Thyroid-Bed Schwannoma Mimicking a Thyroid Neoplasm: A Challenging Diagnosis: Report of a Case and Literature Review
Abstract
:1. Introduction
2. Case Report
3. Review and Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Case | Age/Sex | Presentation | US Localization | Imaging | FNA Result | Surgery | Definitive Pathology | IHC |
---|---|---|---|---|---|---|---|---|
Ledgard C et al., 2022 [25] | 33/F | Large palpable mass, compression | 53 × 19 × 19 mm—Inferior left thyroid nodule | US: Solid and hypoechoic with minimal internal vascularity (TIRADS 4) | Non-diagnostic (acellular) | Nodule Removal | Encapsulated mass (schwannoma) arising adjacent to nerve bundles. Spindle cells with both Type A and B Antoni cells | S-100 and Vimentin+ Ki67 low proliferation |
Kang et al., 2019 [22] | 33/F | None | 30 mm—Inferior left thyroid nodule | US: Well-defined, oval-shaped, markedly hypoechoic intrathyroidal nodule with echogenic foci and macro- and microcalcifications | Non-diagnostic | Left hemi-thyroidectomy | Schwannoma in the perithyroid tissue, with compact areas of spindle cells (Antoni A) and loosely arranged foci (Antoni B) | S-100+ |
Nagavalli et al., 2017 [28] | 60/F | Dysphagia, neck mass | Left thyroid lobe | US: Ovoid hypoechoic mass with smooth borders. CT: diffusely enlarged and heterogeneous thyroid with the left lobe extending to the retropharyngeal space and anterior mediastinum | Spindle cells with a lymphocytic background | Nodule Removal | Spindle cells in whorls with a predominantly Antoni A pattern | S-100+ Ki67 low proliferation |
Simo D et al., 2014 [26] | - | Preoperative suspect of thyroid carcinoma with lymph node metastases | - | - | - | - | Ancient schwannoma | - |
Pillai et al., 2013 [1] | 30/F | Neck mass, voice change, dyspnea | 5.3 × 4.1 × 7.2 cm—Lower pole of left thyroid lobe | US: Large multiseptated hypoechoic lesion. Not vascularized. CT: left thyroid mass measuring 8 × 5 cm with retrosternal extension. Tc-99 m scintigraphy: enlarged right lobe of thyroid and a left lateral palpable nodule, which was cold in nature, possibly an extra-thyroidal mass | Insufficient for diagnosis | Left hemi-thyroidectomy | Cellular ancient schwannoma with spindle cells with wavy nuclei, interspersed throughout hypocellular and cystic areas, extensive hyalinization, hemosiderin-laden macrophages and hyalinized thick-walled vessels. | S-100 and Vimentin+ |
Donatini et al., 2008/1 [27] | 26/F | Neck mass | 41 mm—Inferior right thyroid lobe | US: heterogeneous, partially liquid and with hyper-echogenic spots. Tc-99 m scintigraphy: no hyperactivity. MRI: extra-thyroidal lesion of 47 mm between the vascular neck bundle and the right thyroid lobe | Non-diagnostic | Mass Removal | Ganglioneuroma | S-100+ |
Donatini et al., 2008/2 [27] | 26/F | Thyroid cancer with cervical-lymph-node metastases | 38 mm—Right thyroid lobe | US: nodular lesion close to the neck vascular bundle suspicious for a metastatic lymph node. CT and MRI: enlarged left thyroid lobe pushing the trachea towards right side and in close proximity to a largely necrotic lesion of 4 cm (metastatic disease). Tc-99 m scintigraphy: the “lymph node” showed hypo-activity | Fibrous tissue without any tumoral cell | Mass Removal | Schwannoma | S-100+ Ki67/Mib1- |
