Left Thyroid Lobe Research Articles

ODP497 Multifocal Papillary Thyroid Carcinoma with Anaplastic Dedifferentiation

Abstract A 71-year old male with a two-year history of progressively enlarging right thyroid mass presented with hemoptysis. Chest CT scan showed multiple pulmonary nodules and enlarged right thyroid mass with intrathoracic extension. A fine needle biopsy of the right thyroid mass showed atypia of undetermined significance. Patient underwent total thyroidectomy and complete resection of the intrathoracic component. Histopathology reported multifocal Papillary thyroid carcinoma, right lobe, encapsulated follicular variant (9cm) with extensive and vascular invasion. There was also invasion of the left thyroid lobe, follicular variant, infiltrative (0.6 cm) and conventional (0.6 cm). Extrathyroidal extension to skeletal muscle and lymphovascular invasion was present. The tumor showed areas with more solid growth patterns and some ball-like clustering. Consequently, immunostaining was done which showed the following results: positive for cytokeratin, thyroglobulin and TTF-1 consistent with papillary morphology. The more solid areas with significant nuclear pleomorphism, necrosis and increased mitotic activity (atypical forms) support the focal progression to an anaplastic carcinoma. The final histologic reading showed multifocal papillary thyroid carcinoma with focal (20%) progression to undifferentiated (anaplastic) thyroid carcinoma. Two weeks postoperatively, he developed a 4cm×2cm manubrium mass. There were also several metastases on the brain, pancreas, liver and bones seen on FDG PET scan. One month postoperatively, TSH was 15 uIU/mL Thyroglobulin >500 uIU/mL, anti-thyroglobulin <0.20 ng/dl. Due to the widespread metastases even involving the brain, the multidisciplinary team decided to start treatment with Lenvatinib and check for BRAF V600E gene mutation for a more definitive treatment. He was started on Levothyroxine. He also underwent 27 cycles of radiation therapy to the manubrium mass and was given Denosumab 120mg subcutaneously to stabilize the bone and provide pain relief. BRAF gene mutation analysis result came back negative in two weeks. Close monitoring of his sensorium was done. However, he deteriorated clinically and he succumbed to sudden cardiac death two months after. Presentation: No date and time listed

Metastasis of Mixed Adenoneuroendocrine Carcinoma of the Uterine Cervix to Thyroid Gland.

The thyroid metastasis from cervical cancer is extremely rare compared to other organs. It is sometimes difficult to distinguish primary tumors from metastases, as most metastatic thyroid nodules are asymptomatic. In this case, a 54-year-old woman had undergone radical hysterectomy due to cervical tumor of stage IB1 mixed adenoneuroendocrine carcinoma (MANEC) 5 years ago. After 3 years, ultrasound examination revealed a suspicious malignant nodule in the left lobe of thyroid gland at regular postoperative follow-up. This patient had no obvious clinical symptoms. The ultrasonography (US)-guided core needle biopsy (CNB) of the thyroid nodule was performed on the patient. The immunohistochemistry analyses revealed that it was poorly differentiated small-cell neuroendocrine carcinoma (SCNEC). Subsequently, the patient underwent left hemithyroidectomy plus isthmusectomy. The postoperative pathology and immunohistochemistry, combining with clinical history, confirmed that the thyroid nodule was a metastasis from cervical MANEC. Conventional chemotherapy and regular follow-up were carried out after the operation. The patient was readmitted 1 year later for pancreatic metastatic lesions and died 1 month after surgery. Early detection of metastatic cancer is potentially helpful, and when necessary, ultrasound-guided puncture biopsy can be utilized to further diagnose metastatic thyroid cancer.

