Primary cavernous haemangioma of the thyroid: a rare pathology

Abstract

A 77-year-old female was referred with a 1-year history of an acquired, enlarging neck mass. Her past medical history included hypertension, hypercholesterolaemia, type II diabetes, atrial fibrillation (on aspirin), chronic kidney disease and ulcerative colitis. She had no relevant thyroid history, family history of thyroid cancer, ionizing radiation exposure or neck trauma. She was a lifelong nonsmoker. An obvious goitre was present on inspection (Fig. 1a). Palpation revealed a soft, large, non-tethered mass in the right anterior triangle with retrosternal extension and left tracheal deviation. There was no cervical lymphadenopathy. Normal bilateral vocal cord function was visualized on nasendoscopy despite mild dysphonia. Thyroid function tests confirmed euthyroidism (thyroid stimulating hormone (TSH): 2.88 mIU/L). Thyroid ultrasound showed that the right lobe was completely replaced by a heterogeneous, lobulated mass (9.0 × 8.0 × 5.0 cm) of low vascularity containing microcalcifications. The left lobe measured 5.0 × 1.3 × 1.0 cm with a 1.2-cm hypoechoic lower pole nodule. Computed tomography of the neck demonstrated a large, heterogeneous mass (8.0 × 8.0 cm) extending to the sternal notch causing laryngotracheal deviation to the left with minimal compression (Fig. 2). Initial fine needle aspiration biopsy (FNAB) of the right mass was non-diagnostic, and the left nodule was benign. Repeat right FNAB showed multiple fragments of non-epithelial stromal tissue without follicular cells or colloid. The specialist pathology service performed a core biopsy to assist diagnosis. This showed a meshwork of vascular spaces lined by endothelial cells, confirmed by positive CD31 and negative

Primary cavernous hemangioma of the thyroid mimicking an ectopic cervical thymoma

“…Surgery appears mandatory for a definitive and confirmatory diagnosis, given the need of a histological study. Hemithyroidectomy or total thyroidectomy will be assessed based on preoperative suspicion of malignancy, compressive symptoms or retrosternal extension [ 14 ]. Given the characteristics of the tumor, there is a risk of intraoperative bleeding directly related to the size of the tumor, so an adequate preoperative evaluation is required [ 3 ].…”