PMC10087701_01
(A) Low-power view of cellular aspirate showing granular debris and superficial squamous cells (Papanicolaou, 100x). (B) Fine needle aspiration biopsy showing numerous fragments of amorphous material (Rapid Diff, 200x). (C) High-power view of digestive content bearing close resemblance to colloid in thyroid aspirates (Rapid Diff, 200x). (D) Granular debris and squamous cells (Papanicolaou, 200x). (E) Eosinophilic fibres in granular background (Papanicolaou, 200x). (F) High-power view of striated muscle fibres representing ingested meat (Papanicolaou, 400x). (G) Cell groups resembling plant matter with thick cellulose walls (Rapid Diff, 400x). (H) Fungal spores and hyphae, with bacilliform bacteria (Rapid Diff, 1000x). (I) A few intermediate cells showing mild reactive atypia (Papanicolaou stain, 400x)
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The on-site pathologist considered a squamous lined cyst, possibly of thyroidal origin, at first glimpse, but further scrutiny revealed granular debris, skeletal muscle fragments, plant-like matter, mixed inflammatory cells, and filamentous bacterial and fungal spores with hyphae (Figure 1A-I).
Longitudinal ultrasound image of the left thyroid lobe, showing a lesion (yellow arrow) located posterior to the left lobe. The lesion is hypoechoic with internal echogenic foci and a well-defined smooth hypoechoic border
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A formal US of this squamous-cell containing lesion reported pathology posterior to the left lobe of the thyroid (Figure 2).
Barium swallow showing a left-sided paraesophageal pouch (yellow arrow) in keeping with a Killian-Jamieson diverticulum
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Further imaging confirmed features compatible with a KJD (Figure 3).