scholarly journals Ectopic Papillary Thyroid Cancer with Distant Metastasis

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Oscar R. Vázquez ◽  
Frieda Silva ◽  
Eduardo Acosta-Pumarejo ◽  
Maria L. Marín
Keyword(s):  
Thyroid Carcinoma ◽  
Lymph Nodes ◽  
Mediastinal Mass ◽  
Thyroid Tissue ◽  
Whole Body ◽  
Papillary Thyroid ◽  
Tissue Mass ◽  
Superior Mediastinum ◽  
Pet Ct ◽  
The Right

Ectopic thyroid tissue is a rare clinical entity wherein malignant lesions may arise, the most common one being papillary carcinoma. We present a case of a 68-year-old female who presented with a growing mass in the right clavicle. An MR of the shoulder showed a soft tissue mass arising from the anterior margin of the right distal clavicle. A fine needle aspiration of the mass showed papillary thyroid carcinoma. PET/CT confirmed the clavicular and mediastinal mass. Excision of the clavicular mass and total thyroidectomy with modified right neck dissection were performed. Pathology revealed no evidence of malignancy in the thyroid; lymph nodes were positive for metastatic thyroid carcinoma. Postsurgery CT showed the superior mediastinal mass with surrounding adenopathy; radioiodine (RAI) treatment with dose of 142.1 mCi [5257.7 MBq] was recommended. Posttherapy whole-body scan (WBS) showed RAI avid tissue in the neck and superior mediastinum. Follow-up chest CT revealed pulmonary nodules that increased in number and size; a second RAI therapeutic dose was given. The posttherapy RAI WBS was negative. Repeat PET/CT showed multiple hypermetabolic lesions in the mediastinum, neck, lymph nodes, pulmonary nodes, and right shoulder. The FDG avid lesions with no RAI uptake suggested tumor dedifferentiation.

scholarly journals Metabolic and functional imaging employment in the differentiation of brown tumors from bone metastases in a case of primary papillary thyroid cancer and parathyroid adenoma: case report

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Ula Al-Rasheed ◽  
Fareed Barakat ◽  
Akram Al-Ibraheem
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Lymph Nodes ◽  
Parathyroid Adenoma ◽  
Whole Body ◽  
Bone Lesions ◽  
Papillary Thyroid ◽  
Pet Ct ◽  
Ectopic Parathyroid ◽  
Brown Tumors

Abstract Background Brown tumors are benign osteoclastic bone lesions encountered in patients with hyperparathyroidism. These tumors may demonstrate aggressive, destructive features in the skeleton and imitate metastatic bone lesions, particularly in patients with known primary neoplasm. In this case report of recurrent papillary thyroid cancer and ectopic parathyroid adenoma, we shed light on the importance of combining different nuclear medicine imaging modalities to differentiate brown tumors from metastatic bone lesions. Case presentation We present a 39-year-old woman with a known history of papillary thyroid carcinoma classic type stage pT1N1b post-total thyroidectomy and radioactive iodine (I-131) therapy (RAI) presented with upper limb weakness and pain. An expansile lytic lesion involving the 6th cervical vertebra was seen in cervical spine MRI, which was suspicious for metastatic deposit. Therapeutic and diagnostic I-131 whole-body scans were negative for any I-13-avid lesions. Laboratory results revealed high calcium, parathyroid hormone, and alkaline phosphatase. A Technetium-99m-sestamibi (Tc-99m MIBI) scan was done with the standard protocol of spot views to the neck and upper chest area to localize any suspicious parathyroid adenoma. The scan demonstrated right supraclavicular and mediastinal Tc-99m MIBI-avid lesions suspicious for being ectopic parathyroid adenomas. Whole-body fluorine-18-2-fluoro-2-deoxy-d-glucose (18F-FDG), positron emission tomography/computed tomography (PET/CT) (18F-FDG PET/CT) was performed for further evaluation. It demonstrated multiple focal lytic skeletal lesions of abnormal increased FDG uptake as well as right supraclavicular FDG-avid lymph nodes. However, the superior mediastinal lesion was non-FDG-avid, suggesting the existence of two different entities: ectopic parathyroid adenoma with multiple brown tumors and metastatic right supraclavicular lymph nodes. The patient underwent right neck dissection and superior mediastinal mass excision. An intra-operative fresh serum parathyroid sample was sent, which dropped down to 100ng/ml from 863.7ng/ml. Later, histopathological results revealed that the right supraclavicular lymph nodes were metastatic papillary thyroid carcinoma. At the same time, the superior mediastinal mass proved to be parathyroid adenoma by histopathology, confirming the 18F-FDG PET/CT findings. Conclusions In the case of papillary thyroid carcinoma, metastatic lymph nodes with hyperparathyroidism, and evidence of lytic bone lesions, careful interpretation of the different metabolic and functional imaging modalities are needed to exclude the concurrent parathyroid adenoma and facilitate the differentiation of brown tumors from bone metastases, leading to appropriate surgical and medical treatment plans.

