Presentation
Case of painless thyroid swelling for the last 2 years. Came for one year follow up.
Patient Data
There are two solid, echogenic lymph nodes at the left level III, IV. They show a loss of hilar fat without necrosis/ calcification/ periadenitis.
There is an ill-defined heterogeneous hypoechoic-isoechoic lesion in the thyroid gland involving caudal half of its left lobe. There are tiny echogenic foci in this lesion. There is no halo around the lesion. There is suspicious extrathyroid spread along the posterior side of the left lobe.
The isthmus of the thyroid gland shows a well-defined, heterogenous isoechoic lesion ( 24 x 20 x 11 mm ) which is wider than taller. There is a halo around the lesion. There are no necrosis/ calcification foci.
There is a subcentimeter sized spongiform lesion in the thyroid gland right lobe upper pole. There is a mildly hypoechoic subcentimeter sized lesion in the thyroid gland right lobe lower pole.
Case Discussion
A female patient with a known thyroid gland lesions came for annual follow up. Previous year ultrasound (done somewhere else) reported multinodular goiter involving the isthmus and the left lobe. FNA from the isthmus revealed a benign nodule one year back.
The ultrasound (posted above) shows the thyroid gland left lobe lesion with microcalcifications along with echogenic solid lymph nodes on the left side of the neck. The findings favor papillary thyroid carcinoma and metastatic cervical lymphadenopathy.
FNA was suggested from the left-sided thyroid gland lesion as well as from the left-sided neck lymph nodes. Thyroid gland FNA was suggestive of papillary thyroid carcinoma (The Bethesda system of reporting thyroid cytopathology, Category VI).
Nodal FNA revealed metastatic papillary carcinoma.