PMC9791092_01
CT in a 65-year-old woman with ectopic thyroid in the hepatic hilum. (A) Unenhanced and (B) enhanced axial CT images. Dishomogeneous density and partially calcified mass (arrowheads) can be observed in the right hypochondrium between the duodenum (D), liver (L), pancreas (P), and gallbladder (G). Dishomogeneous enhancement of the mass is appreciable in the arterial phase. (C) Enhanced coronal CT image. The mass (arrowheads) has a bilobated shape and occupies the hepatic hilum, between the liver (L), gallbladder (G), duodenum (D), pancreas (P), and choledoch (C). (D) Enhanced sagittal CT image. The mass (arrowheads) pushes downward the second portion of the duodenum (D), being interposed between it and the liver (L). (E) Axial 3D MIP. The mass (arrowheads) is supplied by a branch of the right hepatic artery (rha); cha, common hepatic artery; rpv, right portal branch.
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Abdomen CT scans with and without contrast (128 slice CT, Somatom Definition AS, Siemens Healthcare, Erlangen, Germany) confirmed the presence in the hepaticum hilum of an extensive tissue portion with irregular margins, unhomogeneously vascularized and characterized by small calcifications in its context, with a diameter on the axial plane of about 8 x 5.5 cm and a cranio-caudal extension of about 6 cm, incorporating the common hepatic duct and imprinting the choledochal duct in the pre-pancreatic site, the gallbladder, and the cystic duct, which could not be dissociated from the contiguous hepatic parenchyma and was in very close proximity to the second duodenal portion and the head of the pancreas ( Figure 1 ).
(A) Fine-needle aspiration biopsy (section colored in hematoxylin-eosin showing thyroid follicles mixed with red blood cells). (B) Fine-needle aspiration biopsy (nuclear positivity for TTF1 in the thyroid follicles). (C) Fine-needle aspiration biopsy (membrane positivity for CK7 in the thyroid follicles). (D) Fine-needle aspiration biopsy (rare positive nuclei for Ki67). (E) CT and SPECT/CT fusion images showing intense 131I accumulation in the region of the hepatic hilum site of known ectopic thyroid tissue that contracts with the hepatic parenchyma, its vascular structures, the displaced gallbladder, the duodenum, and the head of the pancreas.
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To clarify the nature of the lesion, a fine-needle biopsy of the lesion was performed with ultrasound endoscopy, with a cytological report of a hematoxylin and eosin-stained sample comprising fragments of thyroid tissue, consisting of colloid follicles, whose cells were positive for immunohistochemical staining for TTF1 ( Figures 2A, B ) and PAX8 and CK7 ( Figure 2C ), focally positive for CK19 and negative for synaptophysin and HepPar 1. Ki67 showed a proliferative index <1% ( Figure 2D ). Electric Medical Systems, Milwaukee, WI, USA) confirmed the presence of an area of intense accumulation of radioiodine in the upper right quadrant of the abdomen, compatible with ectopic thyroid tissue ( Figure 2E ). Elevated thyroglobulin levels were consistent with the above diagnosis.
MR in a 65-year-old woman with ectopic thyroid in the hepatic hilum. (A) Axial T1 image. Dishomogeneously hypointense (with respect to the liver) mass in the right hypochondrium between the duodenum (D), liver (L), pancreas (P), gallbladder (G), and inferior vena cava (ivc). Axial (B) T2 and (C) T2 fat-sat images. The mass is dishomogenously hyperintense with respect to the liver. (D) DWI B800 image. The mass shows no meaningful restriction. (E) ADC image. High ADC in the mass. (F) MR-Cholangiography. Common bile duct (cbd) compressed and dislocated by the bilobated mass (m); C, choledocus; G, gallbladder; M (mass); Wirsung (arrowheads).
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Tesla, Signa HDxt, GE Medical Systems, Milwaukee, WI, USA) confirmed the presence of a polylobulated solid mass slightly hypointense in the T1-weighted sequences and slightly hyperintense in the T2-weighted sequences, with some areas with fluid signal intensity and calcifications in the context, with non-homogeneous post-contrast enhancement, hypointense in the hepatobiliary phase, with a maximum axial size of approximately 7.8 x 4.8 cm located in the gallbladder bed and the hepaticum hilum ( Figure 3 ). This mass did not present cleavage planes with the liver, biliary branches and vessels to the hepaticum hilum, gallbladder, duodenum, and head of the pancreas.