可疑肾上腺内异位甲状腺1例报道并文献复习_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

陈炜豪 ,  张智

广东医科大学附属医院血管与甲状腺外科（广东湛江 524000）;

Corresponding author：

张智, Email: zzworld2007@163.com

Keywords：

异位甲状腺; 肾上腺; 病理特征; 鉴别诊断; 治疗; 预后

DOI：

10.7507/1007-9424.202310064

Video：

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目的总结肾上腺内异位甲状腺的影像学表现、病理特征、临床诊断、鉴别诊断以及治疗方法和预后。方法回顾性分析2023年3月广东医科大学附属医院收治的1例可疑肾上腺内异位甲状腺的临床表现、病理特征、治疗及预后情况，并结合国内外相关文献报道的26例肾上腺内异位甲状腺的病例资料进行分析。结果本例66岁女性患者，术前检查提示左侧肾上腺占位（考虑嗜铬细胞瘤）并行手术完整切除，术后根据病理学检查和免疫组织化学检查最终考虑诊断为肾上腺内异位甲状腺并腺瘤样增生，术后随访6个月未见复发。复习国内外文献报道的26例肾上腺内异位甲状腺患者资料，亚洲中老年女性多见（22例），左侧多发（17例），大部分（19例）由体检发现，通常表现为无痛性囊性肿块，大体呈类圆形，镜下可见甲状腺样组织，并见甲状腺样滤泡，滤泡腔内见嗜酸性胶质样物，部分区域可见滤泡与肾上腺皮质混杂，通常无肾上腺髓质成分，囊壁被覆扁平上皮细胞或甲状腺滤泡样细胞、可见核重叠，偶见核沟和包涵体，类似甲状腺乳头状癌细胞核，但未见砂粒体。免疫组织化学表现为PCK、EMA、TTF-1、Tg、Vimentin阳性，提示甲状腺分化，BRAF^V600E、KRAS基因突变阴性。治疗以完整切除肿瘤为主，预后良好。结论肾上腺内异位甲状腺罕见，确切发生机制有待研究，临床术前不易辨识，应与肾上腺肿瘤、转移性甲状腺滤泡癌、乳头状癌等鉴别，免疫组织化学染色及基因检测有助于明确诊断，治疗以完整切除肿瘤为主，预后良好。

