Metastatic papillary thyroid cancer

Case contributed by Dr Jayanth Keshavamurthy

Presentation

Post operative chest radiograph.

Patient Data

Age: 70 years old
Gender: Female

Identify the findings.

Modality: X-ray

There is a JP drain overlying the left side of the neck. Surgical clip left side of the neck.

There is atherosclerotic calcifications in the aortic arch.

Also seen are calcified left paratracheal and periaortic lymph nodes.

Calcified lesions overlying the lung. The miliary nodules from metastatic thyroid disease is better seen on cross-sectional imaging (see below).

There is degenerative changes in the thoracic spine.

No pneumothorax or pleural effusion.

IMPRESSION:
No pneumothorax after procedure.
 

2 findings related to papillary thyroid cancer

Modality: CT
  • Miliary lung nodules from metastatic disease.
  • Calcified lung nodules likely from metastatic papillary thyroid cancer.
Modality: Nuclear medicine

FDG avid left retro pharyngeal lymph node.

Case Discussion

Total thyroidectomy 5 years ago for a 6 cm thyroid nodule followed by radio active iodine. Recurrent metastatic disease was addressed by central and left lateral neck dissection with a retropharyngeal lymph node removal 3 years later.  She presents today  after PET scan  revealed left oropharyngeal/retropharyngeal  node as well as miliary lung lesions. Thyroglobulin Ab 26 and Thyroid Peroxidase Ab 35.

Final Pathologic Diagnosis

A) LEFT PAROTID TAIL LYMPH NODE (BIOPSY):

No malignancy identified in one lymph node (0/1).

B) LEFT RETROPHARYNGEAL LYMPH NODE (EXCISION):

Metastatic papillary thyroid carcinoma involving one lymph node (1/1).

 

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Case Information

rID: 44639
Case created: 29th Apr 2016
Last edited: 30th Apr 2016
Systems: Head & Neck, Chest
Inclusion in quiz mode: Included

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