THYMOMA AS A NECK SWELLING - A SURGICAL DILEMMA

Thymomas are rare neoplasm of Anterior Mediastinum originating within the epithelial cells of the thymus and it is exceedingly uncommon in children and young adults, rises in incidence in middle age, and peaks in the seventh decade of life. One third to one half of patients present with an asymptomatic anterior mediastinal mass on chest radiograph, one third present with local symptoms (cough, chest pain, superior vena cava syndrome, and/or dysphagia), and one third of cases are detected during the evaluation of myasthenia gravis. Myasthenia gravis is a disease of the neuromuscular junction which causes progressive weakness of muscles. Indication of thymectomy for all cases of myasthenia gravis has been a topic of debate but thymectomy is indicated in all cases with thymomas no matter the stage of myasthenia gravis. We present a rare case of Thymoma as 70/Female patient presented with a painful lateral neck swelling on left side with Myasthenia Gravis and Dysphagia. We couldnt find any similar cases in literature. USG Neck was done which showed a 5.3x5.3x4.3cm multilobulated mass in left supraclavicular region inferior to left lobe of thyroid with calcification suspicious of malignancy which possible origin from Thyroid and Parathyroid Gland. On CECT scan there was 4.1x3.4x3.8 cm isodense mass which seems to be arising from lower pole of left thyroid lobe and extending in surrounding structures. FNAC was s/o Thymoma type A. Patient underwent Sternotomy- entire tumor along with thymus was dissected, however posteriorly it was densely adhered to Left Vagus Nerve Giving Suspicion of Neurofibroma. Specimen Sent for Frozen Section which confirmed it to be Type A thymoma. Histopathology Report concluded the diagnosis- Type A Thymoma. Post Operative was Uneventful. Thus, we conclude a rare case of Neck Swelling with series of event to reach to a Final Diagnosis of Thymoma.

A sign of love from the thyroid

A 41-year-old woman presented to our office, around valentine’s day, complaining of cervical discomfort. On physical examination, a midline cervical mass was identified. A cervical ultrasonography (Figure 1a and 1b) showed a heart shaped hypoechogenic colloidal cyst (3.4 X 3.5 X 3.5 cm) in her left thyroid lobe containing a hyperechogenic heart shaped colloidal aggregation. A fine needle aspiration was performed, and 21 ml of colloidal liquid was removed. The patient’s symptoms resolved soon after the procedure.

A case report of spindle cell variant of medullary thyroid carcinoma in Hashimoto’s thyroiditis

Background: Hashimoto’s thyroiditis is a common autoimmune thyroid disease and often coexists with differentiated thyroid carcinomas, but the link between medullary thyroid carcinoma and Hashimoto’s thyroiditis is not established, so the cases of these diseases occurring simultaneously are rare in the literature. Here we report a case of spindle cell variant of the medullary thyroid carcinoma in underlying Hashimoto’s thyroiditis. Case presentation: A 65-year old female was followed up in our Center because of hypothyroidism due to thyroid autoimmune disease. On neck ultrasound, an 11 X 7 X 9 mm hypoechoic nodule in the left thyroid lobe was found, and cytology was suggestive for spindle cell variant of medullary thyroid carcinoma. Calcitonin serum level was measured, and found elevated. After total thyroidectomy, pathology was compatible with spindle cell medullary thyroid carcinoma and Hashimoto’s thyroiditis. Conclusion: Medullary thyroid carcinoma in Hashimoto’s thyroiditis is rare, but must not be taken out of consideration when thinking about routine ultrasound check-ups in patients with non-nodular autoimmune thyroid disorder.

The utility of strain elastography in differentiation between healthy thyroid parenchyma and residual/recurrent thyroid parenchyma disorders

