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The Journal of Clinical Endocrinology & Metabolism Vol. 93, No. 1 8-9
Copyright © 2008 by The Endocrine Society

IMAGE IN ENDOCRINOLOGY

Diffuse Lipomatosis of Thyroid Gland

V. Di Scioscio, V. Loffreda, P. Feraco, R. Luccaroni, L. M. Palena, T. Balbi and M. Zompatori

Departments of Radiology (V.D.S., V.L., P.F., R.L., L.M.P., M.Z.) and Pathology (T.B.), S. Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy

Address all correspondence and requests for reprints to: Valerio Di Scioscio, Division of Pneumo-Nefro, Department of Radiology, S Orsola-Malpighi Policlinic, University of Bologna, 40138 Bologna, Italy. E-mail: discioscio{at}aosp.bo.it.

A 64-yr-old man with chronic renal failure and psoriasis presented with enlargement of thyroid gland and dyspnea.

Thyroid function was within normal limits, and no antithyroid antibodies were detected. Nonsteroid therapy was done. Ultrasonography detected diffuse goiter with heterogeneous echogenicity. Scintigraphy revealed enlargement of thyroid, with irregularly reduced uptake, without cold nodules.

Computed tomography, performed to evaluate tracheal diameters, showed a goiter, slightly compressing the airway. Thyroid had a negative density, in the range of fat tissue (Fig. 1Go). Computed tomography also detected mediastinal lipomatosis, clearly separated from thyroid.


Figure 1
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  		FIG. 1. A and B, Non-contrast-enhanced CT in axial and coronal view showed a diffuse goiter with adipose density (-87 Hounsfield Units), slightly compressing the trachea. C, Fine needle aspiration cytology demonstrated mature fat tissue, making up the bulk of the enlarged gland (Papanicolau stain, original magnification, x100). D, Axial CT scan at a lower level demonstrated anterior mediastinal lipomatosis.

 
Fine-needle thyroid cytology showed abundant fat cells between normal follicles, without any sign of hyperplasia, malignancy, or amyloid deposition.

Diffuse thyroid lipomatosis is a rare entity, initially reported by Dhayagude in 1942 (1). A few cases have been reported in the literature (2, 3, 4).

It is characterized by diffuse proliferation of adipose tissue in the gland, sometimes associated with amyloid deposition. This condition has been explained in different ways; the prevailing hypothesis suggests that fat remains included in the gland during the embryogenesis (2).

Adenolipoma and other intrathyroid fat-containing masses were easily excluded, because these rare entities appear as focal nodules, well circumscribed, within an otherwise normal gland.

A benign, symmetrical lipomatosis of the upper trunk, neck, and head, known as Launois-Bensaude syndrome, should spare the thyroid gland (5).

In conclusion, this is an example of idiopathic diffuse lipomatosis of thyroid gland.

Because the natural history of this rare condition is unknown, further follow-up is warranted.

Received July 25, 2007.

Accepted September 20, 2007.


   References
Top
 References
 

  1. Dhayagude RG 1942 Massive fatty infiltration in a colloid goiter. Arch Pathol 33:357–360
  2. Schroder S, Bocker W 1985 Lipomatous lesions of the thyroid gland: a review. Appl Pathol 3:140–149[Medline]
  3. Himmetoglu C, Yamak S, Tezel G 2007 Diffuse fatty infiltration in amyloid goiter. Pathol Int 57:449–453[CrossRef][Medline]
  4. Arslan A, Alic B, Uzunlar AK, Buyukbayram H, Sari I 1999 Diffuse lipomatosis of thyroid gland. Auris Nasus Larynx 26:213–215[CrossRef][Medline]
  5. Meningaud JP, Pitak-Arnnop P, Bertrand JC 2007, Multiple symmetric lipomatosis: case report and review of the literature. J Oral Maxillofac Surg 65:1365–1369




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