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Long-term ultrasound follow-up of intrathyroidal ectopic thymus in children

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Abstract

Objective

To present the sonographic follow-up of intrathyroidal ectopic thymus (IET) in children and adolescent patients.

Patients

Out of the 507 children referred to FNAB between 2006 and 2018, 30 (5.9%) pediatric patients (10 females), mean age 5.7 years (1.2–13.8, median 4.9 years) were diagnosed with IET.

Methods

A retrospective analysis of medical files of patients diagnosed with IET between 2006 and 2018. Assessed data included ultrasound characterisation, elastographic strain ratio (SR) results and hormonal evaluation.

Results

Analysis of thyroid US scans revealed that the mean age at the first thyroid ultrasound was 5.7 (1.2–13.8, median 4.9) years, and at the last US 10.7 (3.7–18, median 10.5) years. The mean time of the IET observation was 59.6 (2–148, median 53.5) months. On US, IET was hypoechoic with multiple linear and punctate echoes, hypovascular, fusiform on longitudinal plane and round or polygonal on an axial plane, more common in the right thyroid lobe (66.7%) and located in the posterior part of the lobes (54.5%), bilateral in two patients and multifocal in one patient. SR of IET was similar to the surrounding normal thyroid tissue. Complete regression of IET was observed in 12/30 patients after a mean time of 81.7 months (median 76.5), at the mean age of 13.7 (9.2–18, median 13.9) years. FNAB was performed in 10/30 and a hemithyroidectomy in 1/30 IET patients. In the FNAB (+) group, patients were younger (5.08 vs 6.08 years) and lesions were larger (0.12 ml vs 0.05 ml) than in the FNAB (−) group. All patients with IET were euthyroid with negative TPOAb and TgAb levels.

Conclusion

The reproducibility of unique ultrasound features of IETs allows for safe long-term follow-up of these benign lesions in the majority of pediatric patients: not only monitoring the regression of IET but also screening towards the rare occurrence of a tumor arising from the IET.

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References

  1. Suster S, Rosai J (2006) Thymus. In: Mills SE (ed) Histology for pathologists, 3rd edn. Lippincott Williams & Wilkins a Wolters Kluwer Business, Philadelphia, pp 505–522

    Google Scholar 

  2. Kabaalioğlu, Oztek MA, Kesimal U, Çeken K, Durmaz E, Apaydın A (2017) Intrathyroidal ectopic thymus in children: a sonographic survey. Med Ultrason. https://doi.org/10.11152/mu-913

    Article  PubMed  Google Scholar 

  3. Yildiz AE, Elhan AH, Fitoz S (2018) Prevalence and sonographic features of ectopic thyroidal thymus in children: a retrospective analysis. J Clin Ultrasound 46:375–379. https://doi.org/10.1002/jcu.22590

    Article  PubMed  Google Scholar 

  4. Gilmour J (1937) The embryology of the parathyroid glands, the thymus and certain associated rudiments. J Pathol Bacteriol 52:213–218

    Article  Google Scholar 

  5. Segni M, di Nardo R, Pucarelli I, Biffoni M (2011) Ectopic intrathyroidal thymus in children: a long-term follow-up study. Horm Res Paediatr 75:258–263

    Article  CAS  Google Scholar 

  6. Hirokawa M, Miyauchi A, Minato H, Yokoyama S, Kuma S, Kojima M (2013) Intrathyroidal epithelial thymoma/carcinoma showing thymus-like differentiation; comparison with thymic. APMIS 121:523–530. https://doi.org/10.1111/apm.12017

    Article  PubMed  Google Scholar 

  7. Pan XB, Lang ZQ, Cai L (2011) Primary T lymphoblastic lymphoma arising from ectopic thymus in the neck of a child. Chin J Otorhinolaryngol Head Neck Surg 46:159–160