Cashman et al., 2008 [32] | 35/F | Neck mass; right Horner’s syndrome | 6 × 2.4 × 2.7 mm—Right thyroid lobe | US: Large mass arising from thyroid gland | Inconclusive | Right hemi-thyroidectomy | Schwannoma with spindle cell without atypia, mitosis, or necrosis | S-100+ Desmin and SMA (smooth muscle actin) |
De Paoli et al., 2005 [23] | 63/F | Foreign body sensation with swallowing | 27 mm—Lower pole of right thyroid lobe | US: Markedly hypoechogenic nodule with rich vascularity | Fragments of adipose tissue, rare thymocytes in aggregates resembling follicular masses, insufficient for diagnosis | Total thyroidectomy | Schwannoma in the perithyroid tissue, with compact areas of spindle cells or Verocay bodies (Antoni A) and loosely arranged foci (Antoni B) | |
Aron et al., 2005/1 [13] | 28/F | Neck mass | Left lobe | - | Spindle-cell tumor without thyroid cell. Diagnosis of benign nerve-sheath tumor | Left hemi-thyroidectomy | Grey-white lobulated tumor of 70 × 50 mm, with compressed normal thyroid tissue at the periphery. Microscopic examination showed features of a schwannoma with nuclear palisading and thick-walled blood vessels | - |
Aron et al., 2005/2 [13] | 23/F | Neck mass | - | - | Spindle-cell tumor without thyroid cell. Diagnosis of benign nerve-sheath tumor | Total thyroidectomy | Grey-white lobulated tumor of 80 × 50 mm, with compressed normal thyroid tissue at the periphery. Microscopic examination showed features of a schwannoma with nuclear palisading and thick-walled blood vessels | - |
Badawi et al., 2002 [29] | 23/F | Neck mass | - | Tc-99 m scintigraphy: cold nodule of the left thyroid lobule | Paucicellular sample with occasional follicular cells of equivocal diagnostic value | Mass excision | Ancient, encapsulated schwannoma with vague nodularity with fibrous septae. Lobules consisted of collagenous stroma and cells with Verocay bodies. | - |
Ahmed et al., 2000 [6] | 14/M | Neck mass | Superior pole to right thyroid lobe | Solid lesion | - | Mass excision | Neurilemmoma | - |
Mikosch et al., 1997 [3] | 31/M | Neck mass | Lateral and lower pole of right thyroid lobe | US: Large markedly hypoechoic nodule with smooth borders. Tc-99 m scintigraphy: normal thyroid | 1. Colloid and thyrocytes 2. Spindle-cell tumor | Mass excision | Schwannoma with Antoni A structures | - |
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Gambardella, C.; Docimo, L.; Candela, G.; Cozzolino, G.; Mongardini, F.; Serilli, F.; Nesta, G.; Filograna Pignatelli, M.; Ferrandes, S.; Gambardella, A.; et al. Thyroid-Bed Schwannoma Mimicking a Thyroid Neoplasm: A Challenging Diagnosis: Report of a Case and Literature Review. Medicina 2022, 58, 1345. https://doi.org/10.3390/medicina58101345
Gambardella C, Docimo L, Candela G, Cozzolino G, Mongardini F, Serilli F, Nesta G, Filograna Pignatelli M, Ferrandes S, Gambardella A, et al. Thyroid-Bed Schwannoma Mimicking a Thyroid Neoplasm: A Challenging Diagnosis: Report of a Case and Literature Review. Medicina. 2022; 58(10):1345. https://doi.org/10.3390/medicina58101345
Chicago/Turabian StyleGambardella, Claudio, Ludovico Docimo, Giancarlo Candela, Giovanni Cozzolino, Federico Mongardini, Francesca Serilli, Giusiana Nesta, Marcello Filograna Pignatelli, Sonia Ferrandes, Antonio Gambardella, and et al. 2022. "Thyroid-Bed Schwannoma Mimicking a Thyroid Neoplasm: A Challenging Diagnosis: Report of a Case and Literature Review" Medicina 58, no. 10: 1345. https://doi.org/10.3390/medicina58101345