1.	Ibrahim NA, Fadeyibi IO. Ectopic thyroid: etiology, pathology and management. Hormones (Athens), 2011, 10(4): 261-269.
2.	Kurman RJ, Prabha AC. Thyroid and parathyroid glands in the vaginal wall: report of a case. Am J Clin Pathol, 1973, 59(4): 503-507.
3.	Takahashi T, Ishikura H, Kato H, et al. Ectopic thyroid follicles in the submucosa of the duodenum. Virchows Arch A Pathol Anat Histopathol, 1991, 418(6): 547-550.
4.	Eyüboğlu E, Kapan M, Ipek T, et al. Ectopic thyroid in the abdomen: report of a case. Surg Today, 1999, 29(5): 472-474.
5.	Cassol CA, Noria D, Asa SL. Ectopic thyroid tissue within the gall bladder: case report and brief review of the literature. Endocr Pathol, 2010, 21(4): 263-265.
6.	Girelli ME, Casara D, Rubello D, et al. Metastatic thyroid carcinoma of the adrenal gland. J Endocrinol Invest, 1993, 16(2): 139-141.
7.	Tsujimura A, Takaha M, Takayama H, et al. Ectopic thyroid tissue in a cystic adrenal mass. Br J Urol, 1996, 77(4): 605-606.
8.	Aktaş Yılmaz B, Aktürk M, Kan E, et al. Ectopic thyroid in the adrenal presenting as an adrenal incidentaloma. Turk J Endocrinol Me, 2016, 20(4): 136-139.
9.	Bohinc BN, Parker JC, Hope WW, et al. Micropapillary thyroid carcinoma and concomitant ectopic thyroid tissue in the adrenal gland: metastasis or metaplasia? Thyroid, 2011, 21(9): 1033-1038.
10.	Bozkirli E, Bakiner O, Belli S, et al. Ectopic thyroid tissue in the adrenal gland: report of a case. EJEA, 2015.
11.	Bramhe S, Dhawan S, Dhamija N. An unusual case of ectopic thyroid tissue in an adrenal gland presenting as a cyst. Indian J Cancer, 2021, 58(2): 294-295.
12.	Casadei GP, Bertarelli C, Giorgini E, et al. Ectopic thyroid tissue in the adrenal gland: report of a case. Int J Surg Pathol, 2015, 23(2): 170-175.
13.	Gourmaud J, Bongiovanni M, Triponez F, et al. Ectopic thyroid tissue in the adrenal gland. Endocr Pathol, 2014, 25(3): 353-355.
14.	Hagiuda J, Kuroda I, Tsukamoto T, et al. Ectopic thyroid in an adrenal mass: a case report. BMC Urol, 2006, 6: 18. doi: 10.1186/1471-2490-6-18.
15.	Li H, Chen Q, Zhu Y, et al. Ectopic thyroid tissue in the adrenal gland: a case report with clinical and pathogenetic implications. Int J Clin Exp Pathol. 2017, 10(8) : 8761-8764.
16.	Ohkubo Y, Yamazaki M, Shimada Y, et al. Rare coexistence of aldosterone-producing adrenocortical adenoma confirmed by an immunohistochemical analysis of steroidogenic enzymes with adrenal ectopic thyroid tissue: a case report and literature review. Intern Med, 2024, 63(2): 259-264.
