Papillary thyroid carcinoma

Case contributed by Dr Bruno Di Muzio

Presentation

Staging workup for a patient with a recent diagnosis of colorectal carcinoma.

Patient Data

Age: 45 years
Gender: Male
Nuclear medicine

FDG PET-CT (selected images)

Selected images of an FDG-PET CT study demonstrates a region of increased uptake in the left thyroid lobe and also some uptake within some ipsilateral lymph nodes. The remainder of the study (not shown) showed uptake in the rectum/sigmoid (the primary tumour), in perirectal lymph nodes, and some peritoneal implants. 

Ultrasound

Thyroid ultrasound

Targeted neck ultrasound confirms a circumscribed predominantly hypoechogenic nodule in the left thyroid lobe which shows some peripheral vascularity. No other thyroid suspicious lesions were seen. Left level III/IV lymph node with no fatty hilum identified. Both lesions were sampled with FNA. 

Case Discussion

This patient has been treated with the rectal tumour resection, hyperthermic intraperitoneal chemotherapy (HIPEC), and chemotherapy for the colorectal disease. FNAs of the neck have demonstrated papillary thyroid carcinoma

Further thyroidectomy and neck dissection has been performed: 

MICROSCOPIC DESCRIPTION: 1-3. Sections show unremarkable parathyroid tissue admixed with adipocytes. There are no atypical features. 4. The tumour is a conventional papillary thyroid carcinoma comprising papillae and cords of columnar cells within fibrotic stroma. Tumour cells have crowded, overlapping nuclei with irregular nuclear borders, grooves and chromatin clearing. Lymphovascular invasion is present. Perineural invasion is not seen. Tumour extends into surrounding fat but there is no invasion of skeletal muscle. Tumour is within 0.5mm of the posterior margin. A 1mm focus of papillary carcinoma is also seen in the left lobe away from the main tumour focus. The remaining thyroid is unremarkable. A small area of normal parathyroid tissue is seen on the right side. 5. Sections show seven of ten lymph nodes with metastatic papillary carcinoma, 1-7mm in size. Extranodal extension is not present. 6. Sections show one of sixteen lymph nodes with metastatic papillary carcinoma, 13mm in size. Extranodal extension is not present. 7. Sections show one of six lymph nodes with metastatic papillary carcinoma, 10mm in size. Extranodal extension is not present. 8. Sections show six of nine lymph nodes with metastatic papillary carcinoma, 2-13mm in size. Extranodal extension is not present. 9. Sections show six lymph nodes with no evidence of malignancy.

DIAGNOSIS: Papillary thyroid carcinoma - Arising in left mide lobe - 15mm maximum dimension - Lymphovascular invasion present - Narrowly clear of margins - No invasion of strap muscles - Separate 1mm focus within left lobe, clear of margins - 15 of 47 lymph nodes with metastatic carcinoma, 1-13mm in size, no extranodal spread; (central 7/10, 2A 1/16, 3 1/6, 4 6/9, 5 0/6). Small amount of normal parathyroid tissue.

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Case information

rID: 55438
Case created: 6th Sep 2017
Last edited: 5th Dec 2017
System: Head & Neck
Inclusion in quiz mode: Included

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