Rare intrathyroid nodule-like lesions: Two case reports

Thyroid nodules and nodule-like lesions, as well as other structural abnormalities of the thyroid gland, are often detected during ultrasonography. True thyroid nodules should be evaluated for sonographic features suggestive of malignancy and appropriately triaged for further diagnostic workup to reduce the risk of missed thyroid cancer. In addition to true thyroid nodules, other lesions may coexist with or mimic them. Among these are branchial cleft cysts and thyroglossal duct cysts, 2 common embryological remnants. Although these lesions are typically found in the lateral neck and midline, respectively, atypical presentations and aberrant anatomical locations may pose diagnostic challenges. Intrathyroidal occurrence of either entity is exceedingly rare. We report 2 cases of intrathyroidal congenital cystic lesions recognized during thyroid ultrasonography. In both patients, suspicious thyroid nodule-like lesions were identified accidentally. Subsequently ultrasound-guided fine-needle aspiration (FNA) was performed. Cytological examination suggested an intrathyroidal branchial cleft cyst in the first case, which was confirmed after surgical excision and histopathological examination, while in the second case suggested an intrathyroidal thyroglossal duct cyst, but that patient declined further diagnostic evaluation. These cases highlight the importance of considering cystic embryological remnants in the differential diagnosis of thyroid nodule-like abnormalities and underscore the value of ultrasound-guided FNA in establishing an accurate diagnosis.