25 October 2007 - Case #98
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This case was contributed by Dr. Julia Braza, Beth Israel Deaconess Medical Center, Boston, Massachusetts (USA).
This Case is sponsored by Milestone Medical, the technological leader in Microwave Accelerated Tissue Processing. Milestone manufactures instrumentation and accessories that enable Histologists and Pathologists to achieve the highest level of productivity, while maintaining their flexibility and safety.
Milestone’s family of rapid microwave lab stations allow tissue samples to be processed in a fraction of the time as compared to conventional methods, allowing for same-day diagnosis. Milestone also offers a line of digital imaging equipment for grossing stations and autopsy rooms. These systems serve as a comprehensive method of storing macroscopic images of all specimens examined in the laboratory, providing an invaluable diagnostic database for routine grossing, teaching, and research.
For more information, please visit Milestone’s website by clicking here.
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Case #98
Clinical history:
An 18 year old man with cystic fibrosis and Burkholderia dolosa infection presented with increasing fever, vomiting, dyspnea and cough. He previously was treated with multiple antibiotics, including tobramycin, minocycline, meropenem and levofloxacin. He continued to have worsening respiratory status and died shortly afterwards. At postmortem examination, the following findings were noted.
Gross image:
Microscopic images:
What is your diagnosis?
Diagnosis: Minocycline associated black thyroid
Discussion:
Black thyroid due to pigment deposition is a well known side effect of minocycline (tetracycline) treatment. Pigment may also be deposited in bone and oral mucosa and a similar effect from doxycycline has been reported (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97:718, Head Neck 2006;28:373).
The pigment may be within thyroid epithelium, colloid or macrophages. Its exact nature is controversial. It stains with Fontana-Masson, resembling melanin. It has also been characterized as lipofuscin, which may be an oxidative product of minocycline, due to its competitive inhibition with thyroid peroxidase (Am J Clin Pathol 1983;79:738, Hum Pathol 1985;16:72).
Black thyroid may also be due to doxepin, lithium carbonate or tricyclic antidepressants. In these patients, the pigment is thought to be due to lysosomal accumulation of drug, not oxidation (Arch Pathol Lab Med 2004;128:355).
Many reports have suggested that black thyroid is associated with thyroid pathology but no clear relationship has yet been established. However, as papillary thyroid carcinoma in black thyroid is often unpigmented, hypopigmented foci should be thoroughly examined (Mod Pathol 1999;12:1181).
Despite the striking histologic findings, no specific cytologic findings have been described after fine needle aspiration (Diagn Cytopathol 2006;34:106).
All cases are archived on our website. To view them sorted by case number, diagnosis or category, visit our main Case of the Month page. To subscribe or unsubscribe to Case of the Month or our other email lists, click here.
This case was contributed by Dr. Julia Braza, Beth Israel Deaconess Medical Center, Boston, Massachusetts (USA).
This Case is sponsored by Milestone Medical, the technological leader in Microwave Accelerated Tissue Processing. Milestone manufactures instrumentation and accessories that enable Histologists and Pathologists to achieve the highest level of productivity, while maintaining their flexibility and safety.
Milestone’s family of rapid microwave lab stations allow tissue samples to be processed in a fraction of the time as compared to conventional methods, allowing for same-day diagnosis. Milestone also offers a line of digital imaging equipment for grossing stations and autopsy rooms. These systems serve as a comprehensive method of storing macroscopic images of all specimens examined in the laboratory, providing an invaluable diagnostic database for routine grossing, teaching, and research.
For more information, please visit Milestone’s website by clicking here.
Case #98
Clinical history:
An 18 year old man with cystic fibrosis and Burkholderia dolosa infection presented with increasing fever, vomiting, dyspnea and cough. He previously was treated with multiple antibiotics, including tobramycin, minocycline, meropenem and levofloxacin. He continued to have worsening respiratory status and died shortly afterwards. At postmortem examination, the following findings were noted.
Gross image:
Microscopic images:
What is your diagnosis?
Click here for diagnosis and discussion:
Diagnosis: Minocycline associated black thyroid
Discussion:
Black thyroid due to pigment deposition is a well known side effect of minocycline (tetracycline) treatment. Pigment may also be deposited in bone and oral mucosa and a similar effect from doxycycline has been reported (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97:718, Head Neck 2006;28:373).
The pigment may be within thyroid epithelium, colloid or macrophages. Its exact nature is controversial. It stains with Fontana-Masson, resembling melanin. It has also been characterized as lipofuscin, which may be an oxidative product of minocycline, due to its competitive inhibition with thyroid peroxidase (Am J Clin Pathol 1983;79:738, Hum Pathol 1985;16:72).
Black thyroid may also be due to doxepin, lithium carbonate or tricyclic antidepressants. In these patients, the pigment is thought to be due to lysosomal accumulation of drug, not oxidation (Arch Pathol Lab Med 2004;128:355).
Many reports have suggested that black thyroid is associated with thyroid pathology but no clear relationship has yet been established. However, as papillary thyroid carcinoma in black thyroid is often unpigmented, hypopigmented foci should be thoroughly examined (Mod Pathol 1999;12:1181).
Despite the striking histologic findings, no specific cytologic findings have been described after fine needle aspiration (Diagn Cytopathol 2006;34:106).