    Google Scholar 

  8. Corrias A, Cassio A, Weber G, Mussa A, Wasniewska M, Rapa A, Gastaldi R, Einaudi S, Baronio F, Vigone MC, Messina MF, Bal M, Bona G, de Sanctis C, Study Group for Thyroid Diseases of Italian Society for Paediatric Endocrinology and Diabetology (SIEDP/ISPED) (2008) Thyroid nodules and cancer in children and adolescents affected by autoimmune thyroiditis. Arch Pediatr Adolesc Med 162(6):526–531. https://doi.org/10.1001/archpedi.162.6.526

    Article  PubMed  Google Scholar 

  9. Niedziela M, Handkiewicz-Junak D, Małecka-Tendera E, Czarniecka A, Dedecjus M et al (2016) Diagnostics and treatment of differentiated thyroid carcinoma in children—guidelines of Polish National Societies. Endokrynologia Polska 67(6):628–642

    Article  Google Scholar 

  10. Kay-Rivest E, Mascarella MA, Puligandla P, Emil S, Saint-Martin C, Nguyen LHP, Daniel SJ, Baird R (2018) Intrathyroidal thymic tissue in children: avoiding unnecessary surgery. J Paediatric Surg 53:1010–1013

    Article  Google Scholar 

  11. Magri F, Chytiris S, Capelli V, Gaiti M, Zerbini F, Carrara R, Malovini A, Rotondi M, Bellazzi R, Chiovato L (2013) Comparison of elastographic strain index and thyroid fine-needle aspiration cytology in 631 thyroid nodules. J Clin Endocrinol Metabol 98(12):4790–4797. https://doi.org/10.1210/jc.2013-2672

    Article  CAS  Google Scholar 

  12. Barr RG, Nakashima K, Amy D, Cosgrove D, Farrokh A, Schafer F, Bamber JC, Castera L, Choi BI, Chou YH, Dietrich CF, Ding H, Ferraioli G, Filice C, Friedrich-Rust M, Hall TJ, Nightingale KR, Palmeri ML, Shiina T, Suzuki S, Sporea I, Wilson S, Kudo M (2015) WFUMB guidelines and recommendations for clinical use of ultrasound elastography: part 2. Breast. Ultrasound Med Biol 41:1148–1160

    Article  Google Scholar 

  13. Stasiak M, Adamczewski Z, Stawerska R, Krawczyk T, Tomaszewska M, Lewiński A (2019) Sonographic and elastographic features of extra and intrathyroidal ectopic thymus mimicking malignancy differential diagnosis in children. Front Endocrinol. https://doi.org/10.3389/fendo.2019.00223.eCollection2019

    Article  Google Scholar 

  14. Cibas ES, Ali SZ (2009) The Bethesda system for reporting thyroid cytopathology. Thyroid 19:1159–1165. https://doi.org/10.1089/thy.2009.0274

    Article  PubMed  Google Scholar 

  15. Erol OB, Şahin D, Bayramoğlu Z, Yılmaz R, Akpınar YE, Ünal ÖF, Yekeler E (2017) Ectopic intrathyroidal thymus in children: prevalence, imaging findings and evolution. Turk J Pediatr 59(4):387–394. https://doi.org/10.24953/turkjped.2017.04.004

    Article  PubMed  Google Scholar 

  16. Avula S, Daneman A, Navarro OM, Moineddin R, Urbach S, Daneman D (2010) Incidental thyroid abnormalities identified on neck US for non-thyroid disorders. Pediatr Radiol 40(11):1774–1780. https://doi.org/10.1007/s00247-010-1684-9Epub 2010 May 21

    Article  PubMed  Google Scholar 

  17. Kim HG, Kim MJ, Lee MJ (2012) Sonographic appearance of intrathyroid ectopic thymus in children. J Clin Ultrasound 40(5):266–271. https://doi.org/10.1002/jcu.21898Epub 2012 Feb 24

    Article  PubMed  Google Scholar 

  18. Fukushima T, Suzuki S, Ohira T, Shimura H, Midorikawa S, Ohtsuru A, Sakai A, Abe M, Yamashita S, Suzuki S, Thyroid Examination Unit of the Radiation Medical Center for the Fukushima Health Management Survey (2015) Prevalence of ectopic intrathyroidal thymus in Japan: the Fukushima health management survey. Thyroid 25(5):534–537. https://doi.org/10.1089/thy.2014.0367Epub 2015 Apr 7

