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Letter to the Editor | Open | Published:

Mucin in benign thyroid nodules: treatment related change or not?

To the Editor,

Sir,

We have read with great interest the report by Namulema et al. [1] of increased gastric mucin after thyroxin administration in indomethacin (1-(4-chlorobenzoyl)-5-méthoxy-2-méthyl-1-H-indole-3-acetic acid)-induced ulcer healing in Wistar rats. We had the opportunity to observe extracellular mucin in 3 thyroidectomy specimens (resections for toxic goiter). Mucin is rare in the thyroid gland [2, 3]. Intra- and extracellular, “not-easily apparent” mucin is reported in thyroid carcinomas possibly in relationship with apparition of highly acidic forms of the thyroglobulin glycoprotein [3]. Thyroid adenomas or hyperplastic nodules may show this change rarely. To mention would be that thyroid nodules with prominent or extensive mucin, mainly in the stroma are reported, however as rare morphological variants [4,5,6]. The present cases are particular by the presence of “lake”-type zones of stromal mucin together with focal, subepithelial foci (Fig. 1). Whether indomethacin, frequently prescribed drug, may favorize or initiate such changes in the context of hyperthyroidism as would be the situation of the 3 present cases, is difficult to precise. To mention would be that in the reported indomethacin-induced gastric ulcer Wistar rats models, thyroid hormones increased the expression of both neural and acidic mucins [1]. To note would also be that in the cases of human thyroid hyperplastic nodules we have analysed, this change was of limited clinical relevance. However, detection of mucus on thyroid fine needle aspiration cytology specimens may rise the question not only of a thyroid carcinoma (primitive or secondary) but also of benign nodules [7].

Fig. 1
figure1

The thyroid nodules showed subepithelial, stromal mucin (a-d: black arrows), stained blue on Alcian blue stain. Hematoxilin and eosin stain a, b; Alcian blue stain c, d. Original magnification × 20 A, × 10 B × 40 (c, d)

In conclusion, thyroid mucin may occur in human thyroid hyperplastic nodules. Whether this change is related to indomethacin treatment in the context of hyperthyroidism, or not remains to be further investigated.

References

  1. 1.

    Namulema J, Nansunga M, Kato CD, Kalange M, Olaleye SB. Thyroid hormones increase stomach goblet cell numbers and mucin expression during indomethacin induced ulcer healing in Wistar rats. Thyroid Res. 2018;11:6.

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    Rosai J. Rosai and Ackerman’s surgical pathology. In: Expert consult. Philadelphia PA: Elsevier; 2011.

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    Rosai J, Carcangiu ML, DeLellis R. Tumors of the thyroid gland. 3rd series fascicle 5. Editors Rosai J LH Sobin. Washington DC: AFIP Armed Forces Institute of Pathology; 1992.

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    Nesa F, Poggi L, Ferrero S, Del Gobbo A. Thyroid Follicular Hyperplasia Associated With Massive Extracellular Mucin Deposition. Int J Surg Pathol. 2017;25:533–5.

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    Murakami S, Sakata H, Okubo K, Tsuji Y, Kayano H. Thyroid adenoma with extensive extracellular mucin deposition: report of a case. Surg Today. 2007;37:226–9.

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    Kim NR, Cho HY, Piña-Oviedo S, De La Roza G, Lee YD, Ro JY. Follicular adenoma with extensive extracellular mucin deposition: report on two cases. Clin Med Insights Case Rep. 2012;5:155–62.

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    Yang GC, Scognamiglio T, Kuhel WI. Fine-needle aspiration of mucin-producing thyroid tumors. Acta Cytol. 2011;55:549–55.

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Acknowledgements

The author thanks the HUSSD technical and administrative teams as well as the NCA/APHP, CMDP/APHP and BIUM teams.

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The author declares that she has no competing interests.

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Data sharing not applicable to this article as no datasets were generated or analysed during the current study. For other data-related requests please contact author.

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AHL analysis of data, writing of the manuscript. The author read and approved the final manuscript.

Correspondence to Adriana Handra-Luca.

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Keywords

  • Thyroid
  • Benign nodule
  • Mucin
  • Treatment