Papillary Thyroid Carcinoma Presenting Research Articles

A Noninvasive Encapsulated Macrofollicular Variant of Papillary Thyroid Carcinoma Presenting with Gross Lymph Node Metastasis: A Case Report and Literature Review

Dear Editor:The follicular variant of papillary thyroid carcinoma (FV-PTC) without vascular or capsular invasion is considered tohave virtually no metastatic potential or recurrence risk (1).The macrofollicular variant of papillary thyroid carcinoma(MFV-PTC) is a very rare variant of FV-PTC the behavior ofwhich appears to be similar to FV-PTC (2). However, morerecently, this phenomenon has been challenged by reports ofsystemic metastases and recurrent and fatal cases (3). We re-port a case of encapsulated noninvasive MFV-PTC that pre-sented with gross lymph node metastases, and briefly reviewthe literature. A right thyroid nodule was incidentally foundby a computed tomography scan in an 80-year-old male.Subsequently, a 3.7cm·3.6cm·3.3cm heterogeneous iso- tohyperechogenic thyroid nodule in the right lobe and a2.2cm·2cm·1.3cm right jugular lymph node, both withcalcifications, were detected by ultrasonography. Fine-needleaspiration biopsy of both lesions was performed under ultra-sonography guidance and showed malignant cells consistentwith PTC. The patient underwent a total thyroidectomy withcentral and right (levels 3–4) lymph node dissection. Thethyroidectomy specimen revealed a 3.7cm·3.2cm·2.9cmencapsulated white solid nodule in the right lobe (Fig. 1),which was entirely submitted for histological evaluation. Onhistology, the nodule was completely surrounded by a thickand focally calcified capsule, without evidence of vascular orcapsular invasion. The nodule was predominantly macro-follicular, with minor areas composed of smaller follicles. Thecells lining the macrofollicles were often attenuated withoutsignificant nuclear atypia (Fig. 1). In contrast, the cells liningthe smaller follicles were more cuboidal and had the typicalnuclear features of PTC (Fig. 1). Numerous intratumoral cal-cifications and psammoma bodies were observed (Fig. 1).Insular/solid growth, necrosis, or mitotic activity was notobserved. Two lymph node metastases were found. Thelargest one (2.4cm) was composed predominantly ofmacrofollicles, akin to the primary tumor (Fig. 1). Im-munohistochemistry was supportive of malignancy, withthe tumor cells being diffusely positive for galectin-3, andfocallypositiveforHBME-1(HectorBattiforamesothelin-1)inthe non-macrofollicular areas only. The proliferative index(Ki-67) in the primary tumor and in the larger metastasis wasvery low ( 50%) was composed ofmacrofollicles (>250lm), corresponding to the arbitrarydefinition of an MFV-PTC (2). Interestingly, that feature wasalso retained in the larger lymph node metastasis, but not inthe smaller one. In the literature, although several cases ofMFV-PTC have presented with lymph node metastasis, mostof these cases were either infiltrative and/or associated withvascular invasion (2). In the largest series of MFV-PTC of 29patients, 6 developed lymph node and 2 developed lungmetastasis (2). The metastases occurred in older patients whohad insular components, extrathyroidal extension, and vas-cular invasion. In our case, although the patient was elderly,no other risk factors were identified. To the best of ourknowledge, there are two other documented cases of encap-sulatedMFV-PTCwithoutcapsularorvascularinvasionwithlymph node and/or systemic metastasis (3). In comparison,we found no well-documented cases of conventional encap-sulated noninvasive FV-PTC with lymph node metastases. Inthe study by Liu et al. (1), the only encapsulated FV-PTC withlymph node metastasis had several foci of lymphovascularinvasion. Moreover, observing that most cases of FV-PTCwith metastatic disease had obvious invasion, Lloyd et al. (4)recommend caution in making a diagnosis of FV-PTC in theabsence of the major histopathologic features or obvious

A case of metastatic papillary thyroid carcinoma presenting with pleural, pulmonary and bone metastases

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Follicular Variant of Papillary Thyroid Carcinoma Presenting as Toxic Nodule in an Adolescent: Coexistent Polymorphism of the TSHR and Gsα Genes

Autonomously functioning, "hot", thyroid nodules are not common in children and adolescents. Such nodules are not considered alarming because they are assumed to be benign adenomas. Herein, we present a 15-year-old girl with a papillary thyroid carcinoma of 3.5 cm in diameter, which was functionally autonomous and scintigraphically hot. The patient, initially referred to our Endocrine Unit because of a thyroid nodule, returned 6 months later for symptoms of hyperthyroidism. Hyperthyroidism was confirmed biochemically. Radioactive iodine ((131)I) thyroid scintigraphy was consistent with an autonomous thyroid nodule. As per guidelines, the patient underwent surgery and a pathological examination revealed papillary carcinoma, follicular variant. The excised nodule was examined for activating mutations of the thyrotropin receptor (TSHR), Gsα (GNAS1), H-RAS, N-RAS, K-RAS, and BRAF genes by direct sequencing. No mutations were found. Nevertheless, two combined nonfunctioning mutations were detected: a single-nucleotide polymorphism (SNP) of the TSHR gene, in exon 7, at codon 187 (AAT→AAC, both encoding asparagine), and a SNP within exon 8 of the Gsα gene at codon 185 (ATC→ATT, both encoding isoleucine). Both SNPs were also identified in the germline DNA of the patient. The same SNPs were sought in the parents and brother of our patient. Her father was heterozygous for the TSHR SNP, her mother heterozygous for the Gsα SNP, and her brother was wild type. This case demonstrates that the presence of hyperfunctioning thyroid nodule(s) does not rule out cancer and warrants careful evaluation, especially in childhood and adolescence to overlook malignancy.

Metastatic papillary thyroid carcinoma with absence of tumor focus in thyroid gland

SummaryBackground:Papillary thyroid carcinoma presenting as isolated cervical lymphadenopathy with clinically and histologically normal thyroid gland is rarely reported.Case Report:We report a case of 31 years old female who presented with a left cervical mass and clinically normal thyroid gland. After inconclusive FANC, excision biopsy of her cervical lymph nodes revealed metastatic papillary thyroid carcinoma. The patient subsequently underwent total thyroidectomy with bilateral lymph node dissection. Interestingly pathological examination showed no primary carcinoma in the gland. Postoperative radioactive iodine scan revealed no other metastasis.Conclusions:Total thyroidectomy is the next best step despite clinically and radiologically normal appearing thyroid gland once cervical lymph nodes are proven to be metastatic in nature followed by a RAI therapy to treat occult foci of PTC.

A Case Report of Papillary Thyroid Carcinoma Presenting as Elevated Serum CA 19-9

본 증례는 수술 전 증가되었던 혈청 CA 19-9 농도가 갑상선전절제술 후 정상화되었고, 갑상선내 다른 병리 소견이 없어서 갑상선유두암 조직이 CA 19-9 분비의 원인이었음을 알수 있는 증례이다. 이는 혈청 CA 19-9 증가의 원인으로서 밝혀진 갑상선유두암의 국내 첫 증례 보고이며, 췌장 담도 질환이 동반되지 않은 환자에서 혈청 CA 19-9 증가가 있다면 갑상선암의 가능성도 고려해야 함을 시사한다.

Erratum to: Paediatric thyroid carcinoma in disguise: papillary thyroid carcinoma presenting with thyrotoxicosis and diffuse goiter

Papillary thyroid carcinoma is rare in children. Its clinical manifestation may deviate from that observed in adult patients. We present a 14-year-old girl with papillary thyroid carcinoma. We then discuss various distinctive sonographic signs that may aid diagnosis, and we discuss differences in clinical features between children and adults.

