Thyroid nodule differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Thyroid nodule}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Thyroid_nodule]]
{{CMG}}; {{AE}} {{MIR}}
{{CMG}}; {{AE}} {{MIR}}
== Overview ==
== Overview ==
Line 7: Line 7:
== Thyroid Nodule Differential Diagnosis ==
== Thyroid Nodule Differential Diagnosis ==
[[Neck masses]] can be mistaken with thyroid nodules. While the diagnosis of a thyroid nodule is established, thyroid nodule should be differentiated based on [[benign]] or [[malignant]] features and the type of nodule:
[[Neck masses]] can be mistaken with thyroid nodules. While the diagnosis of a thyroid nodule is established, thyroid nodule should be differentiated based on [[benign]] or [[malignant]] features and the type of nodule:
{| class="wikitable"
<small>
!Disease
{|  
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Manifestation
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Manifestation
! colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Spread
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Spread
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Nodular growth
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Nodular growth
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Laboratory
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Laboratory
Line 17: Line 18:
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Associated findings
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Associated findings
|-
|-
!
! align="center" style="background:#4479BA; color: #FFFFFF;" + |LN
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Vessel
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Metastasis
! align="center" style="background:#4479BA; color: #FFFFFF;" + |TSH
! align="center" style="background:#4479BA; color: #FFFFFF;" + |TSH
! align="center" style="background:#4479BA; color: #FFFFFF;" + |FT4/T3
! align="center" style="background:#4479BA; color: #FFFFFF;" + |FT4/T3
|-
|-
!Colloid adenoma
! align="center" style="background:#DCDCDC;" + |Colloid adenoma
|
| align="left" style="background:#F5F5F5;" + |
* Benign
* [[Benign]]
* Noncancerous enlargement of thyroid tissue
* Noncancerous enlargement of [[thyroid tissue]]
* May be painful
* May be painful
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |Intermediate
|<nowiki>-</nowiki>
|Intermediate
Slow
Slow
|NL
| align="center" style="background:#F5F5F5;" + |NL
|NL
| align="center" style="background:#F5F5F5;" + |NL
|
| align="left" style="background:#F5F5F5;" + |
* Iso- to hypoechoic
* Iso- to hypoechoic
* May have internal cystic or heterogeneous change
* May have internal cystic or heterogeneous change
* May have [[calcification]]
* May have [[calcification]]
* Multiple echogenic foci (of inspissated colloid) with comet tail artifact
* Multiple echogenic foci (of inspissated colloid) with comet tail artifact
|
| align="left" style="background:#F5F5F5;" + |
* [[Hyperplasia]] of colloid [[parenchyma]] of thyroid gland
* [[Hyperplasia]] of colloid [[parenchyma]] of [[thyroid gland]]
|
| align="left" style="background:#F5F5F5;" + |
* May progress to [[carcinoma]]
* May progress to [[carcinoma]]
|-
|-
![[Hashimoto's thyroiditis]]
! align="center" style="background:#DCDCDC;" + |[[Hashimoto's thyroiditis]]
|
| align="left" style="background:#F5F5F5;" + |
* Benign
* [[Benign]]
* Rarely [[painful]]
* Rarely [[painful]]
* May be accompanied with [[fever]]
* May be accompanied with [[fever]]
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |Rapid
|<nowiki>-</nowiki>
|Rapid
 