    Article  PubMed  Google Scholar 

  19. Carpenter G, Emery J (1976) Inclusions in the human thyroid. J Anat 122(Pt 1):77–89

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Chinn IK, Blackburn CC, Manley NR, Sempowski GD (2012) Changes in primary lymphoid organs with aging. Semin Immunol 24(5):309–320

    Article  CAS  Google Scholar 

  21. Le PT, Lazorick S, Whichard LP, Yang YC, Clark SC, Haynes BF, Singer KH (1990) Human thymic epithelial cells produce IL-6 granulocyte-monocyte-CSF, and leukemia inhibitory factor. J Immunol 145(10):3310–3315

    CAS  PubMed  Google Scholar 

  22. Kushida Y, Kumagai S, Gotoh K, Fujii M, Touma M, Hosono M (2012) T cells affect thymic involution during puberty by inducing regression of the adrenal reticularis. J Physiol Sci 62(3):173–184. https://doi.org/10.1007/s12576-012-0194-y

    Article  PubMed  Google Scholar 

  23. Escobar FA, Pantanowitz L, Picarsic JL, Craig FE, Simons JP, Viswanathan PA, Yilmaz S, Monaco SE (2018) Cytomorphology and sonographic features of ectopic thymic tissue diagnosed in paediatric FNA biopsies. Cytopathology 29:241–246. https://doi.org/10.1111/cyt.12529

    Article  CAS  PubMed  Google Scholar 

  24. Bang MH, Shin J, Lee KS, Kang MJ (2018) Intrathyroidal ectopic thymus in children: a benign lesion. Medicine (Baltimore) 97(14):e0282. https://doi.org/10.1097/md.0000000000010282

    Article  Google Scholar 

  25. Megremis S, Stiakaki E, Tritou I, Bonapart IE, Tsilimigaki A (2008) Ectopic intrathyroidal thymus misdiagnosed as a thyroid nodule: sonographic appearance. J Clin Ultrasound 36:443–447

    Article  Google Scholar 

  26. Janus D, Wojcik M, Kalicka-Kasperczyk A, Drabik G, Wyrobek L, Wedrychowicz A, Starzyk JB (2017) Novel insights in ultrasound evaluation of thyroid gland in children with papillary thyroid carcinoma. Neuro Endocrinol Lett 38:367–374

    PubMed  Google Scholar 

  27. Januś D, Wójcik M, Drabik G, Wyrobek Ł, Starzyk JB (2018) Ultrasound variants of autoimmune thyroiditis in children and adolescents and their clinical implication in relation to papillary thyroid carcinoma development. J Endocrinol Invest 41:371–380. https://doi.org/10.1007/s40618-017-0758-z

    Article  PubMed  Google Scholar 

  28. Januś D, Wójcik M, Taczanowska A, Sołtysiak P, Wędrychowicz A, Roztoczyńska D, Drabik G, Wyrobek Ł, Starzyk JB (2019) Follow-up of parenchymal changes in the thyroid gland with diffuse autoimmune thyroiditis in children prior to the development of papillary thyroid carcinoma. J Endocrinol Invest 42(3):261–270. https://doi.org/10.1007/s40618-018-0909-x

    Article  PubMed  Google Scholar 

  29. Yildiz AE, Ceyhan K, Sıklar Z, Bilir P, Yağmurlu EA, Berberoğlu M, Fitoz S (2015) intrathyroidal ectopic thymus in children: retrospective analysis of grayscale and doppler sonographic features. J Ultrasound Med 34(9):1651–1656. https://doi.org/10.7863/ultra.15.14.10041Epub 2015 Aug 12

    Article  PubMed  Google Scholar 

  30. Han BK, Yoon HK, Suh YL (2001) Thymic ultrasound. II. Diagnosis of aberrant cervical thymus. Pediatr Radiol 31:480–487