scholarly journals Pre-sternal thyroid swellings: a case of rare aberrant site recurrence and review of literature

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Lovenish Bains ◽  
Sushant Bhatia ◽  
Rohit Kaushik ◽  
Sudhir Kumar Jain ◽  
Chandra Bhushan Singh ◽  
...  
Keyword(s):  
Lymph Node ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
De Novo ◽  
Anterior Part ◽  
Thyroid Tissue ◽  
Papillary Thyroid ◽  
Thyroid Cells ◽  
Thyroid Swelling ◽  
The Right

Abstract Background Thyroid swellings enlarge caudally into the mediastinum behind the sternum. Pre-sternal swelling of thyroid origin is very rare. We present our case of pre-sternal thyroid swelling which was albeit a surprisingly rare site of papillary thyroid carcinoma recurrence and review of pre-sternal thyroid swellings reported till date. Case summary A 60 year old female presented with a painless, progressive swelling on the anterior part of the chest for the past 2 years. A 15 cm × 8 cm vertically aligned, non tender, well defined swelling was present on the pre-sternal region, with consistency ranging from soft to firm. The swelling was fixed to the underlying tissues and a fixed level IV lymph node was palpable on the right side. Ultrasonography revealed a large mass of 15 × 7 cm with multiple cystic areas. Fine needle aspiration cytology was inconclusive twice. Patient had undergone a total thyroidectomy for papillary carcinoma 10 years back. Computed tomography findings revealed a large 15 × 6.6 × 7 cm lobulated, pre-sternal, soft tissue lesion with solid & cystic components. The mass was infiltrating the right sided strap muscles and sternocleidomastoid. FNAC was inconclusive and thyroid scan could not pick up any activity in the mass. Henceforth a PET scan was done that showed increased FDG uptake by the lesion and the level IV lymph node. The patient underwent wide excision of the mass with right functional neck dissection, along with removal with both sternal head of sternocleido-mastoid, the strap muscles and the surrounding fascia. Histopathology confirmed papillary thyroid carcinoma. Patient received post-operative radioactive iodine ablation and is healthy with no recurrence up to 30 months of follow up. Discussion The mechanisms for pre-sternal thyroid swelling are not understood due to paucity of cases. The mechanisms proposed are invasion of strap muscles and cervical linea alba and tumor cells spread anterior to sternum, truly ectopic thyroid tissue, de novo carcinogenesis in the embryonal remnants like the thyro-thymic residues, sequestered thyroid tissue which grows later or migration of thyroid cells, incomplete clearance at the time of primary surgery or intraoperative seeding. Conclusion Pre-sternal region masses of thyroid origin are very rare. A proper work up, suspicion for thyroid mass and array of tests will be required to come to a provisional diagnosis. Since the masses reported in literature were primarily malignant, any such mass may be treated on lines of malignancy with radical surgery.

scholarly journals Occult Papillary Thyroid Carcinoma without Detection of the Primary Tumor on Preoperative Ultrasonography or Postoperative Pathological Examination: A Case Report

2020 ◽  
Vol 13 (1) ◽  
pp. 105-112 ◽  
Author(s):  
Gai Yamashita ◽  
Takahito Kondo ◽  
Akira Okimura ◽  
Munehide Nakatsugawa ◽  
Hiroshi Hirano ◽  
...  
Keyword(s):  
Lymph Node ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Primary Tumor ◽  
Thyroid Tissue ◽  
Pathological Examination ◽  
Papillary Thyroid ◽  
Superficial Lobe ◽  
Preoperative Ultrasonography ◽  
The Right

Herein, we report a case of an occult thyroid cancer that was not detected as a primary tumor on preoperative ultrasonography or postoperative pathological examination, although a diagnosis of papillary thyroid carcinoma metastasis was made owing to the presence of a mass in the right upper neck. Needle biopsy of the mass in the right upper neck revealed positive results for thyroglobulin and TTF-1 on immunostaining, and a papillary thyroid carcinoma was observed with papillary and follicular patterns. We suspected papillary thyroid carcinoma (T0N1bM0) or ectopic papillary thyroid carcinoma. Accordingly, we performed total thyroidectomy, central lymph node dissection, right lateral neck dissection, and resection of the superficial lobe of the right parotid. A postoperative pathological examination of 5-mm slices of the specimen revealed no primary tumor in the thyroid. However, a hyalinized image of the thyroid indicated that a micropapillary thyroid carcinoma might have spontaneously disappeared. As there was no normal thyroid tissue in the metastasis to the superior internal jugular lymph node, the tumor was unlikely to be an ectopic papillary thyroid carcinoma. Therefore, we made a diagnosis of a papillary thyroid carcinoma (pT0N1bM0). After surgery, we determined that the tumor belonged to a high-risk group of papillary thyroid carcinomas and a poor-prognosis group of symptomatic papillary thyroid microcarcinomas; accordingly, ablation was performed with 30 mCi iodine-131. There was no recurrence or metastasis 24 months after the first surgery.