Intermediate
Intermediate
|↓↓
| align="center" style="background:#F5F5F5;" + |↓↓
|↓
| align="center" style="background:#F5F5F5;" + |↓
|
| align="left" style="background:#F5F5F5;" + |
* Hypoechoic micronodules (1-6 mm) with surrounding echogenic septations
* Hypoechoic micronodules (1-6 mm) with surrounding echogenic septations
|
| align="left" style="background:#F5F5F5;" + |
* Massive infiltration of the [[thyroid gland]] by [[lymphocytes]] and [[Plasma cell|plasma cells]]
* Massive infiltration of the [[thyroid gland]] by [[lymphocytes]] and [[Plasma cell|plasma cells]]
* [[Germinal centers]]
* [[Germinal centers]]
* [[Thyroid]] follicles are usually absent and the few remaining follicles are devoid of [[colloid]]
* [[Thyroid]] follicles are usually absent and the few remaining follicles are devoid of [[colloid]]
* Hurthle cells
* Hurthle cells
|
| align="left" style="background:#F5F5F5;" + |
* [[HLA-A]]
* [[HLA-A]]
* [[HLA-B]]
* [[HLA-B]]
* [[Autoimmune disease]] of [[thyroid gland]]
* [[Autoimmune disease]] of [[thyroid gland]]
|-
|-
!Cysts nodule
! align="center" style="background:#DCDCDC;" + |Cysts nodule
|
| align="left" style="background:#F5F5F5;" + |
* Benign
* [[Benign]]
* Most common cause of painful neck lesion
* Most common cause of painful [[neck]] lesion
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |Rapid
|<nowiki>-</nowiki>
|Rapid
Intermediate
Intermediate
|NL
| align="center" style="background:#F5F5F5;" + |NL
|NL
| align="center" style="background:#F5F5F5;" + |NL
|
| align="left" style="background:#F5F5F5;" + |
* Cystic non-calcified nodules
* Cystic non-calcified nodules
|
| align="left" style="background:#F5F5F5;" + |
* [[Follicular cells]]
* [[Follicular cells]]
* [[Macrophages]]
* [[Macrophages]]
* [[RBC]]
* [[RBC]]
* [[Colloid]]
* [[Colloid]]
|
| align="left" style="background:#F5F5F5;" + |
* Mostly due to degenerating [[Thyroid adenoma|thyroid adenomas]]
* Mostly due to degenerating [[Thyroid adenoma|thyroid adenomas]]
|-
|-
!Follicular adenoma
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
|
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Manifestation
* Benign
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Spread
 
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Nodular growth
! align="center" style="background:#4479BA; color: #FFFFFF;" + |TSH
! align="center" style="background:#4479BA; color: #FFFFFF;" + |FT4/T3
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Imaging
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Pathology
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Associated findings
|-
! align="center" style="background:#DCDCDC;" + |Follicular adenoma
| align="left" style="background:#F5F5F5;" + |
* [[Benign]]
* Rarely painful
* Rarely painful
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |Intermediate
|<nowiki>-</nowiki>
|Intermediate
Slow
Slow
|↓↓
| align="center" style="background:#F5F5F5;" + |↓↓
|↑
| align="center" style="background:#F5F5F5;" + |↑
| rowspan="5" |
| rowspan="5" align="left" style="background:#F5F5F5;" + |
* Thin peripheral halo
* Thin peripheral halo
* Predominantly [[cystic]] or mixed cystic and solid lesions
* Predominantly [[cystic]] or mixed [[cystic]] and solid lesions
* Isoechoic or predominantly anechoic  
* Isoechoic or predominantly anechoic  
| rowspan="5" |
| rowspan="5" align="left" style="background:#F5F5F5;" + |
* Depends on type
* Depends on type
| rowspan="5" | PAX8-PPAR gamma 1 
| rowspan="5" align="center" style="background:#F5F5F5;" + |PAX8-PPAR gamma 1 
|-
|-
!Hyperplastic nodule
! align="center" style="background:#DCDCDC;" + |Hyperplastic nodule
|
| align="left" style="background:#F5F5F5;" + |
* Benign
* [[Benign]]
 
* Rarely painful
* Rarely painful
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |Rapid
|<nowiki>-</nowiki>
|Rapid
 
Intermediate
Intermediate
|↓↓
| align="center" style="background:#F5F5F5;" + |↓↓
|↑
| align="center" style="background:#F5F5F5;" + |↑
|-
|-
!Macrofollicular adenoma
! align="center" style="background:#DCDCDC;" + |Macrofollicular adenoma
|
| align="left" style="background:#F5F5F5;" + |
* Benign
* [[Benign]]
 
* Rarely painful
* Rarely painful
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |Intermediate
|<nowiki>-</nowiki>
|Intermediate
 
Slow
Slow
|↓↓
| align="center" style="background:#F5F5F5;" + |↓↓
|↑
| align="center" style="background:#F5F5F5;" + |↑
|-
|-
!Microfollicular or cellular adenoma
! align="center" style="background:#DCDCDC;" + |Microfollicular or cellular adenoma
|
| align="left" style="background:#F5F5F5;" + |
* Benign
* [[Benign]]
 
* Rarely painful
* Rarely painful
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |Intermediate
|<nowiki>-</nowiki>
|Intermediate
Slow
Slow
|↓↓
| align="center" style="background:#F5F5F5;" + |↓↓
|↑
| align="center" style="background:#F5F5F5;" + |↑
|-
|-
!Hürthle cell adenoma
! align="center" style="background:#DCDCDC;" + |Hürthle cell adenoma
|
| align="left" style="background:#F5F5F5;" + |
* Benign
* [[Benign]]
 
* Rarely painful
* Rarely painful
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |Intermediate
|<nowiki>-</nowiki>
|Intermediate
 
