International Journal of Surgery Case Reports 114 (2024) 109193

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International Journal of Surgery Case Reports

journal homepage: www.elsevier.com/locate/ijscr

Case report

Ectopic thyroid carcinoma in the nasal septum: A case report

Siquan Guo a, Haixiang Xue a, Jian Zhou b, Feng Qin c, *
a
Department of Otorhinolaryngology, the Third Affiliated Hospital of Soochow University, the First People's Hospital of Changzhou, Changzhou, Jiangsu, China
b
Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
c
Department of Otorhinolaryngology, Changzhou Third People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, China

A R T I C L E I N F O A B S T R A C T

Keywords: Introduction and importance: Ectopic thyroid carcinoma often occurs in the neck, and metastatic carcinoma of the
Heterotopic thyroid carcinoma nasal cavity and sinuses is extremely rare.
Papillary adenocarcinoma Case presentation: An 11-year-old female was admitted to the hospital for one week due to nasal pain without an
Nasal
obvious cause and blood in the nose. A pale red mass with a peduncle at the back end of the right nasal septum
Nasal septum
was seen during the operation. Immunohistochemistry showed low-grade papillary thyroid carcinoma.
Case report
Clinical discussion: Surgeons should be alert to the possibility of ectopic thyroid tissue and related diseases, Pa­
tients with suspected malignant lesions should undergo routine pathological examination, and even a normal
thyroid should be checked for malignant changes to avoid negative outcomes.
Conclusion: Although nasal endoscopic surgery is mature, for tumors with unclear properties, it is still necessary
to undergo routine pathological examination to avoid habitual errors.

1. Introduction 2. Case presentation

Thyroid tissue found outside its normal position is collectively called
ectopic thyroid tissue, which is caused by abnormal descent of thyroid
primordium in the embryonic stage.[1] At present, the mechanism of
ectopic thyroid is not clear. Carcinoma arising from ectopic thyroid
tissue is quite rare, comprising less than 1 % of all thyroid carcinoma
cases. Ectopic thyroid tissue is usually located at the root of the tongue,
but it is also found in other parts of the head and neck, or even in the
chest cavity and abdominal cavity farther away.[2–4] Ectopic thyroid
tissue, just like normal in situ thyroid tissue, can become cancerous[5];
moreover, as with thyroid carcinoma in situ, ectopic thyroid carcinoma
is more common in young women, and the pathological type is mainly
papillary carcinoma.[6] Most case reports of ectopic thyroid cancer
involve patients with good prognoses, but relevant statistics are lacking.
Primary thyroid carcinoma in ectopic tissue is exceptionally uncommon
and challenging to differentiate from metastatic lesions. Here, we report
a rare case of malignant ectopic thyroid papilloma in the nasal septum
treated by our department. The work has been reported in line with the
SCARE criteria.[7]
2.1. Chief complaints
An 11-year-old girl sought medical advice in outpatient department
who had been complaining of nasal pain and headache. Her symptoms
included nasal swelling and pain without an obvious cause, accompa­
nied by nasal discharge stained with blood, headache, nasal congestion
and a runny nose, a sore throat, snoring, and no hyposmia.
2.2. History of present illness
She had a history of nasal congestion and a runny nose last year,
which had been diagnosed as sinusitis in our outpatient clinic and
improved after treated by Cefixime (BaiYunShan Pharmaceutical
Holdings CO.,LTD, Guangzhou, China) (0.1 g po bid), Eucalyptol,
Limonene and Pinene Enteric Capsules (Johamu Pharmaceutical Hold­
ings CO.,LTD, Beijing, China)(0.3 g po tid), NASONEX (MSD Belgium
BVBA/SPRL, Clos du Lynx, 5, 1200 Brussels, Belgium) (one spray, qd)
for 2 weeks.
The patient had a history of tonsillitis, but could't indicate a clear
history.

* Corresponding author at: Department of Otorhinolaryngology, Changzhou Third People's Hospital, Changzhou Medical Center, Nanjing Medical University,
Changzhou 213000, Jiangsu, China.
E-mail address: nia_ccc@foxmail.com (F. Qin).

