RECEP BEDİR, Cüneyt YURDAKUL, HASAN GÜÇER, İbrahim ŞEHİTOĞLU, Afşın Rahman MÜRTEZAOĞLU, Halil İbrahim AYDIN

Matür yağ dokuları içeren tiroid lezyonlarının retrospektif analizi

Amaç: Bu çalışmada, merkezimizde nodüler guatr nedeni ile opere edilen hastaların tiroidektomi materyallerinde matür yağ dokuları içeren lezyonların retrospektif olarak saptanması amaçlanmıştır. Yöntemler: 2010 -2013 yılları arasında Recep Tayyip Erdoğan Üniversitesi Tıp Fakültesi Patoloji bölümüne gelen tiroidektomi yapılan 2800 hastanın spesmenlerinin hematoksilen-eozin ile boyalı kesitleri arşivden çıkartılarak yeniden incelendi. İnceleme sonucunda tiroid parankimi içinde matür yağ dokuları içeren 10 adet lezyon saptanmıştır. Bulgular: Yağ içeren tiroid lezyonları 2800 tiroidektomi materyalinin 10 (%0.004)unda gözlenmiştir. Olguların 8i kadın, 2si erkekti. En küçük yaş 31, en büyük yaş 74 olup, ortalama yaş 52dir. Olguların hepsinde bilateral total tiroidektomi uygulanmıştır. Makroskopik incelemede olgulardan yalnızca bir tanesinin kesit yüzeyinin homojen sarı-gri renkli olduğu gözlendi. Diğer olgularda çeşitli bü- yüklüklerde çok sayıda kolloidden zengin nodüler yapılar gözlendi. Mikroskopik incelemede, matür yağ dokusu içeren lezyonların 5inde nodül içinde yağ dokusu (adenolipom-tirolipom), 4ünde tiroid dokusunda dağınık odaklar halinde matür yağ dokuları (heterotopik adipozis), 1inde ise tüm tiroide diffüz infiltrasyon gösteren matür yağ dokuları (diffüz tirolipomatozis) saptanmıştır. Tirolipom olgularının ikisinde folliküler varyant papiller mikrokarsinom saptanmıştır. Sonuç: Matür yağ dokuları içeren tiroid lezyonları özellikle tiroid bezinin dış yüzeyinde nodül yapması ve paratiroid bezinin yağ dokusu içermesi nedeni ile paratiroid bezi lezyonlarını taklit edebilir. Bu nedenle özellikle paratiroid bezi lezyonlarının aranması sırasında intraoperatif konsültasyon yapılan durumlarda, patologların bu tür lezyonlardan haberdar olmasının ve yanlış bir tedavi yapılmasının önlenmesi açısından önemli olduğu görüşündeyiz.

A retrospective analysis of thyroid lesions containing mature adipose tissue

Objective: The aim of this retrospective study was to investigate the lesions containing mature adipose tissues in surgical materials of the patients who underwent thyroidectomy operation owing to the diagnosis of nodular goiter. Methods: A total of 2800 pathologic specimens of thyroidectomies stained with hematoxylin-eosin were collected between January 2010 and November 2013 in Recep Tayyip Erdogan University School of Medicine. Pathologic sections were selected from pathology archive and re-examined. Upon examination, we determined 10 lesions with mature adipose tissue within thyroid parenchyma. Results: Thyroid lesions containing mature adipose tissue were observed in 10 (0.004 %) of 2800 thyroidectomy materials. Eight of the patients were female and two of them were male. Minimum, maximum and median age of the patients were found to be 31, 74 and 52 years respectively. All of the cases had underwent a bilateral total thyroidectomy operation. In macroscopic examination of the only one cases, a homogenous yellow-gray color was observed. In other cases a large number of colloid-rich nodules of various sizes were observed. On microscopic examination, five adipose tissues in the nodules (adenolipoma-thyrolipoma), four scattered foci of mature adipose tissues (heterotopic adiposis) and one diffuse infiltrating mature adipose tissue on entire thyroid gland (diffuse thyrolipomatosis) were determined among mature adipose tissue containing lesions. A follicular variant of papillary microcarcinoma was found in two of thyrolipoma cases. Conclusion: Nodular thyroid lesions containing mature adipose tissue, as a result of particularly on the outer surface of the gland and parathyroid glands containining mature adipose tissue may mimic parathyroid gland lesion. Therefore, to prevent from inappropriate treatments, pathologists should be aware of these kinds of lesions, especially when they are investigating the lesions of parathyroid glands during an intraoperative consultation.

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1. Schröder S, Böcker W. Lipomatous lesions of the thyroid gland: a review. Appl Pathol 1985;3:140-149.
2. Ge Y, Luna MA, Cowan DF, et al. Thyrolipoma and thyrolipomatosis: 5 case reports and historical review of the literature. Ann Diagn Pathol 2009;13:384-389.
3. Hjorth L, Thomsen LB, Nielsen VT. Adenolipoma of the thyroid gland. Histopathology 1986;10:91-96.
4. DeRienzo D, Truong L. Thyroid neoplasms containing mature fat: a report of two cases and review of the literature. Mod Pathol 1989;2:506-510.
5. Kitagawa W, Kameyama K, Tamai S, et al. Adenolipoma of the thyroid gland: report of a case. Surg Today 2004;34:593- 596.
6. Gupta R, Arora R, Sharma A, Dinda AK. Diffuse lipomatosis of the thyroid gland: A pathologic curiosity. Indian J Pathol Microbiol 2009;52:215-216.
7. Cacchi C, M Arnholdt H, Bartolazzi A. A very unusual thyroid tumor: A nodule with mature fat papillary hyperplasia and focal atypia. Rare Tumors 2013;30:5:e50.
8. Dhayagude RG. Case report: Massive fatty infiltration in a colloid goiter. Archives Pathol 1942;33:357-360.
9. Pradeep PV, Kumar R, Ragavan M, Ramakrishna BA. Diffuse lipomatosis of thyroid with hyperthyroidism. J Postgrad Med 2010;56:35-36.
10. Soda G, Baiocchini A, Nardoni S, et al. Benign tumors of heterotopic tissue in the thyroid gland: a report of two cases of lipomatous lesions. J Exp Clin Cancer Res 2000;19:245- 248.
11. Trites AE, Thyrolipoma, thymolipoma and pharyngeal lipoma: A syndrome. Can Med Assoc J 1996;95:1254-1259.
12. Chesky VE, Dreese WC, Hellwing CA. Adenolipomatosis of the thyroid: a new type of goiter. Surgery 1953;34:38-45.
13. Simha MR, Doctor VM. Adenolipomatosis of the thyroid gland. Indian J Cancer 1983;20:215-217.
14. Himmetoglu C, Yamak S, Tezel GG. Diffuse fatty infiltration in amyloid goiter. Pathol Int 2007;57:449-453.
15. DeRienzo D, Truong L. Thyroid neoplasms containing mature fat: a report of two cases and review of the literature. Mod Pathol 1989;2:506-510
16. Jacob S, Ramdas A, Kapoor R, Basil I. Amyloid goitre: a case report. Indian J Pathol Microbiol 2003;46:88-89.
17. Gonulalan G, Esen H, Erikoğlu M, Cakir M. Thyroid lipomatosis. Intern Med 2012;51:3383-3385.
18. Schröder S, Hösselamann H, Böcker W. Lipid-rich cell adenoma of the thyroid gland. Report of a peculiar tumour. Virchows Arch A Path Anat Histopathol 1984;404:105-108.