Objectives: This study is designed to evaluate the utility of strain elastography in the differentiation between healtly thyroid parenchyma and residual/recurrent thyroid parenchyma after partial thyroidectomy. Methods: Gray-scale ultrasonography (B-mode US) and strain elastography were performed in patients who had undergone partial thyroidectomy due to benign thyroid diseases and volunteers as a control group without any throid disease. The elasticity scores and strain rate values of thyroid parenchyma were obtained in two groups and compared. The strain elastography of the patient and control groups were analyzed with the Pearson Chi-Square test. Strain rates for both groups were compared with the Manny-Whitney U test. Ethical approval and permissions were obtained from legally authorized representatives and patients. Results: There were 94 cases in total, 47 cases (4 male, 43 female; mean age: 51 ± 12.9 years, ranging between 25-79) in the patient group and 47 cases (11 male, 36 female; mean age: 36.8 ± 11.5 years, ranging between 19-71) in the control group. The strain rate of the right (2.22 ± 1.9) and left thyroid lobe (1.9 ± 1.9) were significantly higher than control group (1.05 ± 0.6 and 0.8 ± 0.5, respectively; p = 0.002 and p = 0.043). Conclusions: The elasticity of thyroid parenchyma after partial thyroidectomy differs from healthy thyroid tissue, which may be helpful in differentiation between residual parenchymal changes in thyroid from malignant lesions with strain elastography.

Brown's tumor of mandible as a manifestation of primary hyperparathyroidism

Abstract Hypercalcemia and increased or abnormal serum levels of parathyroid hormone are indicators of primary hyperparathyroidism (HPT). Brown tumor of bone is a rare nonneoplastic lesion that arises due to abnormal bone metabolism caused by HPT. The reported prevalence of brown tumor is 0.1%. In today's world, however, skeletal illness caused by primary HPT is quite rare. Patient consent was obtained. Here, we present a rare case of bony lytic lesion in the mandible that raised suspicion of giant cell lesion, compelling further investigations. The patient underwent blood investigations which revealed hypercalcemia. Ultrasonography revealed a hypoechoic mass on the left inferior thyroid lobe. An incisional biopsy was done which revealed hemorrhagic fibrovascular connective tissue in a background of multinucleated giant cells; the mandibular lesion was classified as a giant cell lesion. A final diagnosis of Brown tumor of the mandible was made based on the investigations. The left parathyroidectomy was done. Curettage of the mandibular lesion was done surgically. The patient was on follow-up for 6 months and showed no signs of recurrence. Although Brown tumor of mandible is a rare lesion, it should be considered a differential diagnosis for osteolytic lesions of the jaw. Early diagnosis can help to prevent late outcomes of the disease.

Determination of Fit to Work Status for Thyroid Cancer Survivor: A Case Study in Occupational Health Setting

Introduction: A thyroid cancer worker after undergoing ablation procedure requires specific recommendation when return to work. This study aims to determine a framework of the fitness to work (FTW) status from the occupational health nursing viewpoint. The implication is to help answer the question whether the worker is fit to work as a cancer survivor.Methods: This study used a Case Study method with descriptive design. The sample was a therapist associate whose scope of work was office-based. The method applied the Test Blueprint of case management assessment by the American Board of Occupational Health Nursing (ABOHN) standard combined with the Glasgow Coma Scale (GCS) after the ablation procedure as the instrument. We analyzed the case with The Fit to Work (FTW) Model of Hybrid Model.Results: FTW assessment showed vital signs within normal limits. Immunological examination found abnormalities. The left and right thyroid lobes were not visualized and there was no mass in the surgical bed. The client was advised for specialist follow up after 6 months. After the ablation procedure, the employee had a verbal communication disorder. The Glasgow Coma Scale (GCS) recorded point 5 hoarseness with decreased tone quantity was about 90%. Based on the medical report and his specialist’s advice, 6 months after ablation the employee’s medical condition showed improvement.Conclusion: With the At-Will Model of Hybrid as the framework to determine the fitness status, we recommended to declare him fit with restrictions and advised for regular fitness status update.