Solitary posterior triangle neck mass as the rare sole presentation of papillary thyroid carcinoma

Introduction: Papillary thyroid carcinoma is the most common differentiated thyroid malignancy. It offers good prognosis and the presentation is usually consistent with an enlarged thyroid, mostly solitary nodule which biochemically euthyroid and radiologically normal appearance. On rare occasions, the thyroid gland enlargement can present together with multiple neck lymphadenopathy.Case report: We report a case of middle aged man presented with a posterior neck mass without any other symptom. Histopathology report of the excised mass confirmed the diagnosis of, papillary thyroid carcinoma which warranted total thyroidectomy and neck dissection. DOI: http://dx.doi.org/10.3329/bjo.v18i1.10427 Bangladesh J Otorhinolaryngol 2012; 18(1): 87-90

Unusual Presentation of Cystic Papillary Thyroid Carcinoma

Papillary thyroid carcinoma is the most common thyroid malignancy, accounting for 80% of all thyroid cancers. The most common presentation of thyroid cancer is an asymptomatic thyroid mass or a nodule. Usually as thyroid enlarges, it extends in to mediastinum. Papillary thyroid carcinoma presentation as multiple true cystic swelling extending from neck to anterior chest wall in subcutaneous plane is not present in the literature. We present a rare case of cystic papillary thyroid carcinoma which is presented as subcutaneous swelling with sinus formation.

Metastatic Papillary Thyroid Carcinoma to the Maxilla: Case Report and Literature Review

Metastatic tumors to the oral cavity are uncommon and a thyroid origin is considered exceedingly rare. A case of metastatic papillary thyroid carcinoma (PTC) presenting as a painful swelling in the right posterior maxilla of a 63-year-old male is reported here. The patient had been diagnosed with PTC 2 years ago and treated with thyroidectomy and radioactive iodine treatment. Radiographically, the metastatic lesion presented as a poorly-defined radiolucent lesion around an impacted maxillary third molar in the right maxilla. Histopathologic examination revealed features of PTC which was immunohistochemically positive for pancytokeratin, keratin 19 and thyroglobulin. Imaging studies revealed the presence of residual maxillary and neck disease as well as additional metastatic lesions in the sternum, ribs, and left tibia. A thorough review of the English language literature revealed only 36 previously published cases of thyroid cancer metastases to the oral cavity, the demographic and clinicopathologic features of which are summarized.

A rare case of an aldosterone secreting metastatic adrenocortical carcinoma and papillary thyroid carcinoma in a 31-year-old male

We report a rare synchronous presentation of adrenocortical carcinoma (ACC) and papillary thyroid carcinoma (PTC). A 31-year-old male first presented with a large left adrenal mass that was identified during the workup for refractory hypertension due to hyperaldosteronism. The mass was removed surgically with pathology showing ACC. The patient was then treated with adjuvant radiation therapy and mitotane chemotherapy. Four months post ACC resection, metastatic ACC to the right upper lung and PTC in the left lobe of the thyroid were found in surveillance imaging. He subsequently developed pulmonary, contralateral adrenal and brain metastases from his ACC. Li Fraumeni syndrome and Multiple Endocrine Neoplasia Type I (MEN I) were considered, but testing of both P53 and menin genes showed no mutation. We also performed a review of the literature and found three similar cases, however gene mutation analysis was not performed..

Paediatric thyroid carcinoma in disguise: papillary thyroid carcinoma presenting with thyrotoxicosis and diffuse goiter

Abstract Papillary thyroid carcinoma is rare in children. Its clinical manifestation may deviate from that observed in adult patients. We present a 14-year-old girl with papillary thyroid carcinoma. We then discuss various distinctive sonographic signs that may aid diagnosis, and we discuss differences in clinical features between children and adults [added].

Follicular Variant of Papillary Thyroid Carcinoma Presenting as a Toxic Nodule by I-123 Scintigraphy

The risk of malignancy in a "hot" thyroid nodule detected by radioiodine scintigraphy is rare. We report a case of a 63-year-old man with a hyperfunctioning nodule demonstrated by radioiodine scintigraphy and cytology suspicious for follicular variant of papillary thyroid carcinoma (FVPTC). There were no locoregional or distant metastases at initial diagnosis. Histopathologic examination following thyroidectomy confirmed the presence of an encapsulated FVPTC. A year into follow-up, his I-131 whole body scan performed following the withdrawal from exogenous thyroid hormone was negative, whereas his serum thyroglobulin (Tg) levels were intermediate. A subsequent PET/CT scan revealed a small, but stable, metabolically active pretracheal lymph node, which on biopsy was confirmed to be stage III FVPTC. In conclusion, the presence of hyperfunctioning thyroid nodule(s) does not preclude malignancy and, therefore, proper cytohistologic evaluation in such patients may help to exclude a coexistent thyroid carcinoma. Patients treated for localized PTC may benefit from serial PET/CT follow-up in the early detection and management of recurrence or distant metastases.

Occult Metastatic Papillary Thyroid Carcinoma Presenting as an Isolated Lateral Cervical Cyst

Occult Metastatic Papillary Thyroid Carcinoma Presenting as an Isolated Lateral Cervical Cyst

Papillary Thyroid Carcinoma Presenting with a Right Preauricular and Intracranial mass

Objective: To describe a case of a papillary thyroid carcinoma presenting with a pre-auricular and an intracranial mass and review the literature on the metastatic nature and invasiveness of papillary thyroid carcinoma. Method: Design: Case Report Setting: Tertiary Private Hospital Patient: One   Results:  A 46-year-old female with a 12-year anterior neck mass and a two-year right pre-auricular pleomorphic adenoma on fine needle aspiration biopsy was found to have an intracranial mass on CT-scan. Total thyroidectomy and section biopsy of the preauricular mass yielded a final histopathologic report of follicular variant of papillary carcinoma, thyroid gland; and metastatic papillary thyroid carcinoma, follicular type, pre-auricular mass. The condition of the patient precluded neurosurgical intervention and RAI therapy, and she underwent 23 sessions of external radiotherapy using 46Gy with significant diminution in size of the intracranial metastasis. Conclusion: Papillary thyroid malignancy may be an indolent tumor but is capable of distant metastasis. We should be alerted by host and tumor factors which can be predictors of a more radical papillary malignant disease. Keywords: papillary thyroid carcinoma; papillary thyroid carcinoma metastasis; infratemporal metastasis; brain metastasis of papillary carcinoma.

Papillary Thyroid Carcinoma Presenting with a Right Preauricular and Intracranial Mass

Objective: To describe a case of a papillary thyroid carcinoma presenting with a pre-auricular and an intracranial mass and review the literature on the metastatic nature and invasiveness of papillary thyroid carcinoma.
 Method: 
 Design: Case Report
 Setting: Tertiary Private Hospital
 Patient: One 
 Results: A 46-year-old female with a 12-year anterior neck mass and a two-year right pre-auricular pleomorphic adenoma on fine needle aspiration biopsy was found to have an intracranial mass on CT-scan. Total thyroidectomy and section biopsy of the preauricular mass yielded a final histopathologic report of follicular variant of papillary carcinoma, thyroid gland; and metastatic papillary thyroid carcinoma, follicular type, pre-auricular mass. The condition of the patient precluded neurosurgical intervention and RAI therapy, and she underwent 23 sessions of external radiotherapy using 46Gy with significant diminution in size of the intracranial metastasis.
 Conclusion: Papillary thyroid malignancy may be an indolent tumor but is capable of distant metastasis. We should be alerted by host and tumor factors which can be predictors of a more radical papillary malignant disease.
 Keywords: papillary thyroid carcinoma; papillary thyroid carcinoma metastasis; infratemporal metastasis; brain metastasis of papillary carcinoma.

Synchronous Presentation of Hashimoto Thyroiditis and Papillary Thyroid Carcinoma in a 7-Year-Old Girl

Journal of Ultrasound in MedicineVolume 29, Issue 6 p. 1007-1010 Case Report Synchronous Presentation of Hashimoto Thyroiditis and Papillary Thyroid Carcinoma in a 7-Year-Old Girl Emma M. Snyder BS, Emma M. Snyder BS Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio USASearch for more papers by this authorKathleen K. Nicol MD, Kathleen K. Nicol MD Department of Anatomic Pathology, Nationwide Children's Hospital, Columbus, Ohio USASearch for more papers by this authorAndrew Buchan, Andrew Buchan Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio USASearch for more papers by this authorBrian D. Coley MD, Corresponding Author Brian D. Coley MD brian.coley@nationwidechildrens.org Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio USAAddress correspondence to Brian D. Coley, MD, Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43205 USA.Search for more papers by this author Emma M. Snyder BS, Emma M. Snyder BS Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio USASearch for more papers by this authorKathleen K. Nicol MD, Kathleen K. Nicol MD Department of Anatomic Pathology, Nationwide Children's Hospital, Columbus, Ohio USASearch for more papers by this authorAndrew Buchan, Andrew Buchan Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio USASearch for more papers by this authorBrian D. Coley MD, Corresponding Author Brian D. Coley MD brian.coley@nationwidechildrens.org Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio USAAddress correspondence to Brian D. Coley, MD, Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43205 USA.Search for more papers by this author First published: 01 June 2010 https://doi.org/10.7863/jum.2010.29.6.1007Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume29, Issue6June 2010Pages 1007-1010 RelatedInformation

