ISSN :2250 - 0359 Volume 5 Issue 3.5 2015 THYROID TISSUE IN BUCCAL MUCOSA: A RARE PRESENTATION OF THYROID ECTOPIA ANUJ JAULKAR NUDRAT PARVEZ KAMAL Dr Bhim Rao Ambedkar Memorial Hospital Raipur Abstract: This also protects the recurrent laryngeal nerve Ectopic thyroid tjssue is a rare entjty resultjng from damage. Capsular dissectjon helps in pro- from developmental defects at early stages of tectjng the recurrent laryngeal nerve and also thyroid gland embryogenesis, during its passage protects the blood supply of parathyroid glands. from the fmoor of the primitjve foregut to its fjnal Minimally invasive transoral excision with CO2 pre - tracheal positjon. It is frequently found along laser was done and the tjssue was sent for histo- the course of the thyroglossal duct or laterally in pathology which revealed heterotopic thyroid the neck, as well as in distant places such as me- diastjnum and subdiaphragmatjc organs. Pres- tjssue with follicular adenoma. Thyroid functjon tests suggested euthyroidism. Ultrasonography ence of thyroid tjssue in buccal mucosa is a rare of the neck showed a normal thyroid gland in its presentatjon of thyroid ectopia. No such case has normal locatjon. been reported in the world literature. We report a case of ectopic thyroid tjssue in buccal mucosa in a seven years old male child who presented with a gradually increasing swelling in the right buccal mucosa. Aspiratjon cytology was sugges- tjve of squamous papilloma. An Initjatjve of drtbalu ’ s Otolaryngology online
Introductjon: Ectopic thyroid tjssue is a rare entjty resultjng The tjssue was sent for histopathology which re- from developmental defects at early stages of vealed heterotopic thyroid tjssue with follicular thyroid gland embryogenesis, during its passage adenoma (Figure 1). Since the diagnosis of ectop- from the fmoor of the primitjve foregut to its fjnal ic thyroid was made post - operatjvely, the child pre - tracheal positjon. It is frequently found along was further evaluated for the presence of eu- the course of the thyroglossal duct or laterally in topic thyroid tjssue and thyroid functjon. Thyroid the neck, as well as in distant places such as me- functjon tests suggested euthyroidism. Ultraso- diastjnum and subdiaphragmatjc organs.[1] Pres- nography of the neck showed a normally located ence of thyroid tjssue in buccal mucosa is a rare thyroid gland which was normal in size, shape presentatjon of thyroid ectopia. No such case has and echotexture. been reported in the world literature. We report a case of ectopic thyroid tjssue in buccal mucosa in a seven years old male child who presented with a gradually increasing swelling in the right cheek. Case Report: A seven years old male child presented with the history of a swelling in the right buccal mucosa fjrst notjced about eight months back. The swell- ing was gradually increasing in size with no histo- ry of pain, ulceratjon or bleeding from the swell- ing. Birth history and developmental milestones were normal. A detailed general and systemic HPE picture showing hypertrophied thyroid tjssue examinatjon did not reveal any abnormality. Lo- cal examinatjon revealed a 1 × 1 centjmetre, sol- id, sofu, smooth margined, mobile and non ten- Discussion: der mass covered with intact mucosa in the right cheek. Ectopic thyroid refers to the presence of thyroid tjssue in locatjons other than the normal anterior Fine needle aspiratjon cytology (FNAC) was done neck region between the second and fourth tra- which was suggestjve of squamous papilloma. cheal cartjlages. It is the most frequent form of The child underwent minimally invasive trans - thyroid dysgenesis, accountjng for 48 - 61% of the oral excision of mass using CO2 laser. cases.[2] An Initjatjve of The drtbalu ’ s Otolaryngology online
Ectopic thyroid may become goitrous and may be associated with either hypofunctjon or hyper- In 1869, Hickman reported the fjrst case of ec- functjon. Sometjmes, benign or malignant neo- topic thyroid tumour of the base of the tongue, plastjc changes can occur in ectopic thyroid tjs- pressing down the epiglottjs on the larynx and sue. The majority of these tumours are described causing death by sufgocatjon sixteen hours afuer as being of the follicular type, while papillary birth.[3] Prevalence of this conditjon is reported forms comprise 23%. This is in contrast to normal to be between 1 per 100,000 - 300,000 persons. thyroid gland neoplasms, of which papillary tu- To date, about 500 cases have been reported in mours form the predominant form.