17.	Paunovic I, Rovcanin B, Jovanovic M, et al. Ectopic thyroid tissue in adrenal gland, case report and review of literature. Gland Surg, 2020, 9(5): 1573-1578.
18.	Rawitzer J, Kapakoglou A, Walz MK, et al. Ectopic thyroid tissue in the adrenal gland : a case report and review of the literature. Pathologe, 2020, 41(2): 177-180.
19.	Romero-Rojas A, Bella-Cueto MR, Meza-Cabrera IA, et al. Ectopic thyroid tissue in the adrenal gland: a report of two cases with pathogenetic implications. Thyroid, 2013, 23(12): 1644-1650.
20.	Shiraishi T, Imai H, Fukutome K, et al. Ectopic thyroid in the adrenal gland. Hum Pathol, 1999, 30(1): 105-108.
21.	Shuno Y, Kobayashi T, Morita K, et al. Ectopic thyroid in the adrenal gland presenting as cystic lesion. Surgery, 2006, 139(4): 580-582.
22.	Tada A, Tanaka T, Takamoto A, et al. Ectopic thyroid tissue in the adrenal gland: CT and MRI findings. Diagn Interv Imaging, 2016, 97(3): 373-375.
23.	Takao H, Doi I, Watanabe T. Ectopic thyroid in the adrenal gland: computed tomography findings. J Comput Assist Tomogr, 2006, 30(2): 221-222.
24.	Wang SC, Hung SW, Lee CH, et al. Ectopic thyroid tissue in the adrenal gland mimicking a pheochromocytoma. J Endourol Case Rep, 2017, 3(1): 149-151.
25.	Zhang L, Zhai X, Wang L, et al. Ectopic thyroid tissue in the adrenal gland: a case report and literature review. Hum Pathol (N Y), 2020, 21: 200386.
26.	高敏, 张世豪, 廖玉婷, 等. 肾上腺内异位甲状腺临床病理观察. 诊断病理学杂志, 2017, 24(3): 198-201.
27.	胡柏来, 相学平, 洪波, 等. 肾上腺异位甲状腺一例. 中华病理学杂志, 2016, 45(6): 421-422.
28.	黄文鹏, 李莉明, 韩懿静, 等. 肾上腺异位甲状腺并囊变出血误诊为囊肿一例. 影像诊断与介入放射学, 2022, 31(1): 61-63.
29.	刘维帅, 郭晓宁, 杨洋, 等. 肾上腺内异位甲状腺临床病理特征与鉴别诊断. 临床医学研究与实践, 2020, 5(5): 4-6.
30.	张小辉, 赵向荣, 袁艳龙. 肾上腺异位甲状腺1例报告. 现代泌尿外科杂志, 2021, 26(3): 274, 276.
31.	Buzejić M, Odalović B, Zorić G, et al. Incidence of ectopic thyroid tissue in the adrenal gland. Praxis medica, 2020, 49(3-4): 39-42.
32.	Noussios G, Anagnostis P, Goulis DG, et al. Ectopic thyroid tissue: anatomical, clinical, and surgical implications of a rare entity. Eur J Endocrinol, 2011, 165(3): 375-382.
33.	Koutkia P, Safer JD. Adrenal metastasis secondary to papillary thyroid carcinoma. Thyroid, 2001, 11(11): 1077-1079.
34.	Yang Y, Li Q, Qu J, et al. Ectopic intratracheal thyroid. South Med J, 2010, 103(5): 467-470.
35.	Rossi ED, Martini M, Straccia P, et al. Detection of ectopic thyroid remnants: a serious diagnostic dilemma. When molecular biology and immunohistochemistry can solve the problem. Pathol Res Pract, 2013, 209(1): 59-61.