Slow
Slow
|↑↓
| align="center" style="background:#F5F5F5;" + |↑↓
|↑↓
| align="center" style="background:#F5F5F5;" + |↑↓
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Manifestation
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Spread
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Nodular growth
! align="center" style="background:#4479BA; color: #FFFFFF;" + |TSH
! align="center" style="background:#4479BA; color: #FFFFFF;" + |FT4/T3
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Imaging
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Pathology
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Associated findings
|-
|-
![[Papillary carcinoma of the thyroid|Papillary carcinoma]]
! align="center" style="background:#DCDCDC;" + |[[Papillary carcinoma of the thyroid|Papillary carcinoma]]
|
| align="left" style="background:#F5F5F5;" + |
* Malignant
* [[Malignant]]
* Fixed
* Fixed
* Painless
* Painless
| +
| align="left" style="background:#F5F5F5;" + |
| +
* Spread to [[Lymph node|lymph nodes]] and [[Blood vessel|vessels]]
|
* Metastases to:
* Pulmonary
** [[Lung]]
* Skeletal [[metastases]]
** [[Skeleton]]
|Intermediate
| align="center" style="background:#F5F5F5;" + |Intermediate
 
Slow
Slow
|NL
| align="center" style="background:#F5F5F5;" + |NL
|NL
| align="center" style="background:#F5F5F5;" + |NL
|
| align="left" style="background:#F5F5F5;" + |
* Solitary mass usually with an irregular outline, located in the subcapsular region  
* Solitary mass usually with an irregular outline, located in the subcapsular region  
* Small punctate regions of [[echogenicity]] representing [[Microcalcification|microcalcifications]] ([[Psammoma body|psammoma bodies]])
* Small punctate regions of [[echogenicity]] representing [[Microcalcification|microcalcifications]] ([[Psammoma body|psammoma bodies]])
|
| align="left" style="background:#F5F5F5;" + |
* Unencapsulated and may be partially cystic
* Unencapsulated and may be partially cystic
* Papillae consisting of one or two layers of [[Tumor cell|tumor cells]] surrounding a well-defined fibrovascular core
* Papillae consisting of one or two layers of [[Tumor cell|tumor cells]] surrounding a well-defined fibrovascular core
* Large, oval, and appear crowded and overlapping [[nuclei]]
* Large, oval, and appear crowded and overlapping [[nuclei]]
* May contain hypodense powdery [[chromatin]], [[cytoplasmic]] pseudoinclusions due to a redundant [[nuclear membrane]], or nuclear grooves
* May contain hypodense powdery [[chromatin]], [[cytoplasmic]] pseudoinclusions due to a redundant [[nuclear membrane]], or nuclear grooves
|
| align="left" style="background:#F5F5F5;" + |
* ''[[RET gene|RET]]''/[[PTC]]
* ''[[RET gene|RET]]''/[[PTC]]
* ''NTRK1''
* ''NTRK1''
Line 196: Line 187:
* ''[[BRAF]]'' 
* ''[[BRAF]]'' 
|-
|-
![[Follicular carcinoma of the Thyroid|Follicular carcinoma]]
! align="center" style="background:#DCDCDC;" + |[[Follicular carcinoma of the Thyroid|Follicular carcinoma]]
|
| align="left" style="background:#F5F5F5;" + |
* Malignant
* [[Malignant]]
* Fixed
* Fixed
* Painless
* Painless
* Most common [[thyroid cancer]] in [[Iodine deficiency|iodine deficient]] areas
* Most common [[thyroid cancer]] in [[Iodine deficiency|iodine deficient]] areas
| +
| align="left" style="background:#F5F5F5;" + |
| +
* Spread to [[Lymph node|lymph nodes]] and [[Blood vessel|vessels]]
|
* Metastases to:
* Bone
** [[Bone]]
* Lung
** [[Lung]]
|Intermediate
| align="center" style="background:#F5F5F5;" + |Intermediate
 
Slow
Slow
|↑↓
| align="center" style="background:#F5F5F5;" + |↑↓
|↑↓
| align="center" style="background:#F5F5F5;" + |↑↓
|
| align="left" style="background:#F5F5F5;" + |
* Lesions are typically hypoechoic
* Lesions are typically hypoechoic
* Usually lacks cystic change
* Usually lacks cystic change
|
| align="left" style="background:#F5F5F5;" + |
* FLUS
* FLUS
* [[Tumor]] capsule
* [[Tumor]] capsule
* Vascular invasion
* Vascular invasion
|
| align="left" style="background:#F5F5F5;" + |
* RAS mutations
* RAS mutations
* PAX8-PPAR gamma 1 
* PAX8-PPAR gamma 1 
|-
|-
![[Medullary carcinoma of thyroid|Medullary carcinoma]]
! align="center" style="background:#DCDCDC;" + |[[Medullary carcinoma of thyroid|Medullary carcinoma]]
|
| align="left" style="background:#F5F5F5;" + |
* Malignant
* Malignant
* Mainly manifest paraneoplastic symptoms:
* Mainly manifest paraneoplastic symptoms:
 
