可疑腎上腺內異位甲狀腺1例報道并文獻復習_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

陳煒豪 ,  張智

廣東醫科大學附屬醫院血管與甲狀腺外科（廣東湛江 524000）;

Corresponding?author：

張智, Email: zzworld2007@163.com

Keywords：

異位甲狀腺; 腎上腺; 病理特征; 鑒別診斷; 治療; 預后

DOI：

10.7507/1007-9424.202310064

Video：

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目的總結腎上腺內異位甲狀腺的影像學表現、病理特征、臨床診斷、鑒別診斷以及治療方法和預后。方法回顧性分析2023年3月廣東醫科大學附屬醫院收治的1例可疑腎上腺內異位甲狀腺的臨床表現、病理特征、治療及預后情況，并結合國內外相關文獻報道的26例腎上腺內異位甲狀腺的病例資料進行分析。結果本例66歲女性患者，術前檢查提示左側腎上腺占位（考慮嗜鉻細胞瘤）并行手術完整切除，術后根據病理學檢查和免疫組織化學檢查最終考慮診斷為腎上腺內異位甲狀腺并腺瘤樣增生，術后隨訪6個月未見復發。復習國內外文獻報道的26例腎上腺內異位甲狀腺患者資料，亞洲中老年女性多見（22例），左側多發（17例），大部分（19例）由體檢發現，通常表現為無痛性囊性腫塊，大體呈類圓形，鏡下可見甲狀腺樣組織，并見甲狀腺樣濾泡，濾泡腔內見嗜酸性膠質樣物，部分區域可見濾泡與腎上腺皮質混雜，通常無腎上腺髓質成分，囊壁被覆扁平上皮細胞或甲狀腺濾泡樣細胞、可見核重疊，偶見核溝和包涵體，類似甲狀腺乳頭狀癌細胞核，但未見砂粒體。免疫組織化學表現為PCK、EMA、TTF-1、Tg、Vimentin陽性，提示甲狀腺分化，BRAF^V600E、KRAS基因突變陰性。治療以完整切除腫瘤為主，預后良好。結論腎上腺內異位甲狀腺罕見，確切發生機制有待研究，臨床術前不易辨識，應與腎上腺腫瘤、轉移性甲狀腺濾泡癌、乳頭狀癌等鑒別，免疫組織化學染色及基因檢測有助于明確診斷，治療以完整切除腫瘤為主，預后良好。

Citation： 陳煒豪, 張智. 可疑腎上腺內異位甲狀腺1例報道并文獻復習. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(5): 612-616. doi: 10.7507/1007-9424.202310064 Copy

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.	Eyübo?lu 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.	Akta? Y?lmaz 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, 張世豪, 廖玉婷, 等. 腎上腺內異位甲狀腺臨床病理觀察. 診斷病理學雜志, 2017, 24(3): 198-201.
27.	胡柏來, 相學平, 洪波, 等. 腎上腺異位甲狀腺一例. 中華病理學雜志, 2016, 45(6): 421-422.
28.	黃文鵬, 李莉明, 韓懿靜, 等. 腎上腺異位甲狀腺并囊變出血誤診為囊腫一例. 影像診斷與介入放射學, 2022, 31(1): 61-63.
29.	劉維帥, 郭曉寧, 楊洋, 等. 腎上腺內異位甲狀腺臨床病理特征與鑒別診斷. 臨床醫學研究與實踐, 2020, 5(5): 4-6.
30.	張小輝, 趙向榮, 袁艷龍. 腎上腺異位甲狀腺1例報告. 現代泌尿外科雜志, 2021, 26(3): 274, 276.
31.	Buzeji? M, Odalovi? B, Zori? 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. Eyübo?lu 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. Akta? Y?lmaz 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, 張世豪, 廖玉婷, 等. 腎上腺內異位甲狀腺臨床病理觀察. 診斷病理學雜志, 2017, 24(3): 198-201.
27. 胡柏來, 相學平, 洪波, 等. 腎上腺異位甲狀腺一例. 中華病理學雜志, 2016, 45(6): 421-422.
28. 黃文鵬, 李莉明, 韓懿靜, 等. 腎上腺異位甲狀腺并囊變出血誤診為囊腫一例. 影像診斷與介入放射學, 2022, 31(1): 61-63.
29. 劉維帥, 郭曉寧, 楊洋, 等. 腎上腺內異位甲狀腺臨床病理特征與鑒別診斷. 臨床醫學研究與實踐, 2020, 5(5): 4-6.
30. 張小輝, 趙向榮, 袁艷龍. 腎上腺異位甲狀腺1例報告. 現代泌尿外科雜志, 2021, 26(3): 274, 276.
31. Buzeji? M, Odalovi? B, Zori? 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.

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