Papillary thyroid carcinoma: invasive

Case contributed by Dr Ian Bickle

Presentation

Several episodes of frank haemoptysis. CT chest performed.

Patient Data

Age: 64
Gender: Male

Calcified nodule in the left lobe of thyroid.

The left lobe is diffusely low attenuation extending into the isthmus.

Soft tissue extension into the left subglottic region.

Annotated image

The soft tissue extension from the thyroid gland into the trachea is indicated by the red arrows.

An ultrasound guided FNAC of the left lobe of thyroid was undertaken.

Photo

Endoscopic assessment.

Irregular mass in the left subglottic region with overlying blood products.

Normal vocal cords.

Calcified left thyroid nodule.

The whole left lobe has altered T1 signal in keeping with diffuse infiltrative tumour involvement.

This is contigous with soft tissue extending into the subglottic space, which is causing approximately 50% luminal stenosis.

Photo

Total thyroidectomy and larynectomy undertaken.

The extension of the thyroid tumour into the trachea is demonstrated without involvement of the vocal cords.

Histology confirming invasive papillary carcinoma of the thyroid gland.

Case Discussion

Papillary thyroid cancer usually occurs in the middle-aged, with a peak incidence in the 3rd and 4th decades. It is more common in women.  It accounts for the majority of thyroid neoplasms.

It is unusual for papillary thyroid cancer to invade the trachea which is a more common attribute of anaplastic tumours.

MRI is infrequently performed, however as this case demonstrates it is more exquisite at delineating the extent of the disease.

In this case tracheal invasion was the cause of the patient's presenting complaint of haemoptysis.

A total thyroidectomy and laryngectomy was performed.

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Case information

rID: 37655
Case created: 16th Jun 2015
Last edited: 19th Mar 2017
System: Head & Neck
Inclusion in quiz mode: Included

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