1990.
LaGuette J, Matias-Guiu X, Rosai J. Thyroid paraganglioma. A clinicopathologic and immunohistochemical study of three cases. Am J Surg Pathol 1997, 21: 748–53.
Collina G, Maiorana A, Fano RA, Cesinaro AM, Trentini GP. Medullary carcinoma of the thyroid gland with sustentacular cell-like cells in a patient with multiple endocrine neoplasia type IIA. Report of a case with ultrastructural and immunohis-tochemical studies. Arch Pathol Lab Med 1994, 118: 1041–4.
Iwase K, Nagasaka A, Nagatsu I, et al. Tyrosine hydroxylase indicates cell differentiation of catecholamine biosynthesis in neuroendocrine tumors. J Endocrinol Invest 1994, 17: 235–9.
Kimura N, Miura Y, Nagatsu I, Nagura H. Catecholamine synthesizing enzymes in 70 cases of functioning and non-functioning phaeochromocytoma and extra-adrenal para-ganglioma. Virchows Arch A Pathol Anat Histopathol 1992, 421: 25–32.
Lack EE, Cubilla AL, Woodruff JM. Paragangliomas of the head and neck region. A pathologic study of tumours from 71 patients. Hum Pathol 1979, 10: 191–218.
Lattes R. Non-chromaffin paragangliomas of the ganglion nodosum, carotid body and aortic arch-bodies. Cancer 1950, 3: 667–694.
Stout AP. The malignant tumor of the peripheral nerves. Am J Cancer 1935, 25: 1–36.
Myssiorek D. Head and neck paragangliomas. Otolaryngol Clin North Am 2001, 34: 829–36.
Walsh RM, Leen EJ, Gleeson MJ, Shaheen OH. Malignant vagal paraganglioma. J Laryngol Otol 1997, 111: 83–8.
Lawson W. The neuroendocrine nature of the glomus cells: an experimental, ultrastructural and histochemical tissue culture study. Laryngoscope 1980, 90: 120–44.
Mitsudo SM, Grajower MD, Balbi H, Silver C. Malignant paraganglioma of the thyroid gland. Arch Pathol Lab Med 1987, 111: 378–80.
de Vries EJ, Watson CG. Paraganglioma of the thyroid. Head Neck 1989, 11: 462–5.
Haegert DG, Wang NS, Farrer PA, Seemayer TA, Thelmo W. Non-chromaffin paragangliomatosis manifesting as a cold thyroid nodule. Am J Clin Pathol 1974, 61: 561–70.
Massaioli N, Fausone G. Paraganglioma branchiomerico en-dotiroideo (non cromaffine). Minerva Chir 1979, 34: 867–73.
Cayot F, Bastien H, Justrabo E, et al. Multiple paragang-liomas of the neck localized in the thyroid region. Papillary thyroid cancer associated with parathyroid adenoma. Semin Hop 1982, 58: 2004–7.
Napolitano L, Francomano F, Angelucci D, Napolitano AM. Thyroid paraganglioma: report of a case and review of the literature. Ann Ital Chir 2000, 71: 511–3.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Corrado, S., Montanini, V., De Gaetani, C. et al. Primary paraganglioma of the thyroid gland. J Endocrinol Invest 27, 788–792 (2004). https://doi.org/10.1007/BF03347525
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03347525