title: Multiple thyroid nodules in the lung: metastasis or ectopia?
abstract: BACKGROUND
  Intrapulmonary thyroid tissue with no malignant history of the thyroid gland is extremely rare. Usually, it is interpreted as ectopic thyroid tissue. Here we describe a case of bilateral pulmonary thyroid nodules with a history of multinodular thyroid goiter.
  
  
  METHODS
  A 37-year-old female had recurrent multinodular thyroid goiter and showed bilateral pulmonary nodules on CT scan. Video-assisted thoracic surgery (VATS) was performed for the largest nodule biopsy. Pathological and molecular examinations were done after biopsy, and both were shown the characters of benign thyroid tissues. To eliminate the possibility of thyroid carcinoma metastases, total thyroidectomy with modified radical neck dissection was performed, and there were no malignant pathological findings. After surgery, this patient accepted adjuvant radiometabolic treatment for ablation of the remaining intrapulmonary nodules. Her thyroglobulin level decreased to an undetectable level, and she has currently survived for 24 months after surgery.
  
  
  CONCLUSIONS
  In this case, pulmonary ectopic thyroid and metastasizing thyroid carcinoma should both be considered, but the metastatic pattern and benign pathological characters were inconsistent with any of the corresponding diagnosis. Ultimately, this patient accepted postoperative treatment of thyroid carcinoma metastasis.
  
  
  CONCLUSIONS
  This is a rare thyroid disease with malignant behavior but no pathological evidence. Careful diagnosis and postoprative follow-up should be carried out whenever such nodules are encountered in clinical practice.
  The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1255194331453728 .
authors.affiliation: Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Dadao, Wuhan, 430030, People's Republic of China. dx_chh@163.com.
authors.forename: Henghui
authors.initials: H
authors.lastname: Cheng
authors.affiliation: Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Dadao, Wuhan, 430030, People's Republic of China. liliyang123@sina.com.
authors.forename: Lili
authors.initials: L
authors.lastname: Yang
authors.affiliation: Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Dadao, Wuhan, 430030, People's Republic of China. Tjxiongjing@163.com.
authors.forename: Jing
authors.initials: J
authors.lastname: Xiong
authors.affiliation: Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China. peter_huazai@163.com.
authors.forename: Jian
authors.initials: J
authors.lastname: Peng
authors.affiliation: Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Dadao, Wuhan, 430030, People's Republic of China. ruanqiurong@sina.com.
authors.forename: Qiurong
authors.initials: Q
authors.lastname: Ruan
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D002828:Choristoma / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology / Q000628:therapy; D003937:Diagnosis, Differential; D005260:Female; D006044:Goiter, Nodular / Q000378:metabolism / Q000473:pathology* / Q000628:therapy; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000737:chemistry / Q000175:diagnosis* / Q000556:secondary* / Q000628:therapy; D055613:Multiple Pulmonary Nodules / Q000737:chemistry / Q000175:diagnosis* / Q000556:secondary* / Q000628:therapy; D037981:Neck Dissection; D011237:Predictive Value of Tests; D018714:Radiotherapy, Adjuvant; D012008:Recurrence; D020775:Thoracic Surgery, Video-Assisted; D013961:Thyroid Gland; D013964:Thyroid Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000628:therapy; D013965:Thyroidectomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor