Presentation
Palpable cervical mass.
Patient Data
The whole right lobe and isthmus of thyroid gland have altered signal in keeping with diffuse infiltrative tumoural involvement. This is contiguous with soft tissue extending into the midline subcutaneous region and right strap muscles. Right anterolateral aspect of trachea shows abnormal signal intensity and right aspect of thyroid cartilage shows abnormal signal intensity and enhancement. There is an enhancing lymph node with isosignal intensity with thyroidal mass at left carotid space (metastasis). Multiple bilateral cervical and right paratracheal lymph nodes are noted too. Abnormal rim enhancing lesion at superior segment of RUL is seen.
Large cold nodule on the right lobe and isthmus.
Left thyroid lobe nodule biopsy showed papillary thyroid cancer.
Case Discussion
Papillary thyroid carcinoma is the most common thyroid cancer (80%), and most commonly PTCs are totally asymptomatic. Cervical lymph node metastasis is present in 50% of small PTCs and in 75% of the larger PTCs. The presence of lymph node metastasis in the neck has a more frequent recurrence rate, but no higher mortality rate. PTCs that invade the adjacent tissues next to the thyroid gland have worse prognosis due to high local recurrence rate. Iodinated contrast materials, used in CT scans, interfere with radioiodine scans. The iodine used for CT scan will be eliminated from the body in approximately two months.
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