Amyloid Goiter: Clinicopathological Assessment of Two Cases and Review of Literature

Rabab Ahmed Ahmed Mohammed^1,2, Etemad Helmy Yassin¹, Moustafa EzEldien M. Radwan^3,4*, Badawy Mohammed Ahmed⁵, Lobna F. Ettouny⁶, Alaa M. Abozied⁶

¹Department of Pathology, Faculty of Medicine, Taibah University, Medina, KSA.
²Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
³Department of Radiodiagnosis, Faculty of Medicine, Taibah University, Medina, KSA.
⁴Department of Radiodiagnosis, Assiut University Hospitals, Assiut, Egypt.
⁵Department of Surgical Oncology, South Egypt Cancer Institute, Assiut, Egypt.
⁶Department of Internal Medicine, Assiut University Hospitals, Assiut, Egypt.

DOI: 10.4236/ojpathology.2015.51004                

Abstract

Amyloid goiter (AG) is a rare but well-established disease entity that may occur in a number of conditions. In the following article, we will report two cases of AG. Both patients were young males: 28 & 24 years old, presented with rapidly enlarging thyroid gland manifested with pressure effects (dyspnea and hoarseness of voice). Provisional clinical diagnosis was malignant thyroid neoplasm. One of the patients was markedly hypothyroid while the other was euthyroid. Histopathological evaluation revealed extracellular deposition of deep pink homogenous material that was confirmed as amyloid with congo red. Patient in case 1 was primary localized AG while patient in case 2 was systemic amyloidosis secondary to interstitial pulmonary fibrosis (IPF) that was first manifested by AG. The main aims of the article were to describe histopathological features of amyloidosis of the thyroid gland and to raise awareness of AG to be included in the differential diagnosis in patients presented with rapidly enlarging goiter with mass effects.

