# Diagnostic Pitfalls and Unique Radiological Insights in Thyroid Paraganglioma: A Case Report and Literature Review

## TL;DR

This case report highlights the diagnostic challenges of thyroid paraganglioma and emphasizes the importance of ultrasound and immunohistochemistry for accurate diagnosis.

## Contribution

The paper presents a rare case of thyroid paraganglioma and emphasizes the need for a robust diagnostic profile to reduce misdiagnosis.

## Key findings

- Ultrasound and immunohistochemical analysis were crucial in diagnosing thyroid paraganglioma in this case.
- The tumor exhibited a zellballen pattern and was positive for synaptophysin, CD56, GATA-3, and S100.
- Postoperative follow-up showed the patient is stable and disease-free.

## Abstract

Paragangliomas (PGLs) are extremely rare endocrine tumors that arise from the autonomic nervous system. Their rarity contributes to their frequent misdiagnosis. Ultrasound and immunohistochemical findings are heavily relied on for correct diagnosis. We present a case of thyroid PGL in a 40-year-old female patient who presented with a 1-year history of anterior neck mass and a 4-month history of hemoptysis. Ultrasound findings showed a solitary, lobulated, hypoechoic, and vascular lesion in the right thyroid lobe. She underwent total thyroidectomy and tracheal end-to-end anastomosis. Histopathology showed cells organized in distinct nests (zellballen) pattern enclosed by a delicate fibrovascular stroma. On immunohistochemical analysis, the tumor was positive for synaptophysin, CD56, GATA-3, and S100. The patient is stable postoperatively and disease-free. The role of ultrasound is vital in forming a correct diagnosis of thyroid PGL preoperatively. We review the current literature regarding diagnostic findings and treatment of thyroid PGLs with the aim of supplementing the findings of the thyroid PGLs that have been previously reported. The creation of a robust imaging and immunohistochemical profile for this entity is needed to combat the frequent misdiagnoses that occur with thyroid PGLs.