Thyroid Volume Measurements in Normal Adult Females of Gujrat, Pakistan

Thyroid gland volume assessment is considered crucial in a variety of pathological circumstances including thyroiditis, iodine deficiency, and goiter, and may vary with age and weight. Objective: To evaluate the normal adult female’s thyroid volume using ultrasonography. Methods: It is a cross-sectional descriptive study conducted at the private healthcare setup of Gujrat Pakistan. After informed consent data was collected over four months. A sample size of 42 patients was calculated via a convenient sampling approach by taking the mean from previous related studies. The data was entered and analyzed by using SPSS version 20. The study included normal adult females and excluded thyroid diseases, neck swelling, and atypical thyroid volumes. Results: This study included 42 females who had a standard thyroid gland. Findings of thyroid volume showed a positive strong correlation between thyroid volume, age, and weight. The mean weight of patients was 67.66±10.3 Kg and the mean age of patients was 42.07±14.5 years. The mean volume of the right lobe of the thyroid was 3.70±0.96ml, mean volume of left lobe of thyroid was 3.51±0.94 ml and mean volume of total thyroid was 7.22±1.90 ml. Paired Sample t-test of right and left thyroid lobes volume was calculated having with the significance of (.000). Conclusions: It is concluded that ultrasound is the preferred approach for the evaluation of thyroid volume. The thyroid volume had a positive strong correlation with weight and age.

Is There a Relationship Between Vascularity and Echogenicity of Thyroid Lobes in Ultrasonography With BMI? A Large Retrospective Cohort Study

Objective: The aim of this study was to investigate the relationship between sonographic vascularity and echogenicity of the thyroid lobes, compared with a participant’s body mass index (BMI). Materials and Methods: A total of 3722 participations, with varied BMI, were included in the study. For all the participants, the thyroid-stimulating hormone (TSH) was measured, as well as thyroid volume, sonographic echogenicity, and vascularity were recorded. A multiple regression analysis was performed to assess the relationship between the sonographic vascularity and echogenicity, of thyroid lobes, compared with the participants’ BMI. Results: The serum TSH values were significantly higher in patients with a BMI > 25 kg/m². The sonographic vascularity and volume of thyroid lobes were positively correlated the participants’ BMI ( P < .005). Sonographic heterogenicity of the left thyroid lobe, right thyroid lobe, and the isthmus were positively associated with BMI ( P < .005). However, the hyper/hypoechogenicity did not demonstrate any significant correlation with BMI ( P > .005). Conclusion: Based on the findings of this study, it was concluded that thyroid volumes may have a significant positive relationship with BMI. In overweight participants (i.e., BMI more than 25), thyroid echogenicity was more heterogeneous and their thyroid lobes were more hypovascular.

Intrathyroidal Parathyroid Carcinoma: Case Report and Literature Review.

Intrathyroidal parathyroid carcinoma (PC) is a rare malignancy that is usually difficult to diagnose. We present a case of a 31-year-old male with a history of hyperparathyroidism who was found to have intrathyroidal PC upon review of immunostains along with a review of the current literature. A systematic review of the literature utilizing the PubMed database identified 24 relevant, full-text articles. 25 cases were analyzed, including our own report. The case of a 31-year-old man with a history of hyperparathyroidism managed with subtotal thyroidectomy and subtotal parathyroidectomy who had persistent hypercalcemia and elevated parathyroid hormone. Abnormal radiotracer uptake was noted in the left thyroid gland. Neck exploration with left parathyroidectomy and revision thyroidectomy was performed. A candidate left inferior parathyroid was found within the left thyroid lobe remnant and identified as parathyroid carcinoma. Immunostains determined an intrathyroidal parathyroid carcinoma. The literature review shows the average presenting age was 50.9years. 54.17% (CI, 43-82%) of affected patients are female. Right-sided thyroid involvement is seen in 54.17% (CI, 34-74%) of cases. The inferior aspect of the thyroid is involved in 66.67% of cases (CI, 53-89%). Intrathyroidal parathyroid carcinoma is a rare and challenging diagnosis due to similarities with other more common endocrine abnormalities. This review found that the inferior parathyroid is more likely to be located within the thyroid gland. Surgeons may consider aberrant anatomical locations, including intrathyroidal locations, for the inferior parathyroid glands.