Keywords

Amyloidosis, Amyloid Goiter, Thyroid Gland

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Villa, F., Dionigi, G., Tanda, M.L., Rovera, F. and Boni, L. (2008) Amyloid Goiter. International Journal of Surgery, 6, S16-S18. http://dx.doi.org/10.1016/j.ijsu.2008.12.025
[2]	Duzgun, N., Morris, Y., Yildiz, H.I., Ozturk, S., Ayva, S.K., Ensari, A., et al. (2003) Amyloid Goiter in Juvenile Onset Rheumatoid Arthritis. Scandinavian Journal of Rheumatology, 32, 253-254. http://dx.doi.org/10.1080/03009740310003776
[3]	Hamed, G., Heffess, C.S., Shmookler, B.M. and Wenig, B.M. (1995) Amyloid Goiter. A Clinicopathologic Study of 14 Cases and Review of the Literature. American Journal of Clinical Pathology, 104, 306-312.
[4]	Alvarez-Sala, R., Prados, C., Sastre Marcos, J., Garcia Rio, F., Vicandi, B., et al. (1995) Amyloid Goitre and Hypothyroidism Secondary to Cystic Fibrosis. Postgraduate Medical Journal, 71, 307-308. http://dx.doi.org/10.1136/pgmj.71.835.307
[5]	Cohan, P., Hirschowitz, S., Rao, J.Y., Tanavoli, S. and Van Herle, A.J. (2000) Amyloid Goiter in a Case of Systemic Amyloidosis Secondary to Ankylosing Spondylitis. Journal of Endocrinological Investigation, 23, 762-764.
[6]	Habu, S., Watanobe, H., Kimura, K. and Suda, T. (1999) A Case of Amyloid Goiter Secondary to Crohn’s Disease. Endocrine Journal, 46, 179-182. http://dx.doi.org/10.1507/endocrj.46.179
[7]	Chraibi, A., Msyah, L., Laaribi, O., Marrakchi, A. and Hafidi, A. (2009) Amyloid Goiter: First Sign of Systemic Amyloidosis. Annales d’Endocrinologie, 70, 80-82. http://dx.doi.org/10.1016 /j.ando.2007.10.002
[8]	D’Antonio, A., Franco, R., Sparano, L., Terzi, G. and Pettinato, G. (2000) Amyloid Goiter: The First Evidence in Secondary Amyloidosis. Report of Five Cases and Review of Literature. Advances in Clinical Pathology, 4, 99-106.
[9]	Yildiz, L., Kefeli, M., Kose, B. and Baris, S. (2009) Amyloid Goiter: Two Cases and a Review of the Literature. Annals of Saudi Medicine, 29, 138-141. http://dx.doi.org/10.4103/0256-4947.51808
[10]	Bell, G.O. and Mena, B.A. (1963) Amyloid Goiter Associated with the Nephrotic Syndrome. Medical Clinics of North America, 47, 385-389.
[11]	Danovitch, G.M., Le Roith, D., Sobel, R., Sikuler, E. and Straus, R. (1979) Amyloid Goitre in Familial Mediterranean Fever. Clinical Endocrinology, 11, 595-601. http://dx.doi.org/10.1111/j.1365-2265.1979.tb03113.x
[12]	Kanoh, T., Shimada, H., Uchino, H. and Matsumura, K. (1989) Amyloid Goiter with Hypothyroidism. Archives of Pathology & Laboratory Medicine, 113, 542-544.
[13]	Villamil, C.F., Massimi, G., D’Avella, J. and Cole, S.R. (2000) Amyloid Goiter with Parathyroid Involvement: A Case Report and Review of the Literature. Archives of Pathology & Laboratory Medicine, 124, 281-283.
[14]	Siddiqui, M.A., Gertz, M. and Dean, D. (2007) Amyloid Goiter as a Manifestation of Primary Systemic Amyloidosis. Thyroid, 17, 77-80. http://dx.doi.org/10.1089/thy.2006.0045
[15]	Ozdemir, B.H., Akman, B. and Ozdemir, F.N. (2001) Amyloid Goiter in Familial Mediterranean Fever (FMF): A Clinicopathologic Study of 10 Cases. Renal Failure, 23, 659-667. http://dx.doi.org/10.1081/JDI-100107362
[16]	Srivastava, A., Baxi, M., Yadav, S., Agarwal, A., Gupta, R.K., Misra, S.K. and Mithal, A. (2001) Juvenile Rheumatoid Arthritis with Amyloid Goiter: Report of a Case with Review of the Literature. Endocrine Pathology, 12, 437-441. http://dx.doi.org/10.1385/EP:12:4:437
[17]	Arafa, S., Sakr, M., Khedr, M., Khalil, R., Abdel-Baset, H., Moussa, M. and El-Sharaky, M. (2001) Amyloid Goiter: A Diagnostic and Therapeutic Challenge. Egyptian Journal of Surgery, 20, 561-567.
[18]	Duhra, P. and Cassar, J. (1990) Thyroid Function Tests in Amyloid Goitre. Postgraduate Medical Journal, 66, 304-306. http://dx.doi.org/10.1136/pgmj.66.774.304
[19]	Ozdemir, D., Dagdelen, S., Erbas, T., Sokmensuer, C., Erbas, B. and Cila, A. (2011) Amyloid Goiter and Hypopituitarism in a Patient with Systemic Amyloidosis. Amyloid, 18, 32-34. http://dx.doi.org/10.3109/13506129.2010.545961
[20]	Kimura, H., Yamashita, S., Ashizawa, K., Yokoyama, N. and Nagataki, S. (1997) Thyroid Dysfunction in Patients with Amyloid Goitre. Clinical Endocrinology, 46, 769-774. http://dx.doi.org/10.1046/j.1365-2265.1997.1841000.x
[21]	Schroder, S. and Bocker, W. (1985) Lipomatous Lesions of the Thyroid Gland: A Review. Applied Pathology, 3, 140-149.
[22]	Kumar, V., Cotran, R.S. and Robbins, S. (1997) Amyloidosis. In: Basic Pathology, 6th Edition, W.B. Saunders Company, Philadelphia, 126-130.
[23]	Kisilevsky, R. and Axelrad, M. (1976) The Pathogenesis of Amyloid Deposition: A New Hypothesis. Medical Hypotheses, 2, 233-237. http://dx.doi.org/10.1016/S0306-9877(76)80002-3
[24]	Husby, G. (1980) A Chemical Classification of Amyloid: Correlation with Different Clinical Types of Amyloidosis. Scandinavian Journal of Rheumatology, 9, 60-64. http://dx.doi.org/10.3109 /03009748009098131
[25]	Sharma, O.P. (2001) Unusual Systemic Disorders Associated with Interstitial Lung Disease. Current Opinion in Pulmonary Medicine, 7, 291-294. http://dx.doi.org/10.1097/00063198-200109000-00007
[26]	DiBartola, S.P. and Benson, M.D. (1989) The Pathogenesis of Reactive Systemic Amyloidosis. Journal of Veterinary Internal Medicine, 3, 31-41. http://dx.doi.org/10.1111/j.1939-1676.1989.tb00326.x
[27]	Gertz, M.A. and Kyle, R.A. (1991) Secondary Systemic Amyloidosis: Response and Survival in 64 Patients. Medicine, 70, 246-256. http://dx.doi.org/10.1097/00005792-199107000-00002
[28]	Migita, K., Yamasaki, S., Shibatomi, K., Ida, H., Kita, M., Kawakami, A. and Eguchi, K. (2001) Impaired Degradation of Serum Amyloid A (SAA) Protein by Cytokine-Stimulated Monocytes. Clinical & Experimental Immunology, 123, 408-411. http://dx.doi.org/10.1046/j.1365-2249.2001.01472.x