scholarly journals A Case of Unresectable Papillary Thyroid Carcinoma Treated with Lenvatinib as Neoadjuvant Chemotherapy

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Hiroyuki Iwasaki ◽  
Soji Toda ◽  
Hiroyuki Ito ◽  
Daiji Nemoto ◽  
Daisuke Murayama ◽  
...  
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Neoadjuvant Chemotherapy ◽  
Thyroid Carcinoma ◽  
Lung Metastasis ◽  
Vena Cava ◽  
Maximum Diameter ◽  
Brachiocephalic Vein ◽  
Papillary Thyroid ◽  
Superior Mediastinum ◽  
The Right

A 75-year-old woman visited a nearby clinic with complaints of right clavicle discomfort, and she underwent diagnostic thoracoscopic lung biopsy, being diagnosed with lung metastasis and a right-upper mediastinal mass. The superior mediastinum mass was extrapulmonary and covered by the pleura, and it was not biopsied. Papillary thyroid carcinoma was diagnosed following biopsy of the lung metastasis. Only a small tumor, with a maximum diameter of 70 mm from the right neck to the superior mediastinum, in the thyroid gland invades the internal jugular vein and subclavian vein, forming a tumor embolus in the right brachiocephalic vein and reaching the vicinity of the superior vena cava. For life-saving purposes, we obtained approval from the Cancer Board of Kanagawa Cancer Center and used lenvatinib according to unresectable undifferentiated cancer IRB approval number 28–41. The tumor had shrunk after 4 months, and surgery was performed. The postoperative course has been good, and the patient is being followed up. The patient is alive three months after surgery, and lung metastases have disappeared on CT images. This case is reported as a successful case of neoadjuvant chemotherapy and interval debulking surgery.

scholarly journals Papillary Thyroid Carcinoma as a Lateral Neck Cyst: A Cystic Metastatic Node versus an Ectopic Thyroid Tissue

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Frhana Rahmat ◽  
Ananth Kumar Marutha Muthu ◽  
Navarasi S Raja Gopal ◽  
Soh Jo Han ◽  
Azura Sharena Yahaya
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Lymph Nodes ◽  
Total Thyroidectomy ◽  
Primary Tumour ◽  
Thyroid Tissue ◽  
Ectopic Thyroid ◽  
Lateral Neck ◽  
Papillary Thyroid ◽  
Histopathological Results

Papillary thyroid carcinoma is the most common thyroid malignancy and frequently metastasizes to regional lymph nodes. Occasionally, metastatic lymph nodes are palpable without the evidence of primary tumour. Papillary thyroid carcinoma of lateral neck cyst is a rare condition. It may arise from thyroid primary which underwent cystic degeneration or true malignant transformation of ectopic thyroid tissue. Herein, we reported two cases with preoperative diagnosis of benign lateral neck cyst but postoperative histopathological results showed primary papillary thyroid carcinoma. Ultrasonography and computed tomography of the neck in both cases showed no significant thyroid lesion. However, the patient in Case  2 was subjected for total thyroidectomy and histopathological results showed the origin of primary tumour. In conclusion, thorough investigations including total thyroidectomy are indicated in cases of papillary thyroid carcinoma of lateral neck cyst. This practice is to ensure that this type of thyroid cancer can be detected earlier because it has a very good prognosis if treated earlier.

scholarly journals F-18 FDG-PET-CT in the Diagnostic of a Late Medullary Thyroid Carcinoma Recurrence in a Patient with Follicular-Papillary Thyroid Cancer

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Doina Piciu ◽  
Andra Piciu
Keyword(s):  
Thyroid Carcinoma ◽  
Papillary Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Fdg Pet ◽  
Whole Body ◽  
Serum Calcitonin ◽  
Medullary Thyroid ◽  
Superior Mediastinum ◽  
Pet Ct ◽  
Fdg Pet Ct

