Pharyngoesophageal diverticula simulating thyroid nodules: An unusual occurrence with unique features

Abstract

Pharyngoesophageal diverticula (PED) of the Zenker's and Killian-Jamieson types arise in close proximity to the thyroid gland, and may rarely be confused with a thyroid nodule on ultrasonography. In this brief report, we detail the cytologic, clinical, and radiologic findings of three PED that were thought to be thyroid nodules, and were subjected to fine-needle aspiration (FNA). The patients were females with an age range of 51-64 years. All three patients had multiple thyroid nodules, and two patients reported symptoms attributable to the diverticulum. Nodule sizes ranged from 1.0 to 2.7 cm, and either the right or left thyroid lobe could be involved. Microcalcifications were present by ultrasonography in all three cases. FNA of these thyroid nodule mimics showed squamous cells with granular or amorphous debris, bacterial and/or fungal colonies, inflammation, and food particles. These cytologic features, particularly the presence of vegetable or meat fragments, are characteristic, and have also been reported in the few previous reports of PED. The presence of a diverticulum was confirmed with imaging studies in all our patients. Although a rare occurrence, the inadvertent FNA of a PED masquerading as a thyroid nodule is important to recognize, as a recommendation for appropriate radiologic studies could potentially avoid inappropriate therapy for thyroid disease.

Thyroid FNA biopsies comprised of abundant, mature squamous cells can be reported as benign: A cytologic study of 18 patients with clinical correlation

“…We posit that in addition to the entities listed above, direct sampling of the esophagus rarely may be the source of a “thyroid” FNA consisting of benign squamous cells. Nauschuetz et al recently reported a series of 3 “thyroid” FNA specimens that actually sampled previously undiagnosed esophageal diverticula . They found that the presence of granular or amorphous debris, bacteria and/or fungal organisms, and/or food particles suggested the diagnosis .…”

Killian‐Jamieson diverticulum mimicking a thyroid nodule: A case report

“…However, these incidence and prevalence values may represent underestimations, since most patients with KJD are asymptomatic and may not seek medical advice. Most cases of KJD are left‐sided, although the reason for this laterality is unknown . Screening ultrasonography of the thyroid or carotid artery may incidentally detect such pharyngoesophageal diverticula.…”

“…Screening ultrasonography of the thyroid or carotid artery may incidentally detect such pharyngoesophageal diverticula. Unnecessary biopsy has been performed in patients with KJD following misdiagnosis as a thyroid nodule . Medical practitioners and sonographers should be aware that KJD can mimic thyroid nodules to avoid unnecessary invasive procedures.…”

“…Killian‐Jamieson diverticulum (KJD) is a form of pharyngoesophageal diverticulum, representing an evagination through a muscular gap in the anterolateral wall of the proximal cervical esophagus. Several reports have described incidental detection of KJD misidentified as thyroid nodules on thyroid ultrasonography . Dysphagia is the most common symptom of KJD and may be associated with regurgitation, cough, food retention, epigastric pain, halitosis, and swelling of the neck, but 81% of KJD cases are asymptomatic .…”

“…Several reports have described incidental detection of KJD misidentified as thyroid nodules on thyroid ultrasonography. [1][2][3] Dysphagia is the most common symptom of KJD and may be associated with regurgitation, cough, food retention, epigastric pain, halitosis, and swelling of the neck, but 81% of KJD cases are asymptomatic. 1 Many cases of KJD may thus go undiagnosed.…”