:* [[Diarrhea]]
** [[Diarrhea]]
:* [[Itching]]
** [[Itching]]
:* [[Flushing]]
** [[Flushing]]
| align="left" style="background:#F5F5F5;" + |
| +
* Spread to [[lymph nodes]]
| -/+
* May spread to [[vessels]]
|
* Metastasis locally to [[neck]]
* Locally to neck
* Can metastasize to all body organ systems
* Can metastase to all body organ systems
| align="center" style="background:#F5F5F5;" + |Intermediate
|Intermediate
 
Slow
Slow
|NL
| align="center" style="background:#F5F5F5;" + |NL
|NL
| align="center" style="background:#F5F5F5;" + |NL
|
| align="left" style="background:#F5F5F5;" + |
* Unifocal
* Unifocal
* May present as multifocal
* May present as multifocal
|
| align="left" style="background:#F5F5F5;" + |
* Hypoechoic
* Hypoechoic
* [[Microcalcification|Microcalcifications]]
* [[Microcalcification|Microcalcifications]]
|
| align="left" style="background:#F5F5F5;" + |
* May be associated with other co-existing diseases
* May be associated with other co-existing diseases
* Associated with high levels of [[calcitonin]]
* Associated with high levels of [[calcitonin]]
|-
|-
![[Anaplastic thyroid cancer|Anaplastic carcinoma]]
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
|
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Manifestation
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Spread
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Nodular growth
! align="center" style="background:#4479BA; color: #FFFFFF;" + |TSH
! align="center" style="background:#4479BA; color: #FFFFFF;" + |FT4/T3
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Imaging
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Pathology
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Associated findings
|-
! align="center" style="background:#DCDCDC;" + |[[Anaplastic thyroid cancer|Anaplastic carcinoma]]
| align="left" style="background:#F5F5F5;" + |
* Very [[malignant]], always considered as stage IV
* Very [[malignant]], always considered as stage IV
* [[Dyspnea]]
* [[Dyspnea]]
* [[Metastasis]]
* [[Dysphagia]]
* [[Vocal cord paralysis]]
* [[Dysphonia|Hoarseness of voice]]
* [[Dysphonia|Hoarseness of voice]]
| +
| align="left" style="background:#F5F5F5;" + |
| +
* Spread to [[Lymph node|lymph nodes]] and [[Blood vessel|vessels]]
|
* Very aggressive
* Very aggressive
* Invade directly into adjacent organs, such as the [[trachea]], [[larynx]], [[esophagus]], [[blood vessel]] and [[muscle]], resulting in suffocation, vocal cord paralysis, [[dyspnea]] or [[dysphagia]]
* Invade directly into adjacent organs, such as the [[trachea]], [[larynx]], [[esophagus]], [[blood vessel]] and [[muscle]]
|Slow
| align="center" style="background:#F5F5F5;" + |Slow
|↓
| align="center" style="background:#F5F5F5;" + |↓
|↑
| align="center" style="background:#F5F5F5;" + |↑
|
| align="left" style="background:#F5F5F5;" + |
* [[Microcalcification|Microcalcifications]]
* [[Microcalcification|Microcalcifications]]
* Infiltrative lesion
* Infiltrative lesion
|Cytologically [[malignant]]:
| align="left" style="background:#F5F5F5;" + |Cytologically [[malignant]]:
* Huge nuclear-cytoplasmic ratio
* Huge nuclear-cytoplasmic ratio
* [[Mitosis]]
* [[Mitosis]]
* Presence or absence of [[necrosis]]
* Presence or absence of [[necrosis]]
|
| align="left" style="background:#F5F5F5;" + |
* P53
* P53
* BRAF
* BRAF
|-
|-
![[Primary thyroid lymphoma]]
! align="center" style="background:#DCDCDC;" + |[[Primary thyroid lymphoma]]
|
| align="left" style="background:#F5F5F5;" + |
* Malignant
* [[Malignant]]
* Vocal cord paralysis
* [[Vocal cord paralysis]]
* [[Dyspnea]]
* [[Dyspnea]]
* [[Dysphagia]]
* [[Dysphagia]]
| +
| align="left" style="background:#F5F5F5;" + |
| -
* Spread to [[lymph nodes]]
|
* [[MALT lymphoma]] less aggressive
* [[MALT lymphoma]] less aggressive
* Diffuse large cell lymphomas more aggressive
* Diffuse large cell lymphomas more aggressive
|Intermediate
| align="center" style="background:#F5F5F5;" + |Intermediate
 