1. Ibrahim NA, Fadeyibi IO. Ectopic thyroid: etiology, pathology and management. Hormones (Athens), 2011, 10(4): 261-269.
2. Kurman RJ, Prabha AC. Thyroid and parathyroid glands in the vaginal wall: report of a case. Am J Clin Pathol, 1973, 59(4): 503-507.
3. Takahashi T, Ishikura H, Kato H, et al. Ectopic thyroid follicles in the submucosa of the duodenum. Virchows Arch A Pathol Anat Histopathol, 1991, 418(6): 547-550.
4. Eyüboğlu E, Kapan M, Ipek T, et al. Ectopic thyroid in the abdomen: report of a case. Surg Today, 1999, 29(5): 472-474.
5. Cassol CA, Noria D, Asa SL. Ectopic thyroid tissue within the gall bladder: case report and brief review of the literature. Endocr Pathol, 2010, 21(4): 263-265.
6. Girelli ME, Casara D, Rubello D, et al. Metastatic thyroid carcinoma of the adrenal gland. J Endocrinol Invest, 1993, 16(2): 139-141.
7. Tsujimura A, Takaha M, Takayama H, et al. Ectopic thyroid tissue in a cystic adrenal mass. Br J Urol, 1996, 77(4): 605-606.
8. Aktaş Yılmaz B, Aktürk M, Kan E, et al. Ectopic thyroid in the adrenal presenting as an adrenal incidentaloma. Turk J Endocrinol Me, 2016, 20(4): 136-139.
9. Bohinc BN, Parker JC, Hope WW, et al. Micropapillary thyroid carcinoma and concomitant ectopic thyroid tissue in the adrenal gland: metastasis or metaplasia? Thyroid, 2011, 21(9): 1033-1038.
10. Bozkirli E, Bakiner O, Belli S, et al. Ectopic thyroid tissue in the adrenal gland: report of a case. EJEA, 2015.
11. Bramhe S, Dhawan S, Dhamija N. An unusual case of ectopic thyroid tissue in an adrenal gland presenting as a cyst. Indian J Cancer, 2021, 58(2): 294-295.
12. Casadei GP, Bertarelli C, Giorgini E, et al. Ectopic thyroid tissue in the adrenal gland: report of a case. Int J Surg Pathol, 2015, 23(2): 170-175.
13. Gourmaud J, Bongiovanni M, Triponez F, et al. Ectopic thyroid tissue in the adrenal gland. Endocr Pathol, 2014, 25(3): 353-355.
14. Hagiuda J, Kuroda I, Tsukamoto T, et al. Ectopic thyroid in an adrenal mass: a case report. BMC Urol, 2006, 6: 18. doi: 10.1186/1471-2490-6-18.
15. Li H, Chen Q, Zhu Y, et al. Ectopic thyroid tissue in the adrenal gland: a case report with clinical and pathogenetic implications. Int J Clin Exp Pathol. 2017, 10(8) : 8761-8764.
16. Ohkubo Y, Yamazaki M, Shimada Y, et al. Rare coexistence of aldosterone-producing adrenocortical adenoma confirmed by an immunohistochemical analysis of steroidogenic enzymes with adrenal ectopic thyroid tissue: a case report and literature review. Intern Med, 2024, 63(2): 259-264.
17. Paunovic I, Rovcanin B, Jovanovic M, et al. Ectopic thyroid tissue in adrenal gland, case report and review of literature. Gland Surg, 2020, 9(5): 1573-1578.
18. Rawitzer J, Kapakoglou A, Walz MK, et al. Ectopic thyroid tissue in the adrenal gland : a case report and review of the literature. Pathologe, 2020, 41(2): 177-180.
19. Romero-Rojas A, Bella-Cueto MR, Meza-Cabrera IA, et al. Ectopic thyroid tissue in the adrenal gland: a report of two cases with pathogenetic implications. Thyroid, 2013, 23(12): 1644-1650.
20. Shiraishi T, Imai H, Fukutome K, et al. Ectopic thyroid in the adrenal gland. Hum Pathol, 1999, 30(1): 105-108.
21. Shuno Y, Kobayashi T, Morita K, et al. Ectopic thyroid in the adrenal gland presenting as cystic lesion. Surgery, 2006, 139(4): 580-582.
22. Tada A, Tanaka T, Takamoto A, et al. Ectopic thyroid tissue in the adrenal gland: CT and MRI findings. Diagn Interv Imaging, 2016, 97(3): 373-375.
23. Takao H, Doi I, Watanabe T. Ectopic thyroid in the adrenal gland: computed tomography findings. J Comput Assist Tomogr, 2006, 30(2): 221-222.
24. Wang SC, Hung SW, Lee CH, et al. Ectopic thyroid tissue in the adrenal gland mimicking a pheochromocytoma. J Endourol Case Rep, 2017, 3(1): 149-151.
25. Zhang L, Zhai X, Wang L, et al. Ectopic thyroid tissue in the adrenal gland: a case report and literature review. Hum Pathol (N Y), 2020, 21: 200386.
26. 高敏, 张世豪, 廖玉婷, 等. 肾上腺内异位甲状腺临床病理观察. 诊断病理学杂志, 2017, 24(3): 198-201.
27. 胡柏来, 相学平, 洪波, 等. 肾上腺异位甲状腺一例. 中华病理学杂志, 2016, 45(6): 421-422.
28. 黄文鹏, 李莉明, 韩懿静, 等. 肾上腺异位甲状腺并囊变出血误诊为囊肿一例. 影像诊断与介入放射学, 2022, 31(1): 61-63.
29. 刘维帅, 郭晓宁, 杨洋, 等. 肾上腺内异位甲状腺临床病理特征与鉴别诊断. 临床医学研究与实践, 2020, 5(5): 4-6.
30. 张小辉, 赵向荣, 袁艳龙. 肾上腺异位甲状腺1例报告. 现代泌尿外科杂志, 2021, 26(3): 274, 276.
31. Buzejić M, Odalović B, Zorić G, et al. Incidence of ectopic thyroid tissue in the adrenal gland. Praxis medica, 2020, 49(3-4): 39-42.
32. Noussios G, Anagnostis P, Goulis DG, et al. Ectopic thyroid tissue: anatomical, clinical, and surgical implications of a rare entity. Eur J Endocrinol, 2011, 165(3): 375-382.
33. Koutkia P, Safer JD. Adrenal metastasis secondary to papillary thyroid carcinoma. Thyroid, 2001, 11(11): 1077-1079.
34. Yang Y, Li Q, Qu J, et al. Ectopic intratracheal thyroid. South Med J, 2010, 103(5): 467-470.
35. Rossi ED, Martini M, Straccia P, et al. Detection of ectopic thyroid remnants: a serious diagnostic dilemma. When molecular biology and immunohistochemistry can solve the problem. Pathol Res Pract, 2013, 209(1): 59-61.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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