PMC8432356_01
A - Gross view of the diffuse thyroid swelling; B - Contrast enhanced CT scan of the neck showing a large hypodense cystic lesion involving the left lobe of thyroid and partly the isthmus.
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On the physical examination, a soft cystic thyroid mass (left side) was detected, which was approximately 10x10 cm in size (Figure 1A). A contrast-enhanced CT scan of the neck revealed a large hypodense cystic lesion involving the left lobe of the thyroid along with the isthmus, and an intact right lobe (Figure 1B).
A - Fine needle aspiration smear showing sheets of anucleated squames admixed with few nucleated squamous cells without any nuclear atypia (Leishman stain; 200x); B - Intraoperative photograph showing complete removal of the tumor with preservation of the neurovascular structures.
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The cytological smear showed sheets of anucleated squames admixed with few nucleated squamous cells (Figure 2A). The patient had undergone a left hemithyroidectomy with complete preservation of the ipsilateral recurrent laryngeal nerve and the parathyroid glands (Figure 2B).
A - Photomicrograph of the surgical specimen showing a cyst wall lined by benign squamous epithelium with rim of compressed benign thyroid parenchyma (H&E; 100x); B - Focally the cyst wall shows moderate infiltration of lymphocytes with formation of lymphoid aggregate in the adjacent surrounding thyroid parenchyma (H&E; 200x).
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On microscopic examination, the cyst was lined by stratified squamous epithelium, surrounded by compressed benign thyroid parenchyma (Figure 3A). The surrounding thyroid parenchyma shows foci of chronic inflammatory infiltrate with lymphoid aggregates (Figure 3B).
Photographs showing the negative reaction for A - TTF1; B - PAX8; C - CK7.
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The histopathological sample was found negative for all the mentioned markers specific for thyroglossal cyst (Figure 4).
Follow up photograph (3 months) with healed scar and without evidences of recurrence.
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The patient is doing well and is on regular follow-up for the last 18 months in the thyroid clinic without any clinical and radiological evidence of recurrence of the disease (Figure 5).