    Article  CAS  Google Scholar 

  31. Hernandez-Cassis C, Poniecka A, Vogel CK, McKenzie JM (2008) A six-year-old boy with a suspicious thyroid nodule: intrathyroidal thymic tissue. Thyroid 18:377–380

    Article  Google Scholar 

  32. Durmaz E, Barsal E, Parlak M, Gurer I, Karaguzel G, Akcurin S, Bircan I (2012) Intrathyroidal ectopic thymic tissue may mimic thyroid cancer: a case report. J Pediatr Endocrinol Metab 25(9–10):997–1000

    PubMed  Google Scholar 

  33. Cohen JB, Troxell M, Kong CS, McDougal R (2003) Ectopic intrathyroidal thymoma: a case report and review. Thyroid 13:305–308

    Article  Google Scholar 

  34. Lignitz S, Musholt TJ, Engel R, Bzezinska R, Pohlenz J (2008) Intrathyroidal thymic tissue surrounding an intrathyroidal parathyroid gland, the cause of a solitary thyroid nodule in a 6-year-old boy. Thyroid 18:1125–1130

    Article  Google Scholar 

  35. Corrias A, Mussa A (2013) Thyroid nodules in paediatrics: which ones can be left alone, which ones must be investigated, when and how. J Clin Res Pediatr Endocrinol 5(Suppl. 1):57–69

    PubMed  PubMed Central  Google Scholar 

  36. Kuo TC, Wu MH, Chen KY, Hsieh MS, Chen A, Chen CN (2019) Ultrasonographic features for differentiating follicular thyroid carcinoma and follicular adenoma. Asian J Surg. https://doi.org/10.1016/j.asjsur.2019.04.016(Epub ahead of print)

    Article  PubMed  Google Scholar 

  37. Liu MJ, Liu ZF, Hou YY, Men YM, Zhang YX, Gao LY, Liu H (2017) Ultrasonographic characteristics of medullary thyroid carcinoma: a comparison with papillary thyroid carcinoma. Oncotarget 8(16):27520–27528. https://doi.org/10.18632/oncotarget.15897

    Article  PubMed  PubMed Central  Google Scholar 

  38. Dhall G, Ginsburg HB, Bodestein L, Fefferman NR, Greco A, Chang MW, Gardner S (2004) Thymoma in children. Report of two cases and review of literature. J Pediatr Hematol Oncol 26:681–685

    Article  Google Scholar 

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Acknowledgements

Łukasz Wyrobek, MD, PhD (Department of Pediatric Radiology, University Children’s Hospital, Krakow, Poland).

Funding

This study has not received any funding.

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Authors and Affiliations

  1. Department of Paediatric and Adolescent Endocrinology, Chair of Paediatrics, Institute of Paediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Kraków, Poland

    D. Januś, A. Kalicka-Kasperczyk, M. Wójcik & J. B. Starzyk

  2. Department of Paediatric and Adolescent Endocrinology, University Children’s Hospital, Kraków, Poland

    D. Januś, A. Kalicka-Kasperczyk, M. Wójcik & J. B. Starzyk

  3. Department of Clinical Immunology and Transplantation, Institute of Paediatrics, Jagiellonian University Medical College, Kraków, Poland

    G. Drabik

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Contributions

Study design: DJ, AKK. Study conduct: DJ, AKK. Data collection: DJ, MW, AKK, GD. Data analysis: DJ, AKK, MW. Data interpretation: DJ, MW, AKK. Drafting manuscript: DJ. Revising manuscript content: DJ, MW, and JS. Approving final version of manuscript: DJ, AKK, MW, and JS. DJ takes responsibility for the integrity of the data analysis.

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Correspondence to D. Januś.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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This study was retrospective and involved patients medical files and did not involve human or animal participants.

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Informed consent was waived by our Institutional Ethical Commission.

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Januś, D., Kalicka-Kasperczyk, A., Wójcik, M. et al. Long-term ultrasound follow-up of intrathyroidal ectopic thymus in children. J Endocrinol Invest 43, 841–852 (2020). https://doi.org/10.1007/s40618-019-01172-w

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  • DOI: https://doi.org/10.1007/s40618-019-01172-w

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