Thyroid carcinoma of the pyramidal lobe: A narrative review of reported cases

Table 1 Summary of cases of pyramidal lobe carcinoma

Ref.	Sex	Age	Clinical features	Thyroid function	Imaging	Pre-op biopsy	Initial diagnosis	Operation	Pathology	Multifocality	Extrathyroidal extension	TNM	RAI	Follow-up
Ogawa et al[17]	F	21	Neck enlargement	Normal	US: Isoechoic encapsulated mass (40.3 mm × 27 mm × 17.6 mm) in the pyramidal lobe. CT: Hypoattenuated mass adjacent to pyramidal lobe. 201Tl Scintigraphy: Uptake from nodule with dilution at washout	FNAB: IIIb	Follicular cancer	Isthmusectomy, pyramidal lobe excision and prelaryngeal lymphadenectomy	Minimally invasive follicular carcinoma of the pyramidal lobe (35 mm)	No	Invasion of capsule and nearby blood vessels	NA	NA	Well-after 15 months
Kim et al[33]	F	54	Neck mass	NA	US: 30 mm mass of mixed echogenicity, with microcalcifications, extending from submental area to thyroid cartilage, abnormal lymph nodes in levels IV (R), III (L), and IV (L). CT: Dumbbell shaped mass with cystic and solid components, expanding to right isthmus of thyroid gland	FNA: VI	Papillary cancer with lymph node metastasis in levels IV (R) and III (L)	Total thyroidectomy with central and bilateral modified, radical neck dissection	Papillary carcinoma of the pyramidal lobe (15 mm). Bilateral lymph node metastasis	No	Strap muscle involvement	NA	NA	NA
Santrac et al[10]	F	36	NA	NA	NA	No	NA	Total thyroidectomy with central neck dissection, sentinel lymph node biopsies bilaterally (III/IV levels)	Papillary carcinoma of the pyramidal lobe (12 mm). Colloid nodular goiter	No	No	pT1bN0M0	No	Well-after 18 months
Santrac et al[10]	F	41	NA	NA	NA	FNAB: VI	Papillary thyroid cancer	Total thyroidectomy with central neck dissection, sentinel lymph node biopsies bilaterally (III/IV levels)	Papillary carcinoma of the pyramidal lobe (20 mm). Hashimoto thyroiditis	No	No	pT1bN0M0	No	Well-after 18 months
Santrac et al[10]	F	22	NA	NA	NA	FNAB: III	NA	Total thyroidectomy with central neck dissection, sentinel lymph node biopsies bilaterally (III/IV levels)	Papillary carcinoma of the pyramidal lobe (15 mm). Delphian lymph node metastasis. Hashimoto thyroiditis	No	No	pT1bN1M0	Yes	Well-after 18 months
Ha et al[23]	F	48	Normal	Normal	US: Suspiciously malignant nodules in pyramidal lobe (4.1 mm) and right mid-lobe (3.6 mm), a hypoechoic nodule in the left mid-lobe (2 mm)	FNAB: VI (from right mid-lobe)	Thyroid malignancy	Total thyroidectomy with central lymph node dissection	Papillary thyroid microcarcinomas-pyramidal lobe, right lobe and left lobe	Yes	No	pT1aN0M0	No	Well-at recent follow-up
Wagner et al[34]	F	62	Neck mass, swelling, weight loss	Normal	US: Large submental mass with heterogeneity. CT: Mass located superiorly to thyroid isthmus, destroying hyoid bone, left submandibular lymph node (15 mm)	FNAB: VI	Papillary thyroid cancer	Total thyroidectomy with en bloc resection of tumor element, skeletal muscle, hyoid bone, central lymph node dissection and left radical neck dissection (II/III/IV)	Tall cell variant of papillary carcinoma of the pyramidal lobe (65 mm). Metastatic lateral lymph node	No	Infiltration of nearby soft, fibroadipose tissue, skeletal muscle and hyoid bone-multiple pulmonary nodules bilaterally (< 10 mm)	NA	Yes	NA
Ritterhouse et al[25]	F	24	Neck mass	Normal	US and CT: Irregular, lobulated, hypervascular mass arising from pyramidal lobe	Open biopsy: Papillary thyroid carcinoma	Papillary thyroid cancer	Total thyroidectomy with central and lateral neck dissection, en bloc resection of tumor overlying strap muscle and wedge resection of left thyroid lamina and cricothyroid membrane	Solid variant papillary carcinoma of the pyramidal lobe (37 mm). Metastatic central and left compartment lymph nodes with extranodal extension. PTC of the right thyroid lobe (2 mm)	Yes	Skeletal muscle and cricothyroid membrane involvement	pT4aN1bM0	Yes	Well-after 14 days
Yoon et al[11]	F/M: 8/2	58 ± 12.5	NA	NA	NA	NA	NA	8/10 patients: Total thyroidectomy, 2/10 completion thyroidectomy, 3/10 central lymph node dissection, 2/10 modified radical neck dissection	Papillary thyroid carcinoma of the pyramidal lobe	5/10	8/10	T1: 2/10, T2: 0, T3: 7/10, T4: 1. N0: 5/10, N1a: 3/10, N1b: 2/10	NA	No recurrence at follow-up
Papavramidis et al[16]	F	43	Difficulty swallowing, cervical pain	Normal	US: Hyperechoic nodules in left (n = 3) and right (n = 2) thyroid lobe, hypoechoic submandibular mass. CT: Round mass above the hyoid bone. MRI: Heterogeneous mass above the hyoid bone, right lobe mass and multiple swollen lymph nodes (d ≤ 12 mm)	FNA: VI	Papillary thyroid cancer	Total thyroidectomy	Papillary thyroid carcinoma of the pyramidal lobe (14 mm), PTC in right thyroid lobe (3 mm)	Yes	No	pT1bN0M0	NA	NA