D2 MTE3 Case 7: Localising parathyroid gland

A 56 year old lady walked into our clinic with history of bilateral renal calculi and generalised weakness of 6 months duration. She was known to have well- controlled hypertension on medications. Clinical examination did not reveal any positive findings. She had been seen by a visiting Endocrinologist in Maldives twice, administered calcium and vitamin D. She also underwent tests to rule out osteoporosis, (17/09/2019) PTH- 180 pg/mL [10.0-65.0] and Serum Calcium levels: Total-11.3 mg/dl [8.0-10.5], Ionised-6.12 mg/dl [4.40-5.30], Vitamin D: 38.6 ng/ml [30-80], renal function was normal. She underwent CT Contrast for Neck & Thorax for Parathyroid adenoma on 28/09/2019 which showed suspicious nodular enhancing lesion in the left lobe of the thyroid (7x4 mm in the trachea-oesophageal groove). In view of her raised PTH, Sestamibi scan done revealed no definite evidence but Methyl-Choline scan showed hypodense area in the left lobe of the thyroid. She therefore underwent surgical exploration of left minimally invasive Parathyroidectomy on 28/09/2019. Frozen section showed Parathyroid hyperplasia hence underwent 3 and a half parathyroid excision on 30/09/2019. HPE report did not reveal any parathyroid adenoma. Post-operatively, Serum PTH and Calcium levels remained high (229.5 and 11.5 mg/dl, Ionised-5.97 mg/dl). Patient later underwent excision of lymph node and left lobe of thyroid on 02/01/20 in view of persistent hyperparathyroidism. However, on biopsy it showed reactive nodes and thyroid tissue with colloid filled follicles. We still faced persistent elevation of Serum PTH and Calcium. Hence it was decided to start the patient on Cincalcet 30 mg daily after a joint meeting with surgical and nephrology consultants. Patient was not able to follow up due to the covid pandemic. Presently, her PTH -288.2, Serum Calcium-11, Vitamin D- 33.2, Phosphorus-2.9 (October 2021). This clearly shows the treatment has not been effective and we are dealing with persistent hypercalcaemia, hyperparathyroidism and no localisation. We are also faced with the problem of post-operative management of hypercalcaemia.How to manage persistent hypercalcaemia and hyperparathyroidism?How to proceed with localisation of the primary source of PTH?

Abstract 38: Sellar mass – An unusual presentation of metastatic thyroid carcinoma

Background: Sellar metastases are rare. They may precede the diagnosis of primary malignancy in 20-30% of the cases.Case Report: A 47year female presented with ptosis and diminished vision of right eye. She had a mass in the sellar region extending into the suprasellar area. Her serum prolactin level was 215 ng/ml. She had galactorrhea, secondary hypothyroidism, secondary hypocortisolemia. A trial of cabergoline was given for 6 weeks. She had progressive diminution in vision and a repeat MRI brain showed an increase in the size of the mass. She underwent tumour decompression. The histopathology was suggestive of metastatic tumor of the sella. Immunohistochemistry of pituitary biopsy was positive for CK and TTF-1 (nuclear). On evaluation, FDG-PET CT scan showed metabolically active nodule in the left lobe of thyroid. Ultrasound scan of thyroid showed multinodular goiter (TIRADS 5). FNAC of the left thyroid nodule was suggestive of Hashimoto's thyroiditis. With a suspicion of primary thyroid malignancy, total thyroidectomy was performed. Surgical biopsy report of thyroid showed well-differentiated follicular carcinoma. Radioablation with I-131 was performed for residual thyroid tissue in the neck and metastases.Conclusion: Metastasis to the pituitary can be a rare presentation of thyroid cancer. It may mimic a pituitary adenoma.