Slow
Slow
|NL
| align="center" style="background:#F5F5F5;" + |NL
|NL
| align="center" style="background:#F5F5F5;" + |NL
|
| align="left" style="background:#F5F5F5;" + |
* [[Nodular]] (hypoechoic mass), diffuse (mixed echotexture) or mixed
* [[Nodular]] (hypoechoic mass), diffuse (mixed echotexture) or mixed
* [[Calcification|Calcifications]] uncommon
* [[Calcification|Calcifications]] uncommon
|
| align="left" style="background:#F5F5F5;" + |
* Lymphoepithelial lesion
* Lymphoepithelial lesion
* [[Plasma cells]]
* [[Plasma cells]]
* [[Thyroid|Thyroid parenchyma]] displaced by [[lymphocytes]]
* [[Thyroid|Thyroid parenchyma]] displaced by [[lymphocytes]]
|
| align="left" style="background:#F5F5F5;" + |
* BRAF
* BRAF
* NRAS
* NRAS
* MAPK  
* MAPK  
* [[Hashimoto's thyroiditis]]
* [[Hashimoto's thyroiditis]]
|-
|-
!Metastatic carcinoma  
! align="center" style="background:#DCDCDC;" + |Metastatic carcinoma  
|
| align="left" style="background:#F5F5F5;" + |
* Malignant
* [[Malignant]]
* [[Thyroid]] and extra thyroid manifestations
* [[Thyroid]] and extra thyroid manifestations
| +
| align="left" style="background:#F5F5F5;" + |
| +
* Spread to [[Lymph node|lymph nodes]] and [[Blood vessel|vessels]]
| +
* Metastases
|Intermediate
| align="center" style="background:#F5F5F5;" + |Intermediate
 
Slow
Slow
|↑↓
| align="center" style="background:#F5F5F5;" + |↑↓
|↑↓
| align="center" style="background:#F5F5F5;" + |↑↓
| -
| align="center" style="background:#F5F5F5;" + |−
| -
| align="center" style="background:#F5F5F5;" + |−
|
| align="left" style="background:#F5F5F5;" + |
* [[Malignant melanoma]]
* [[Malignant melanoma]]
* [[Lung cancer]]
* [[Lung cancer]]
Line 328: Line 321:
* [[Gastrointestinal cancer]]
* [[Gastrointestinal cancer]]
|-
|-
![[Thyroglossal duct cyst]]<ref name="pmid22338239">{{cite journal |vauthors=Yaman H, Durmaz A, Arslan HH, Ozcan A, Karahatay S, Gerek M |title=Thyroglossal duct cysts: evaluation and treatment of 49 cases |journal=B-ENT |volume=7 |issue=4 |pages=267–71 |year=2011 |pmid=22338239 |doi= |url=}}</ref>
! align="center" style="background:#DCDCDC;" + |[[Thyroglossal duct cyst]]<ref name="pmid22338239">{{cite journal |vauthors=Yaman H, Durmaz A, Arslan HH, Ozcan A, Karahatay S, Gerek M |title=Thyroglossal duct cysts: evaluation and treatment of 49 cases |journal=B-ENT |volume=7 |issue=4 |pages=267–71 |year=2011 |pmid=22338239 |doi= |url=}}</ref>
|
| align="left" style="background:#F5F5F5;" + |
* Mostly midline
* Mostly midline
* Can be painful if get infected
* Can be painful if get infected
| -
| align="center" style="background:#F5F5F5;" + |−
| -
| align="center" style="background:#F5F5F5;" + |
| ---
| align="center" style="background:#F5F5F5;" + |NL
| ---
| align="center" style="background:#F5F5F5;" + |NL
|NL
| align="left" style="background:#F5F5F5;" + |
|NL
|
* [[Cyst]] in subhyoid portion or lateral tip of the [[hyoid bone]]
* [[Cyst]] in subhyoid portion or lateral tip of the [[hyoid bone]]
| ---
| align="center" style="background:#F5F5F5;" + |−
|NA
| align="center" style="background:#F5F5F5;" + |NA
|-
|-
![[Branchial cleft cyst]]<ref name="pmid27904209">{{cite journal |vauthors=Nahata V |title=Branchial Cleft Cyst |journal=Indian J Dermatol |volume=61 |issue=6 |pages=701 |year=2016 |pmid=27904209 |pmc=5122306 |doi=10.4103/0019-5154.193718 |url=}}</ref>
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
|
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Manifestation
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Spread
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Nodular growth
! align="center" style="background:#4479BA; color: #FFFFFF;" + |TSH
! align="center" style="background:#4479BA; color: #FFFFFF;" + |FT4/T3
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Imaging
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Pathology
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Associated findings
|-
! align="center" style="background:#DCDCDC;" + |[[Branchial cleft cyst]]<ref name="pmid27904209">{{cite journal |vauthors=Nahata V |title=Branchial Cleft Cyst |journal=Indian J Dermatol |volume=61 |issue=6 |pages=701 |year=2016 |pmid=27904209 |pmc=5122306 |doi=10.4103/0019-5154.193718 |url=}}</ref>
| align="left" style="background:#F5F5F5;" + |
* Cystic mass that develops under the skin in the neck between the [[sternocleidomastoid muscle]] and the [[pharynx]]
* Cystic mass that develops under the skin in the neck between the [[sternocleidomastoid muscle]] and the [[pharynx]]
| -
| align="left" style="background:#F5F5F5;" + |
|<nowiki>+</nowiki>
* May adhere to great vessels at the mandibular angle
 
