Mummification of Benign Thyroid Nodule

Mummification of benign thyroid nodule
Example of spontaneous mummification of a benign nodule in another 60-year-old female patient with known multinodular goitre. The dominant nodule noted in the mid to lower pole of the right thyroid lobe initially appeared predominantly isoechoic, almost entirely solid, wider-than-tall with smooth margins. Minor internal vascularity and several large comet tail artefacts were also seen, overall in keeping with a colloid nodule (A) At 1-year follow-up, the nodule shrank significantly, appeared hypoechoic and developed increased internal echogenic foci with comet tail artefacts, consistent with degeneration or mummification (B).

This article describes the case of a 21-year-old who presented with a non-tender lump in her left lower neck. The patient’s medical history did not show any significant findings. She was both clinically and biochemically euthyroid. Doctors advised a thyroid ultrasound for further evaluation which showed a solitary large solid-cystic nodule in the left lobe-isthmus. However, there were no signs of cervical lymphadenopathy. Whereas fine needle aspiration cytology (FNAC) of the nodule yielded haemorrhagic contents. Based on the investigation findings, this was a case of mummification of benign thyroid nodule.

For the next 3 years doctors followed the nodule via an ultrasound. The findings showed a progressive shrinkage of the nodule’s cystic portions with calcification an content replacement with iso-to-hypoechoic contents. Doctors suspected for the nodule to be malignant, therefore, classified it as a TR-5 nodule based on he thyroid imaging reporting and data system (ACR-TIRADS).

FNAC was repeated on the solid portions which showed non-diagnostic acellular contents. The most recent follow-up showed that the nodule continued to decrease in size with degenerative changes.

The findings were consistent with benign mummification of the thyroid nodule.

Over time, benign thyroid nodules are known to undergo mummification and degeneration. This is either spontaneous, because of percutaneous ethanol or laser ablation, following FNAC or due to cystic portions becoming desiccated. The vascular supply is disrupted in mummified solid components which results in intranodal hypoxia associated with haemorrhage and scarring.

The mummified thyroid nodule typically presents as necrosis associated with posterior shadowing, avascularity and shrinkage. In addition, it also presents as a subcapsular granulation tissue with peripheral black and white halos. In some cases the mummification can mimic malignancy.

According to the study, mummified nodules may demonstrate irregular ill-defined nodule margins due to capsular collapse, taller-than-wide shape from asymmetric fibrous healing with transverse shrinking, replacement of cystic contents with iso-to-hypoechoic ‘solid’ contents due to fibrosis and internal echogenic foci attributed to dystrophic calcifications or colloid material, usually seen in later stages. Nodule shrinkage, a key feature of mummification, may rarely be seen in papillary thyroid carcinomas.

Therefore, it is important to distinguish mummification from malignancy. The case iterates the importance of reviewing prior comparison imaging for morphological changes and shrinkage.


Mummified thyroid nodule: a diagnostic and management conundrum

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.


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