Quantitative analysis of thyroid gland blood supply in children and adolescents

Aim 
 This study aims to determine the reference vascularization index (VI) values for the thyroid gland in healthy children and adolescents using Super microvascular imaging (SMI). It was also investigated the correlation between thyroid vascularity and thyroid lobe volumes, age, sex, weight, height, and body mass index (BMI). 
 Material and Methods
 One hundred and twenty-four children and adolescents without a thyroid gland, systemic disease, and medical history affecting the thyroid gland were included in the study. Participants with abnormal thyroid function tests were excluded from the study. Age, gender, height, and weight were recorded before ultrasonography and SMI examinations. After the grayscale ultrasonography, VI values for each participant were obtained using SMI. The association between the VI and thyroid lobe volumes, age, sex, weight, height, and BMI values were analyzed.
 Results
 Median values of the age, height, weight, and BMI of 124 participants were 10 (6-12) years, 1.3 (1.2-1.52) m, 30.5 (21-47) kg, 17.55 (15.37-21.14) kg/m2, respectively. Median (IQR) values of the left and right thyroid lobe volumes were 1.4 (0.9-2.07) mL and 1.9 (1.2-3.07) mL, respectively, and the mean VI value was 5.31±1.84%. There was no significant association of VI values with the thyroid lobe volume. Also, there was no relation between the mean VI values and the auxological parameters.
 Conclusion
 This study defines the VI values of thyroid glands in healthy adolescents and children. It also demonstrated no correlation between VI values of the thyroid gland and thyroid lobe volume, sex, age, weight, height, and BMI.

Features of diagnostics and treatment of thyrotoxicosis in patients with severe comorbid pathology: clinical case

Objective. To demonstrate the stages of diagnostics and successful treatment of thyrotoxicosis in a patient with severe comorbid pathology.
 Materials and methods. A clinical case report of a patient with toxic goiter is presented.
 Results. To specify the state of the thyroid gland, diagnostic and laboratory methods were applied: ultrasound examination (thyroid volume increased up to 182 cm2, isoechogenic nodule in the left lobe up to 1 cm, thyroid vascularization increased), spiral computed tomography (picture of diffuse nodular goiter with partial retrosternal location of the left thyroid lobe), hormone studies, the results of which revealed thyrotoxicosis. Thyroidectomy was subsequently carried out. Both thyroid lobes with isthmus were removed step-by-step with technical difficulties and high bleeding of tissues. The patient was discharged in 10 days in a satisfactory state.
 Conclusions. Thyrotoxicosis is certainly a complex surgical pathology, in which correct assessment of the diagnosis by instrumental, clinical and laboratory methods is required, as well as successful surgical intervention. Not only normalization of hormonal status of a patient has to be taken into account, but also the possibility of disease relapse, contraindications due to age, physiological status, and comorbid abnormalities.

Curious case of Retrosternal Colloid Goitre

Background: Retrosternal goitre is considered to be a rare entity. It is a slow growing enlargement of the thyroid gland which remains asymptomatic for many years. Symptoms are mainly due to compression of airways and oesophagus. Surgical management with the removal of the involved lobe is considered sufficient. Summary: Here we report a case of a 33 yrs. old lady who presented to us with complaints of neck pain, facial flushing, difficulty in breathing and vague body ache. Clinical examination was within normal limits. The patient was referred to orthopedician for further evaluation. MRI cervical spine was done which was suggestive of large swelling in left lobe of thyroid with retrosternal extension causing deviation of trachea to opposite side. FNAC was done which was inconclusive. The involved lobe was removed surgically with frozen section suggestive of Colloid goitre. Conclusion: Retrosternal goitre are slow growing enlargement of thyroid gland which may present with vague symptoms, best managed surgically often followed relief from the symptoms post-surgery.

Exophytic and Fungating Papillary Thyroid Carcinoma: A Rare and Complex Presentation of a Well-differentiated Malignancy

