Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
Home Print this page Email this page
Users Online: 372



 Table of Contents  
LETTER TO THE EDITOR
Year : 2012  |  Volume : 9  |  Issue : 2  |  Page : 71-72

Follicular adenoma of thyroid with black pigmentation


1 Department of Pathology, Maulana Azad Medical College and Associated Hospital, New Delhi, India
2 Department of ENT, Maulana Azad Medical College and Associated Hospital, New Delhi, India

Date of Web Publication12-May-2012

Correspondence Address:
Prerna Arora
Department of Pathology, Maulana Azad Medical College, New Delhi - 110 002
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-0354.96062

Rights and Permissions

How to cite this article:
Arora P, Rao S, Khurana N, Raj A. Follicular adenoma of thyroid with black pigmentation. Thyroid Res Pract 2012;9:71-2

How to cite this URL:
Arora P, Rao S, Khurana N, Raj A. Follicular adenoma of thyroid with black pigmentation. Thyroid Res Pract [serial online] 2012 [cited 2019 Aug 19];9:71-2. Available from: http://www.thetrp.net/text.asp?2012/9/2/71/96062

Sir,

Black pigmentation of thyroid gland is a rare and poorly recognized entity. It is usually associated with chronic minocycline therapy, and less commonly with hemochromatosis, ochronosis, mucoviscidosis, ceroid storage disease, bruising, and hemorrhage. [1] We report black pigmentation in follicular adenoma as incidental finding in a 55-year-old female.

Our patient presented with gradually progressive swelling in the neck for two years with history of chronic constipation. Thyroid function tests fell within normal limits. Fine needle aspiration cytology (FNAC) suggested cystic colloid goiter. Peroperatively, thyroid was multinodular. Total thyroidectomy was performed and the specimen revealed multiple colloid-filled cysts along with a well-circumscribed, grey brown nodule in isthmic region measuring 2.5 × 2.0 × 1.5 cm. Microscopic examination of bilateral thyroid lobes revealed cystic colloid goiter [Figure 1]a. Sections from the isthmic nodule showed features of follicular adenoma [Figure 1]b. In addition, there was presence of clumps of intracytoplasmic golden brown pigment in adenoma cells [Figure 2]a. The pigment was positive with Masson fontanna [Figure 2]b and negative with Perl's stain. Pigment was confined to the adenoma only and surrounding parenchyma showed no such pigment. Thus, a final diagnosis of black adenoma on a background of colloid goiter was made. In the present case, no evident cause of pigmentation was found.
Figure 1a: Thyroid revealing features of cystic colloid goiter (H and E, x10)
Figure 1b: Isthmic nodule showed follicular adenoma thyroid (H and E, x20)


Click here to view
Figure 2a: Clumps of intracytoplasmic golden brown pigment in adenoma cells (H and E, x40)
Figure 2b: Pigment showed positivity with Masson fontana (H and E, x60)


Click here to view


Thyroid gland with black pigmentation has mostly been observed as incidental and autopsy finding as there is no associated disturbance in thyroid function. However, it is reported in association with tumors like hyalinizing trabecular adenoma, [2] follicular adenoma, [3] follicular carcinoma, [4] and papillary carcinoma. [1] Thus, recognition of black thyroid necessitates serious consideration of coexistent malignancy.

Of additional interest in the present case was presence of pigment confined to adenoma cells only. To the best of our knowledge, only single study by Koren et al., reported similar features, and hypothesized hyper-functioning of adenoma as a cause of selective pigmentation. [3] Remaining publications in literature had shown either selective pigmentation of the adjacent thyroid gland without any pigmentation of the adenoma [5] or no distinctive difference in the pigmentation between the adenoma and the surrounding thyroid gland. [6] Moreover, few authors have emphasized that the presence of hypopigmented focus in a black thyroid heralds thorough pathological examination as such foci are known to be associated with a higher incidence of developing malignant change. [7] It is postulated that there is diminished function of thyroid peroxidase in carcinomatous area resulting in failure to incorporate pigment. In the present case, unusual functional divergence between neoplastic and non-neoplastic tissues needs further explanation for the possible pathogenesis.

Despite increasing use of FNAC and large number of patients who receive tetracycline, there are too few reports on FNAC of black thyroid, which may either be due to lack of awareness or the pigment getting obscured by other pigments such as hemosiderin.

In conclusion, presence of brown-black pigment in FNA smears, especially in follicular cells, should alert the cytopathologist for possibility of Black thyroid. Incidental discovery of black thyroid deserve thorough pathological examination with serial sectioning to avoid missing coexistent malignancy.

 
  References Top

1.Kandil E, Khalek MA, Ibrahim WG, Alabbas H, Yau CL, Friedlander P, et al. Papillary thyroid carcinoma in black thyroids. Head Neck 2011;33:1735-8.  Back to cited text no. 1
    
2.Kang SW, Hong SW, Yeon PJ, Jeong JJ, Sung TY, Lee SC, et al. A case of black thyroid associated with hyalinizing trabecular tumor. Endocr J 2008;55:1109-12.   Back to cited text no. 2
    
3.Koren R, Bernheim J, Schachter P, Schwartz A, Siegal A, Gal R. Black thyroid adenoma.Clinical, histochemical,and ultrastructural features. Appl Immunohistochem Mol Morphol 2000;8:80-4.   Back to cited text no. 3
    
4.Jennings TA, Sheehan CE, Chodos RB, Figge J. Follicular carcinoma associated with minocycline-induced black thyroid. Endocr Pathol 1996;7:345-8.  Back to cited text no. 4
    
5.Faddis DM, Daroca PJ Jr, Krementz ET. Oxyphilic (Hürthle Cell) adenoma arising in a black thyroid gland. South Med J 1990;83:976-8.   Back to cited text no. 5
    
6.Reid JD. The black thyroid associated with minocycline therapy. A local manifestation of a drug-induced lysosome/substrate disorder. Am J Clin Pathol 1983;79:738-46.  Back to cited text no. 6
    
7.Thompson AD, Pasieka JL, Kneafsey P, Di Francesco LM. Hypopigmentation of a papillary carcinoma arising in a black thyroid. Mod Pathol 1999;12:1181-5.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
References
Article Figures

 Article Access Statistics
    Viewed2623    
    Printed100    
    Emailed0    
    PDF Downloaded251    
    Comments [Add]    

Recommend this journal