Presentation
Anterior neck swelling 1 year. Non tender on clinical palpation.
Patient Data
A right-sided thyroid gland lobe expansile, mixed pattern nodular lesion with cystic and solid mural parts with the solid area demonstrating an eccentric configuration and isoechoic reflectivity to the rest of the normal thyroid glandular parenchyma is noted. Peripheral borders of the mural part are gently lobulated, however, with acute angling at the nodular pedicle.
Color flow Doppler mapping yields a centripetal flow pattern and, accompanying mid-level echoes is appreciated within the fluid-filled cystic expanse. The nodule is relatively retrosternal extended into the thoracic inlet as well. The isthmus body and the left thyroid lobe was unremarkable, with initial ultrasound findings given TIRADS category 3 assessment.
Post-surgical and thereafter, histological findings showed a benign lesion with Hurthle changes.
Case Discussion
Partially cystic thyroid nodules are common, more so in the adult population however, are quite rare in pediatrics. Most literature has shown post-surgical histological or pre-operative cytological benign entities (as the major category of the lesions). Most tend to undergo a cystic degenerative change from an initial solid nodule. Hurthle cell adenomas (also referred to as oncocytic adenomas) are benign thyroid neoplasms predominantly composed of >75% oncocytes and can be homogenously solid but may also change with scarring calcifications, hemorrhages or massive cystic degeneration ¹. Such nodular lesions are more suspicious for a malignant process in the pediatric population and should be treated with the urgency they deserve.