Presentation
Slowly growing neck mass.
Patient Data
Massive complex neck mass arising from the left hemithyroid gland, characterized by soft tissue with irregular margins and small calcifications with a large, frond-like soft tissue anterior projection and branching irregular cysts containing variable amounts of complex layering material and wall thickening. Smaller complex cysts extend inferiorly into the thoracic inlet.
Compressing and displacement of the trachea and esophagus. Left vocal cord palsy indicating invasion of the left recurrent laryngeal nerve. Smaller nodule in the right hemithyroid. Left cervical adenopathy. Borderline axillary and prepectoral lymph nodes.
Case Discussion
Dramatic presentation with several features typical for a papillary thyroid carcinoma, including irregular soft tissue with calcifications replacing the left hemithyroid and multiple complex cysts. Cervical adenopathy is concerning for local spread, and I am unsure if the axiallary/preprectoral lymph nodes are related or due to a systemic/reactive process (a full staging exam would be appropriate).