Papillary thyroid carcinoma presenting as an asymptomatic pelvic bone metastases.

Thyroid carcinoma is rare comprising 1% of all malignancies and commonly presents as a neck lump. Papillary thyroid carcinoma unlike follicular thyroid carcinoma tends not to metastasise to distant sites.We present a case of papillary thyroid carcinoma presenting as a solitary asymptomatic pelvic bone metastases and highlight current management of bone metastases. A 59-year old female was found on abdominal computerised tomography to have an incidental finding of a 4.5 cm soft tissue mass in the right iliac bone. Biopsy of the lesion confirmed metastatic thyroid carcinoma. There was no history of a neck lump, head and neck examination was normal. Further imaging confirmed focal activity in the right lobe of the thyroid. A total thyroidectomy and level VI neck dissection was performed and histology confirmed follicular variant of papillary carcinoma.Early detection of bone metastases have been shown to improve prognosis and thyroid carcinoma should be considered as a potential primary malignancy.

Occult Papillary Thyroid Carcinoma Presenting as a Huge Mediastinal Cystic Metastasis

The initial presentation of distant metastases in patients with papillary thyroid carcinoma is quite rare. Most distant metastases are solid nodular lesions. A 67-year-old man who complained of severe dyspnea underwent surgery due to a large mediastinal cystic mass compressing the trachea and great vessels. Pathologically, the cystic mass was a metastatic thyroid papillary carcinoma. The thyroid evaluations were compatible with a well differentiated thyroid carcinoma. An occult thyroid carcinoma presenting as a large mediastinal cystic lesion is extremely rare.

Papillary thyroid carcinoma presenting with upper respiratory tract obstruction and pulmonary metastases

Thyroid cancer is rare in children especially before the age of 10 years. Upper airway obstruction and pulmonary infiltration are rare manifestations of such tumor. An 8-year-old school girl was admitted to Mansoura University Children's Hospital for a papillary thyroid carcinoma manifested by severe upper respiratory tract obstruction. CT scan of the chest revealed multiple miliary shadows in both lungs. Total thyroidectomy was performed and pathological examination confirmed the diagnosis of papillary carcinoma of the thyroid gland. The patient received ablative dose of Iodine 131 and replacement therapy of L-thyroxine. Thyroid cancer, although rare, should be considered for differential diagnosis of upper airway obstruction and pulmonary metastases.

Cerebellar mass as a primary presentation of papillary thyroid carcinoma: case report and literature review

BackgroundPapillary carcinoma is the most common differentiated malignant thyroid neoplasm. The biological course of this cancer is typically indolent with a protracted clinical course. Metastases commonly occur in regional lymph nodes, and distant metastasis is a late and rare occurrence. We report a patient who presented with cerebellar metastasis prior to the diagnosis of papillary thyroid carcinoma and review the literature of brain metastasis from papillary thyroid carcinoma.ResultsA 75-year old female presented at the emergency room with progressive dizziness, headache and vomiting, where a brain CT and MRI showed a posterior cerebellar tumor. Surgical resection revealed papillary carcinoma consistent with thyroid origin. Subsequent ultrasound and CT-scan revealed a thyroid nodule, after which the patient underwent total thyroidectomy. Pathologic evaluation was consistent with papillary thyroid carcinoma.ConclusionBrain metastasis may rarely be the initial presentation of papillary thyroid carcinoma. Solitary brain metastasis can completely be resected with better prognosis.