| align="center" style="background:#F5F5F5;" + |−
May adhere to great vessels at the mandibular angle
| align="center" style="background:#F5F5F5;" + |NL
| ---
| align="center" style="background:#F5F5F5;" + |NL
| ---
| align="left" style="background:#F5F5F5;" + |
|NL
|NL
|
* [[Cyst]] between [[sternocleidomastoid]] and [[pharynx]]
* [[Cyst]] between [[sternocleidomastoid]] and [[pharynx]]
| ---
| align="center" style="background:#F5F5F5;" + |−
|NA
| align="center" style="background:#F5F5F5;" + |NA
|-
|-
![[Neck masses|Neck abscess]]<ref name="pmid28058371">{{cite journal |vauthors=Bulgurcu S, Arslan IB, Demirhan E, Kozcu SH, Cukurova I |title=Neck abscess: 79 cases |journal=North Clin Istanb |volume=2 |issue=3 |pages=222–226 |year=2015 |pmid=28058371 |pmc=5175110 |doi=10.14744/nci.2015.50023 |url=}}</ref>
! align="center" style="background:#DCDCDC;" + |[[Neck masses|Neck abscess]]<ref name="pmid28058371">{{cite journal |vauthors=Bulgurcu S, Arslan IB, Demirhan E, Kozcu SH, Cukurova I |title=Neck abscess: 79 cases |journal=North Clin Istanb |volume=2 |issue=3 |pages=222–226 |year=2015 |pmid=28058371 |pmc=5175110 |doi=10.14744/nci.2015.50023 |url=}}</ref>
|
| align="left" style="background:#F5F5F5;" + |
* Painful mass in the neck, may be accompanied with [[erythema]]
* Painful mass in the [[neck]], may be accompanied with [[erythema]]
| +
| align="left" style="background:#F5F5F5;" + |
| -
* Spread to [[lymph nodes]]
| ---
| align="center" style="background:#F5F5F5;" + |Rapid
|Rapid
| align="center" style="background:#F5F5F5;" + |NL
|NL
| align="center" style="background:#F5F5F5;" + |NL
|NL
| align="left" style="background:#F5F5F5;" + |
|
* [[Cyst]] with hyperechoic debris containing pus
* [[Cyst]] with hyperechoic debris containing pus
| ---
| align="center" style="background:#F5F5F5;" + |−
|NA
| align="center" style="background:#F5F5F5;" + |NA
|-
|-
!Parathyroid cyst<ref name="pmid17180630">{{cite journal |vauthors=Ujiki MB, Nayar R, Sturgeon C, Angelos P |title=Parathyroid cyst: often mistaken for a thyroid cyst |journal=World J Surg |volume=31 |issue=1 |pages=60–4 |year=2007 |pmid=17180630 |doi=10.1007/s00268-005-0748-8 |url=}}</ref>
! align="center" style="background:#DCDCDC;" + |Parathyroid cyst<ref name="pmid17180630">{{cite journal |vauthors=Ujiki MB, Nayar R, Sturgeon C, Angelos P |title=Parathyroid cyst: often mistaken for a thyroid cyst |journal=World J Surg |volume=31 |issue=1 |pages=60–4 |year=2007 |pmid=17180630 |doi=10.1007/s00268-005-0748-8 |url=}}</ref>
|
| align="left" style="background:#F5F5F5;" + |
* Painless mass
* Painless mass
| -
| align="center" style="background:#F5F5F5;" + |
| -
| align="center" style="background:#F5F5F5;" + |Rapid
| ---
|Rapid
 