https://doi.org/10.1016/j.ijscr.2023.109193
Received 28 October 2023; Received in revised form 18 December 2023; Accepted 20 December 2023
Available online 24 December 2023
2210-2612/© 2023 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
S. Guo et al.
2.3. History of past illness
The patient had no previous medical history.
2.4. Personal and family history
History-taking also revealed that the patient had no other relevant
medical history or family history.
2.5. Physical examination
The patient had normal vital signs. Her bilateral tonsils showed
second-degree hypertrophy with pus thrombi in the crypts. Additionally,
her right nasal cavity was blocked by the neoplasm, and there was an
increase in soft tissue in the Posterior wall of nasopharynx.
2.6. Laboratory examinations
Results of routine blood tests, tests for immunoglobulin light chains,
thyroid hormone levels, and tests for autoimmune antibodies are
negative.
2.7. Imaging examinations
Nasal endoscopy showed adenoid hypertrophy and a reddish and
pedicled neoplasm raised from the right posterior end of the nasal
septum blocking the nostril in Fig. 1 below. CT was not taken as was not
required by the outpatient doctor.
2.8. Primary diagnosis
Due to the medical history, physical examination, laboratory exam­
ination, and imaging examination. This patient was diagnosed with a
Fig. 1. Nasal Endoscope: Adenoid hypertrophy; Neoplasms from the posterior end of the nasal septum.
2
International Journal of Surgery Case Reports 114 (2024) 109193
nasal tumor and tonsil hypertrophy with adenoid hypertrophy.
2.9. Treatments
This patient was admitted to our hospital on August 25, 2022 for
further treatment. Endoscopic nasal tumor resection and plasma ton­
sillectomy were performed under general anesthesia on August 26,
2022. During the operation, a 70-degree nasal endoscope showed that
the base of the nasal tumor was located at the right end of the nasal
septum, which was fragile and easy to bleed from touching, the tumor
was completely removed with a plasma knife. The left nasal cavity is fine
under the endoscope.
After surgery, Shiomarin (Latamoxef Sodium for Injection, Hainan
Hailing Chemipharma Co., Ltd., Haikou, Hainan, China)(1 g bid ivgtt),
SLOUNASE Injection [Hemocoagulase Injection, Zhaoke Pharmaceu­
tical (Hefei),Co., Ltd., Hefei, Anhui China](0.5u qd iv) were taken after
the operation for three days.
Her pathology results with routine paraffin section and hematoxylin-
eosin staining(H&E staining) obtained on the 5th day after the operation
showed papillary hyperplasia of the glandular epithelium with atypia of
the nasal tumor (Fig. 2A). Therefore, it was recommended that she
consult a Higher-level hospital to ascertain the nature of the lesion. After
discharge, the patient went to a top ear, nose and throat specialist
hospital in China for further diagnosis with her pathological sections.
Pathological consultation combined with morphology and immunohis­
tochemistry of the nasal tumor led to a diagnosis of a low-grade ma­
lignant papillary thyroid adenocarcinoma with CK8 (+), CK19 (+), TTF-
1 (+), CK20 (− ), CDX2 (− ), DOG-1 (− ), Ki67 (5 %+), PAX_8 (− ), S100
(− ), SOX-10 (− ), mammaglobin (− ), P63 (small amount +), P16 (− ),
and GCDFP-15 (− ). (Fig. 2 B,C,D,E,F).while doctors in that hospital
suggested the examination for thyroid is not necessary.
S. Guo et al.
(a)
(c)CK19
(e) Ki67
Fig. 2. (a) Pathological diagnosis: the glandular epithelium of papillary hyperplasia was accompanied by dysplasia.(b, c, d, e, f)Pathological consultation: low-grade
malignant papillary thyroid adenocarcinoma.
2.10. Outcome and follow-up
At present, after two months of required follow-ups, the girl has
recovered well without obvious signs of recurrence. Therefore, no
further treatment has been needed.
3. Discussion
The thyroid gland that appears outside its normal position is called
ectopic thyroid. Ectopic thyroid cancer refers to the cancerous trans­
formation of ectopic thyroid tissue. Ectopic thyroid tissue, like a normal
thyroid gland, can secrete hormones and undergo various physiological
and pathological changes, even cancerous transformation. Ectopic thy­
roid cancer often occurs in the neck, with papillary carcinoma being the
main pathological feature. Ectopic thyroid cancer occurring in the nose
3
International Journal of Surgery Case Reports 114 (2024) 109193
(b)CK8
(d)TTF-1
(f)P63
is rare and has only been reported in one case in Russia.[8]
At present, surgery is still the first choice for the treatment of ectopic
thyroid cancer.[9] Whether a normal and functioning thyroid exists or
not, ectopic thyroid tissue with malignant changes or compression
symptoms should be removed surgically. For patients with ectopic thy­
roid carcinoma accompanied by thyroid canceration in the normal po­
sition, ectopic thyroidectomy and total thyroidectomy in the normal
position should be performed simultaneously.[10] Thyroid function
should be monitored regularly after the surgery.[11] If necessary, lymph
node dissection can be included. Local radiotherapy, chemotherapy,
biological therapy, and endocrine therapy after surgery are necessary
means of improving the post-surgical survival rate. For some well-
differentiated papillary carcinomas, I-131 radiotherapy can also be
considered after surgery.[12] Plasma scalpel is a minimally invasive
surgical instrument and an advanced auxiliary tool, which has the
S. Guo et al.
advantage of reducing intraoperative bleeding, but oncologic surgeons
still need to follow the tumor-free principle.
4. Conclusion
In summary, ectopic thyroid carcinoma is rare and easily mis­
diagnosed. We should be alert to the possibility of ectopic thyroid tissue
and related diseases, and it is important to determine whether a patient
has a normal thyroid to avoid lifelong hypothyroidism caused by sur­
gery. Patients with suspected malignant lesions should undergo routine
pathological examination, and even a normal thyroid should be checked
for malignant changes to avoid negative outcomes.
Ethical approval
This case report study is exempt from ethnical approval in our
institution. Because it is a retrospective study not involving experi­
mental medication.
Funding
This study is supported by Changzhou Science and Technology Bu­
reau (CJ20220106).
Author contribution
Siquan Guo: Data collection, data analysis, paper writing. Haixiang
Xue: Data collection, study design. Jian Zhou: Study design. Feng Qin:
Data analysis, paper writing.
Guarantor
We suggested Feng Qin as the guarantor in this study.
Declaration of competing interest
All authors declare that there are no competing financial interests.
International Journal of Surgery Case Reports 114 (2024) 109193
Data availability
The datasets in the current study are available from the corre­
sponding author upon reasonable request.
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