Metastatic papillary thyroid cancer

Case contributed by Jayanth Keshavamurthy

Presentation

Post-operative chest radiograph.

Patient Data

Age: 70 years
Gender: Female

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

Chest X-ray

x-ray

There is a JP drain overlying the left side of the neck. Surgical clip left side of the neck.
There are atherosclerotic calcifications in the aortic arch. Also seen are calcified left paratracheal and periaortic lymph nodes. Calcified lesions overlying the lungs.

Miliary nodules from metastatic thyroid disease are better seen on cross-sectional imaging (see below).

There are degenerative changes in the thoracic spine. No pneumothorax or pleural effusion.

Chest CT with findings related to disease

ct

Miliary lung nodules from metastatic disease.

Calcified lung nodules are likely from metastatic papillary thyroid cancer.

FDG study and CT

Nuclear medicine

FDG avid uptake in the left retropharyngeal lymph node.

Case Discussion

Total thyroidectomy 5 years prior to study for a 6 cm thyroid nodule followed by radioactive iodine. Recurrent metastatic disease was addressed by central and left lateral neck dissection with a retropharyngeal lymph node removal 3 years later.  The patient had a PET scan which revealed left oropharyngeal/retropharyngeal node as well as miliary lung lesions. Her laboratory values included thyroglobulin Ab 26 and thyroid peroxidase Ab 35.

Final Pathological Diagnoses:

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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