Intermediate
Intermediate
|NL
| align="center" style="background:#F5F5F5;" + |NL
|NL
| align="center" style="background:#F5F5F5;" + |NL
|
| align="left" style="background:#F5F5F5;" + |
* Cystic lesion that is uniformly anechoic
* Cystic lesion that is uniformly anechoic
| ---
| align="center" style="background:#F5F5F5;" + |−
|NA
| align="center" style="background:#F5F5F5;" + |NA
|-
|-
![[Parathyroid cancer]]<ref name="pmid3059245">{{cite journal |vauthors=Solomon PR, Pendlebury WW |title=A model systems approach to age-related memory disorders |journal=Neurotoxicology |volume=9 |issue=3 |pages=443–61 |year=1988 |pmid=3059245 |doi= |url=}}</ref>
! align="center" style="background:#DCDCDC;" + |[[Parathyroid cancer]]<ref name="pmid3059245">{{cite journal |vauthors=Solomon PR, Pendlebury WW |title=A model systems approach to age-related memory disorders |journal=Neurotoxicology |volume=9 |issue=3 |pages=443–61 |year=1988 |pmid=3059245 |doi= |url=}}</ref>
|
| align="left" style="background:#F5F5F5;" + |
*[[Lymphadenopathy]]
*[[Lymphadenopathy]]
*Palpable lump in the neck
*Palpable lump in the [[neck]]
| +
| align="left" style="background:#F5F5F5;" + |
| +
* Spread to [[lymph nodes]] and [[vessels]]
| +
* Rarely distant [[metastases]], mainly [[thyroid gland]], overlying strap muscles, recurrent laryngeal nerve, [[trachea]], or [[esophagus]]
Rarely distant [[metastases]], mainly  [[thyroid gland]], overlying strap muscles, recurrent laryngeal nerve, [[trachea]], or [[esophagus]]
| align="center" style="background:#F5F5F5;" + |Slow
|Slow
Intermediate
Intermediate
|NL
| align="center" style="background:#F5F5F5;" + |NL
|NL
| align="center" style="background:#F5F5F5;" + |NL
|
| align="left" style="background:#F5F5F5;" + |
* Normal [[thyroid]] size with a complex echogenic structure
* Normal [[thyroid]] size with a complex echogenic structure
* May contain hyperechoic solid part and several centrally located anechoic cavities
* May contain hyperechoic solid part and several centrally located anechoic cavities
|
| align="left" style="background:#F5F5F5;" + |
* [[Tumor cell|Tumor cells]] form branching cord surrounded by [[fat cells]] with areas of [[fibrosis]] and [[Chronic inflammatory|chronic inflammatory cells]] or abundant granular [[eosinophilic]] cytoplasm
* [[Tumor cell|Tumor cells]] form branching cord surrounded by [[fat cells]] with areas of [[fibrosis]] and [[Chronic inflammatory|chronic inflammatory cells]] or abundant granular [[eosinophilic]] cytoplasm
|
| align="left" style="background:#F5F5F5;" + |
* FIHP
* FIHP
* [[MEN1]]
* [[MEN1]]
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Manifestation
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Spread
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Nodular growth
! align="center" style="background:#4479BA; color: #FFFFFF;" + |TSH
! align="center" style="background:#4479BA; color: #FFFFFF;" + |FT4/T3
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Imaging
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Pathology
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Associated findings
|}
|}
</small>


== References ==
== References ==

Latest revision as of 19:22, 25 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

Neck masses can be mistaken with thyroid nodules. The most important neck masses that can be mistaken with thyroid nodules include: Thyroglossal duct cyst, parathyroid cancer, parathyroid cyst, and branchial cleft cyst. While the diagnosis of a thyroid nodule is established, thyroid nodule should be differentiated based on benign or malignant features and the type of nodule.