Papavramidis et al[16]	F	73	Neck swelling	Normal	CT: Pyramidal lobe mass	No	Undifferentiated carcinoma of the pyramidal lobe	Total thyroidectomy with central and bi-lateral neck dissection	Papillary thyroid carcinoma of the pyramidal lobe (50 mm). Metastasis of central and lateral lymph nodes in levels III (R) and II (L). Multiple papillary microcarcinomas in left and right thyroid lobe	Yes	Focal extension	pT3N1bM0	NA	NA
Petris et al[22]	F	50	Neck mass	Hyperthyroidism	MRI: Expansive tumoral mass, adjacent to hyoid bone	No	NA	Tumor excision and Sistrunk procedure followed by total thyroidectomy with central lymph node dissection	Solid and sclerosant variant papillary thyroid carcinoma of the pyramidal lobe, PTC in thyroid isthmus	Yes	Invasion of capsule, infiltration of adjacent fibroadipose and muscular tissue	pT3N0M0	Yes	NA
Kang et al[35]	F	52	Neck mass	NA	US: Anterior neck mass and hypoechoic nodule in left thyroid lobe. CT: Solid mass with cystic and calcified components	FNAC: VI	Thyroglossal duct or ectopic thyroid carcinoma	Sistrunk and lobectomy of left thyroid lobe with central lymph node dissection	Papillary thyroid carcinoma of the pyramidal lobe (30 mm). Metastatic lymph nodes. PTC in left thyroid lobe (5 mm)	Yes	No	pT2N1aM0	NA	NA
Pinto et al[36]	F	38	Neck swelling, compression symptoms	Normal	US: Multinodular goiter with large nodule in left thyroid lobe	FNAC: II	NA	Total thyroidectomy (excision of pyramidal lobe and tubercle of Zuckerkandl)	Papillary microcarcinoma of the pyramidal lobe (2.5 mm)	No	No	pT1aN0M0	No	NA
Messias et al[3]	F	77	Neck mass	Normal	US and CT: Thyroid nodules in pyramidal (largest) and right thyroid lobe	FNAC: VI	Papillary thyroid cancer	Total thyroidectomy en block with pyramidal lobe and hyoid bone, central lymph node dissection	Papillary thyroid carcinoma of the pyramidal lobe (25 mm). Metastatic central lymph nodes	Yes	RLN invasion (R)	pT3bN1aM0	Yes	Well-after 6 months
Own Case	F	22	Lymphadenopathy	Normal	US: Suspicious nodule in right lower lobe, normal pyramidal lobe, multiple pathological lymph nodes. CT: Hyperattunuated enlarged lymph nodes nearby thyroid lower right lobe, enhanced entity in anterior upper mediastinum. MRI: Ectopic thymic tissue above suprasternal notch and supraclavicularly (R)	Lymph node open biopsy: Metastatic papillary thyroid carcinoma	PTC in right lower lobe or burnt out primary tumor or ectopic thyroid tissue and metastatic lymph nodes	Total thyroidectomy with radical central and right lateral neck dissection	Papillary thyroid carcinoma of the pyramidal lobe (7 mm). Metastatic intermuscular lymph nodes (IV-VI)	No	No	pT1aN1M0	Yes	Well-after 20 months
Ren et al[37]	F	21	Neck mass	NA	US: Large entity with distinct borders in anterior neck. CT: Soft tissue mass anterior to thyroid cartillage	No	NA	Right thyroid lobectomy with isthmus resection, central lymph node dissection and modified zone I dissection	Papillary thyroid carcinoma of the pyramidal lobe (30 mm). Metastatic central lymph nodes in level I	No	No	pT1N1M0	NA	Well-after 5 years
Mao et al[38]	F	32	Neck mass	NA	US: Solid-cystic mixed nodule with calcification in pyramidal lobe	FNA: VI	Papillary thyroid cancer	Pyramidal lobe resection	Papillary thyroid carcinoma of the pyramidal lobe	No	No	T1bN1aM0	NA	NA
Hage et al[9]	F	33	Neck swelling	Normal	US: Large mixed solid-cystic nodule between left lobe and isthmus with calcifications, smaller nodule nearby	FNA: III	NA	Left hemithyroidectomy followed by completion thyroidectomy with central lymph node dissection	Papillary carcinoma of the pyramidal lobe (30 mm). Metastatic peri-thyroid lymph nodes	No	No	pT2N1M0	NA	NA
Pathak et al[39]	M	27	Neck swelling	Normal	NA	FNAC: Medullary carcinoma (right lobe)	Medullary Cancer	Total thyroidectomy with central and right radical lymph node dissection	Medullary carcinoma of the right lobe and isthmus with extrathyroid extension. Papillary microcarcinoma of the pyramidal lobe. Metastatic lymph nodes (medullary-central and lateral, papillary-central)	No	No	NA	NA	NA

TNM: Tumor-node-metastasis; RAI: Radioactive iodine; F: Female; US: Ultrasound; CT: Computed tomography; FNAB: Fine-needle aspiration biopsy; NA: Not available; 201Tl: Thallium-201; R: Right; L: Left; FNA: Fine-needle aspiration; PTC: Papillary thyroid carcinoma; M: Male; MRI: Magnetic resonance imaging; FNAC: Fine-needle aspiration cytology; RLN: Recurrent laryngeal nerve.