Papillary thyroid carcinoma is the most common well-differentiated thyroid malignancy accounting for more than 80 to 90% of all thyroid tumors. It has an overall excellent prognosis owing to advances in screening via imaging and ultrasound-guided fine-needle aspiration biopsy, which have facilitated early detection, diagnosis, and surgical treatment followed by adjuvant radioactive iodine therapy. Exceptionally rare cases of papillary thyroid tumors may present with enormous growth due to delayed consultation and, thus, late diagnosis, posing a challenge to definitive management, quality of life, overall survival, and prognosis. We report a case of a 35-year-old woman who presented with a 4-year history of a bleeding exophytic and fungating anterior neck mass. Computed tomography showed a fungating mass arising from the left thyroid lobe that measured 14.1 x 14.0 x 11.1 cm with areas of necrosis and hemorrhage, left internal jugular vein thrombus formation, and compression of the left internal carotid artery. The mass causes a displacement of the trachea to the right side and multiple bilateral cervical lymphadenopathies. The patient was fully aware, and she consented to undergo wide excision, total thyroidectomy, neck dissection, and pectoralis major muscle flap reconstruction. However, she went into arrest intraoperatively attributed to massive pulmonary embolism. Papillary thyroid cancer is well known for its excellent prognosis. However, outcomes may not be favorable and can even be fatal in advanced and extensive cases. Although fungating papillary cancers are rare, they remain more common in the developing countries, where early detection and access to healthcare remains limited. They also represent a big challenge to surgeons. Even if the outcome was not good, we opted to report this case as there were many learning points. If only patients with good and excellent outcomes are reported in the literature, it will overestimate the treatment success of these complex cases.

Fungal Granulomatous Thyroiditis in A Renal Transplant Recipient

Fungal granulomatous thyroiditis is a relatively rare entity. Aspergillus is the fungus that most commonly affects the thyroid gland and is generally missed until autopsy. Aspergillus granulomatous thyroiditis diagnosed antemortem and treated in renal transplant recipient patients are extremely rare. We report a 35-year-old female renal transplant recipient who presented with fever, generalized weakness, and loss of appetite; her clinical examination revealed a left thyroid lobe nodule. Fine needle aspiration cytology (FNAC) microscopic examination of the nodule revealed fungal granulomatous thyroiditis. Subsequent examination of FNAC material with special stain Gomori`s Methenamine Silver (GMS), 10% KOH (potassium hydroxide) mounting, and culture confirmed the presence of fungus Aspergillus flavus. This case emphasizes the need for thorough clinical examination and the utility of FNAC in examining thyroid nodules. J Microbiol Infect Dis 2021; 11(4):234-238.

A 17-Year-old Boy With Nodular Lesions in the Thyroid and Lymphadenopathy.

A 17-Year-old Boy With Nodular Lesions in the Thyroid and Lymphadenopathy.

An aggressive case of Warthin-like variant of papillary thyroid carcinoma (PTC)

Abstract Introduction/Objective Warthin-like variant of PTC is a rare subtype of PTC, characterized by papillary growth lined with oncocytic neoplastic cells and lymphocytic rich stroma in the stalks of the papillae. It is frequently associated with Hashimoto thyroiditis and has good prognosis due to lower risk of metastasis. An association with BRAF V600E mutation has been reported. Here we report an aggressive case of Warthin-like variant of PTC. Methods/Case Report A 33-year-old Hispanic female presented with a progressively expanding neck mass, difficulty swallowing, voice hoarseness, and neck pain. Ultrasound showed a 3.8 cm left thyroid nodule which on biopsy was positive for PTC. Laboratory tests were positive for anti-peroxidase and anti-thyroglobulin antibodies. A total thyroidectomy was performed. Grossly, the left thyroid lobe nodule was well-circumscribed, unencapsulated, and firm with solid homogenous gray-tan cut surface. Microscopically, the nodule consisted of large eosinophilic cells demonstrating characteristic PTC nuclear features, arranged in papillary structures with the cores packed with prominent lymphoplasmacytic infiltrate consistent with Warthin-like variant of PTC (figure). Separate sub-centimeter foci of PTC with similar features were identified in a background of chronic lymphocytic thyroiditis. Central and left neck dissection showed extensive lymph node metastasis which had features similar to the primary tumor but with less pronounced lymphoplasmacytic cores. The patient is currently 6-month post operation and is receiving iodine ablative therapy. Results (if a Case Study enter NA) NA Conclusion Molecular analysis of the tumor may aid in identifying molecular aberrations responsible for the aggressive nature in this case and potentially guide treatment.