[6] the literature.[4] Lingual thyroid is the most com- mon type accountjng for 90% of cases, while sub- Radionuclide thyroid imaging employing techne- lingual types which may be suprahyoid, infrahy- tjum - 99m pertechnetate, iodine - 131 or iodine oid or at the level of the hyoid bone are less fre- 123 is useful in the evaluatjon for ectopic thy- quently encountered.[5] Other locatjons include roid. Thyroid tjssue takes up the radioisotope the trachea, submandibular, lateral cervical re- and this helps in localizing the ectopic thyroid gions, axilla, palatjne tonsils, heart, ascending and at the same tjme in determining the pres- aorta, thymus, oesophagus, adrenal gland, ovary, ence of a eutopic thyroid gland.[4] High resolu- fallopian tube, uterus and vagina.[6] But the tjon ultrasound scanning is also favoured in the presence of thyroid tjssue in the buccal mucosa initjal assessment, especially in patjents pre- has not been reported in the literature. sentjng with neck masses. It is non - invasive, cost - efgectjve and does not expose patjents to ioniz- Thyroid gland is the fjrst of the body ’ s endocrine ing radiatjon. At the same tjme it can be used to glands to develop, as a proliferatjon of endoder- determine the presence of a eutopic thyroid.[8] mal epithelial cells on the median surface of the CT scan and MRI are useful when a eutopic thy- developing pharyngeal gut between the 1st and roid gland is not identjfjed by ultrasound. Tissue 2nd pharyngeal pouches and descends in front of biopsy for histology or fjne needle aspiratjon cy- the hyoid bone and the laryngeal cartjlages to tology (FNAC) is important to confjrm the diag- reach the fjnal positjon in front of the trachea in nosis and rule out malignancy.[9] the 7th week of gestatjon. Although the molecu- lar mechanisms involved in thyroid dysgenesis Asymptomatjc euthyroid patjents with ectopic are not fully known, genetjc research has shown thyroid do not usually require therapy but are that the gene transcriptjon factors TITF - 1(Nkx2 - kept under observatjon. 1), Foxe1 (TITF - 2) and PAX - 8 are essentjal for thy- roid morphogenesis and difgerentjatjon. Muta- tjon in these genes may be involved in abnormal migratjon of the thyroid or heterotopic difgeren- tjatjon of uncommitued endodermal cells.[2,7] An Initjatjve of drtbalu ’ s Otolaryngology online
In patjents with hypothyroidism, suppressive therapy References: is administered using exogenous thyroid hormone. This suppresses the TSH level and causes reductjon in 1. Noussios G, Anagnostjs P, Goulis DG, Lap- the size of the gland. Euthyroid patjents with mild pas D, Natsis K. Ectopic thyroid tjssue: anatomi- obstructjve symptoms can also benefjt from suppres- cal, clinical and surgical implicatjons of a rare en- sive therapy.[10] tjty. Eur J Endocrinol 2011 Sept; 165(3): 375 - 82. Surgical interventjon is indicated when severe 2. Felice MD, Lauro RD. Thyroid develop- obstructjve symptoms, bleeding, ulceratjon, ment and its disorders: Genetjc and molecular cystjc degeneratjon and malignancy occur or for mechanisms. Endocrine Reviews 2004; 25: 722 - cosmetjc reasons. It is important to determine 46. the presence of a normally located thyroid gland before removal of the ectopic tjssue to avoid hy- 3. Hickman W. Congenital tumor of the base pothyroidism.[4,11] Radioactjve iodine 131 ther- of the tongue, pressing down the epiglottjs on apy is an alternatjve to surgical ablatjon. It is in- the larynx and causing death by sufgocatjon six- dicated in patjents who are not fjt for surgery, in teen hours afuer birth. Trans Pathol Soc Lond those who refused operatjon and where surgical 1869; 20: 160 - 1. resectjon is not feasible due to anatomical diffj- cultjes. It is contraindicated in pregnant women 4. Yoon JS, Won KC, Cho IH, Lee JT, Lee HW. and avoided in younger paediatric patjents.[10] Clinical characteristjcs of ectopic thyroid in Ko- rea. Thyroid 2007; 17: 1117 - 21. Ectopic thyroid remains a rare entjty with buccal mucosa as a site of presentatjon reported no- 5. Batsakis JG, El - Naggar AK, Luna MA. Thy- where in the literature. Therefore we decided to roid gland ectopias. Am Otol Rhinol Laryngol report this case and have a brief review about its 1996; 105: 996 - 1000. various aspects. 6. Ibrahim NK, Fadeyibi IO. Ectopic thyroid: etjology, pathology and management. Hormones 2011; 10(4): 261 - 9. An Initjatjve of The drtbalu ’ s Otolaryngology online
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