Mixed medullary and follicular or papillary carcinoma of thyroid is an extremely rare tumor, characterized by coexistence of morphological and immunohistochemical features of both medullary carcinoma and follicular (or papillary) carcinoma. This case report describes for the first time in the indexed database a late recurrence of a medullary thyroid carcinoma initially diagnosed as follicular-papillary form, treated and monitored accordingly. After 14 years, a superior mediastinum tumor was discovered incidentally at a thorax computer tomography. The whole-body I-131 scan was negative and F-18 FDG-PET-CT showed glucose avidity of the tumor. The patient was operated on and the histology revealed medullary thyroid carcinoma. If there are no possibilities to have routinely extensive immunohistologic profiles, it is recommended to check the serum calcitonin, at least in any patient with confirmed thyroid carcinoma.

Posterior Mediastinal Hyperfunctioning Insular Thyroid Carcinoma

2005 ◽  
Vol 91 (4) ◽  
pp. 358-360 ◽  
Author(s):  
Rocco Bellantone ◽  
Celestino Pio Lombardi ◽  
Maurizio Bossola ◽  
Guido Fadda ◽  
Massimo Salvatori ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Thyroid Carcinoma ◽  
Mediastinal Mass ◽  
Thyroid Tissue ◽  
Posterior Mediastinum ◽  
Pathological Examination ◽  
Posterior Mediastinal Mass ◽  
Posterior Mediastinal ◽  
Poorly Differentiated ◽  
The Right

A case is presented of a posterior mediastinal mass arising in a 57-year-old woman with severe compressive cervical symptoms and hyperthyroidism. Computed tomography showed intrathoracic thyroid tissue that displaced the trachea towards the front and the right and invaded the posterior mediastinum. Pathological examination showed features of a poorly differentiated (insular) thyroid carcinoma. To the best of our knowledge, this is the first reported case of a posterior mediastinal insular thyroid carcinoma with thyroid hyperfunction.

scholarly journals Clinical and morphological characteristics of papillary thyroid carcinoma associated withhashimoto's thyroiditis

2019 ◽  
Vol 1 (7) ◽  
pp. 41-46
Author(s):  
R.P. Tkachenko ◽  
O.G. Kuryk ◽  
A.S. Golovko
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Lymph Nodes ◽  
Clinical Medicine ◽  
Thyroid Tissue ◽  
Morphological Characteristics ◽  
State Institution ◽  
Papillary Thyroid ◽  
Group 6 ◽  
Cervical Lymphnodes

The aim of the work is to study the clinical and morphological features of papillary thyroid carcinoma (PTC) with the autoimmune thyroiditis Hashimoto (TH)Material and methods. 236 clinical observations of patients with PTC of the surgical hospital of he State Institution of Science "Research and Practical Centre of Preventive and Clinical Medicine" State Administrative Department during 2012-2018 were investigated. We study the size of the tumor, the presence of invasions in the thyroid tissue and in the capsule of the gland, multifocal growth, metastases in the lymph nodes of group 6 and metastases in the lymph nodes of 2,3,4 groups. For statistical analysis, Fischer' sex act test and Student's t-criterion were used. Valuesare interpreted by the trueat p <0,05.Results.Of the 236 cases of PTC, TH was found in 72 patients (30.5%), in 56 cases- other proliferative-hyperplastic processesor nodal thyroid pathology (23.7%), and 108 cases (45.8%) were without concomitant pathology. There were 142 (60.2%)women with PTC, and 94 (39.8%) men, p <0.05. In patients with PTC and TH were 53 women (73.6%) and 19 men (26.3%), p <0.05. In patients with TH in comparison with the group without concomitant thyropathology, a significantly higher number of microcarcinoma was noted, the size of tumors in TH was lower (with TH 23 (31.9%), without TH 57 (52.8%), p <0.05 ). In patients without TH, carcinoma invasion was more likely to occur in the thyroid tissue (with TH 32 (44.4%), without TH 66 (61.1%), p <0.05), invasion to the capsule of the gland with extra thyroid invasion (with TH 17 (23.6%), without TX 42 (38.9%), p <0.05), multifocal growth (with TH 15 (20.8%), without TH 48 (44.4%), p <0 , 05). Patients with TH more often had metastasis to the lymphnodes of group 6 (with TH36 (50.0%), without TH 43 (39.8%), p <0.05), and in patients without TH, more often in lateral cervical lymphnodes (with TC 7 (9.7%), without TH 31 (28.7%), p <0.05).Conclusions. 1) PTC with TH more often occur in women. 2) PTC with TH has a less aggressive course regarding the size of the tumor node, intratireoid and extrathyroid invasion, multifocal growth, and metastasis in lateral cervical lymphnodes.

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