Thyroid Nodule Differential Diagnosis

Neck masses can be mistaken with thyroid nodules. While the diagnosis of a thyroid nodule is established, thyroid nodule should be differentiated based on benign or malignant features and the type of nodule:

Disease Manifestation Spread Nodular growth Laboratory Imaging Pathology Associated findings
TSH FT4/T3
Colloid adenoma Intermediate

Slow

NL NL
  • Iso- to hypoechoic
  • May have internal cystic or heterogeneous change
  • May have calcification
  • Multiple echogenic foci (of inspissated colloid) with comet tail artifact
Hashimoto's thyroiditis Rapid

Intermediate

↓↓
  • Hypoechoic micronodules (1-6 mm) with surrounding echogenic septations
Cysts nodule Rapid

Intermediate

NL NL
  • Cystic non-calcified nodules
Disease Manifestation Spread Nodular growth TSH FT4/T3 Imaging Pathology Associated findings
Follicular adenoma Intermediate

Slow

↓↓
  • Thin peripheral halo
  • Predominantly cystic or mixed cystic and solid lesions
  • Isoechoic or predominantly anechoic
  • Depends on type
PAX8-PPAR gamma 1 
Hyperplastic nodule Rapid

Intermediate

↓↓
Macrofollicular adenoma Intermediate

Slow

↓↓
Microfollicular or cellular adenoma Intermediate

Slow

↓↓
Hürthle cell adenoma Intermediate

Slow

↑↓ ↑↓
Disease Manifestation Spread Nodular growth TSH FT4/T3 Imaging Pathology Associated findings
Papillary carcinoma Intermediate

Slow

NL NL
  • Unencapsulated and may be partially cystic
  • Papillae consisting of one or two layers of tumor cells surrounding a well-defined fibrovascular core
  • Large, oval, and appear crowded and overlapping nuclei
  • May contain hypodense powdery chromatin, cytoplasmic pseudoinclusions due to a redundant nuclear membrane, or nuclear grooves
Follicular carcinoma Intermediate

Slow

↑↓ ↑↓
  • Lesions are typically hypoechoic
  • Usually lacks cystic change
  • FLUS
  • Tumor capsule
  • Vascular invasion
  • RAS mutations
  • PAX8-PPAR gamma 1 
Medullary carcinoma
  • Malignant
  • Mainly manifest paraneoplastic symptoms:
  • Spread to lymph nodes
  • May spread to vessels
  • Metastasis locally to neck
  • Can metastasize to all body organ systems
Intermediate

Slow

NL NL
  • Unifocal
  • May present as multifocal
  • May be associated with other co-existing diseases
  • Associated with high levels of calcitonin
Disease Manifestation Spread Nodular growth TSH FT4/T3 Imaging Pathology Associated findings
Anaplastic carcinoma Slow Cytologically malignant:
  • P53
  • BRAF
Primary thyroid lymphoma Intermediate

Slow

NL NL
Metastatic carcinoma Intermediate

Slow

↑↓ ↑↓
Thyroglossal duct cyst[1]
  • Mostly midline
  • Can be painful if get infected
NL NL NA
Disease Manifestation Spread Nodular growth TSH FT4/T3 Imaging Pathology Associated findings
Branchial cleft cyst[2]
  • May adhere to great vessels at the mandibular angle
NL NL NA
Neck abscess[3] Rapid NL NL
  • Cyst with hyperechoic debris containing pus
NA
Parathyroid cyst[4]
  • Painless mass
Rapid

Intermediate

NL NL
  • Cystic lesion that is uniformly anechoic
NA
Parathyroid cancer[5] Slow

Intermediate

NL NL
  • Normal thyroid size with a complex echogenic structure
  • May contain hyperechoic solid part and several centrally located anechoic cavities
Disease Manifestation Spread Nodular growth TSH FT4/T3 Imaging Pathology Associated findings

References

  1. Yaman H, Durmaz A, Arslan HH, Ozcan A, Karahatay S, Gerek M (2011). "Thyroglossal duct cysts: evaluation and treatment of 49 cases". B-ENT. 7 (4): 267–71. PMID 22338239.
  2. Nahata V (2016). "Branchial Cleft Cyst". Indian J Dermatol. 61 (6): 701. doi:10.4103/0019-5154.193718. PMC 5122306. PMID 27904209.
  3. Bulgurcu S, Arslan IB, Demirhan E, Kozcu SH, Cukurova I (2015). "Neck abscess: 79 cases". North Clin Istanb. 2 (3): 222–226. doi:10.14744/nci.2015.50023. PMC 5175110. PMID 28058371.
  4. Ujiki MB, Nayar R, Sturgeon C, Angelos P (2007). "Parathyroid cyst: often mistaken for a thyroid cyst". World J Surg. 31 (1): 60–4. doi:10.1007/s00268-005-0748-8. PMID 17180630.
  5. Solomon PR, Pendlebury WW (1988). "A model systems approach to age-related memory disorders". Neurotoxicology. 9 (3): 443–61. PMID 3059245.