Presentation
Neck swelling post right hemithyroidectomy.
Patient Data
A well-defined hypoechoic subcutaneous ovoid lesion is seen anterior to the left thyroid lobe. It measures 11x 7 mm. another similar but smaller is seen in the contralateral right side subcutaneously. Both are seen anterior to the strap muscles with no signs of an invasion. They show peripheral and scanty intralesional vascularity.
Two subcutaneous nodules are seen subcutaneously as described in the previous US anterior to the strap muscles. They show homogenous intense enhancement as the native thyroid tissue. No pathologically enlarged cervical lymphadenopathy.
After discussing this cytological result with the cytologist, he reported that the examined tissues of the thyroid nodules are bizarre in nature and very suspicious for malignancy and the patient is in need of histopathological study. The patient infomed that he had an unavailable histopathological report of malignant nature.
Case Discussion
Subcutaneous implantation of metastatic deposits of follicular variants of papillary thyroid cancer is very rare. Actually, the two subcutaneous nodules were diagnosed as tumor recurrence and managed on this basis. Such cases establish the need for surgeons to take into consideration the tumor-free technique during the operation, and to a great extent prevent the occurrence of implantation recurrence. It is well known that thyroid cancer in a pediatric patient raises the possibility of an underlying syndrome, e.g. MEN, but the status in this patient is not known.