Papillary Thyroid Carcinoma Presenting Research Articles

P25 When fevers hide secrets: a case report of papillary thyroid carcinoma presenting as secondary haemophagocytic lymphohistiocytosis

P25 When fevers hide secrets: a case report of papillary thyroid carcinoma presenting as secondary haemophagocytic lymphohistiocytosis

7235 Papillary Thyroid Carcinoma in a Hyperfunctioning Thyroid Nodule

Abstract Disclosure: J. Yang: None. P.V. Nadkarni: None. Background: The prevalence of malignancy in a hyperfunctioning or hot thyroid nodule is considered to be low. According to the 2015 American Thyroid Association Guidelines, no cytologic evaluation is routinely recommended for hyperfunctioning nodules since they are rarely associated with malignancy (1). We present a case of a 71-year-old female with a hot nodule containing papillary thyroid cancer. Clinical Case: A 71-year-old female with Type 1 diabetes mellitus and coronary artery disease on dual antiplatelet therapy was found to have a 1.5 cm firm, non-tender right-sided thyroid nodule on a routine physical exam. Laboratory tests demonstrated low TSH <0.01 (normal 0.36 - 3.74 m[IU]/L) and FT4 level elevated at 1.62 (normal 0.76 -1.46 ng/dL). She noticed palpitations and started on low dose Methimazole. Thyroid ultrasound results showed a 2.1 x 2.0 x 2.0 cm right inferior lobe thyroid nodule. This thyroid nodule appeared mixed cystic and solid, hypoechoic, not taller than wide, with ill-defined margins and peripheral calcifications (ACR TI-RADS risk category: TR4). Nuclear medicine thyroid uptake scan demonstrated focally increased activity in the right lower pole corresponding with her right inferior thyroid nodule seen on ultrasound. Remainder of the gland appeared suppressed. She was recommended for ultrasound-guided fine needle aspiration biopsy of her right inferior thyroid nodule, given concerning characteristics on ultrasound findings despite results consistent with a hot nodule. Timing of her antiplatelet therapy was coordinated with her cardiologist, and her biopsy procedure scheduled after she stopped dual antiplatelet therapy. Her FNA results showed clusters of follicular cells with nuclear and architectural atypia, suspicious for papillary thyroid carcinoma. She underwent right thyroid lobectomy. Surgical pathology revealed 2 foci of papillary thyroid carcinoma, follicular variant (2.0 cm, 0.1 cm) and confined to the thyroid. All regional lymph nodes were negative for tumor. Methimazole was discontinued post-operatively, and she started Levothyroxine suppression therapy. Discussion: We present a rare association of papillary thyroid carcinoma presenting as a hot thyroid nodule. Though uncommon, detection of a hyperfunctioning thyroid nodule does not exclude the possibility of thyroid carcinoma and warrants careful evaluation. Clinicians should retain a high index of suspicion particularly when ultrasonography demonstrates findings suspicious for malignancy and consider additional evaluation with fine needle aspiration. Reference: (1) Haugen BR, Alexander EK, Bible KC et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016 Jan;26(1):1-133. Presentation: 6/2/2024

Occult Papillary Thyroid Carcinoma Presenting as Cystic Lateral Neck Swelling. Case Series and Review of Literature.

Occult Papillary Thyroid Carcinoma Presenting as Cystic Lateral Neck Swelling. Case Series and Review of Literature.

Spontaneous hepatic hemorrhage as presentation of metastasized papillary thyroid carcinoma: a case report

BackgroundSpontaneous hepatic hemorrhage is a rare condition, most commonly diagnosed in patients with hepatocellular carcinoma or hepatic adenomas, and is seldom caused by metastatic disease. In this case report, we present a patient with spontaneous hepatic hemorrhage due to hepatic metastasis of papillary thyroid carcinoma, an exceptionally rare occurrence.Case presentationThe patient was a 77-year-old white male with a history of atrial fibrillation treated with apixaban. He presented at a local hospital with abdominal pain and nausea. A CT scan revealed a hepatic lesion in segment 3 with an adjacent hematoma. He was referred to our tertiary center and treated conservatively. Further evaluation revealed an intrathoracic goiter containing a tumorous process diagnosed as a papillary thyroid carcinoma (PTC), and the patient subsequently underwent thyroidectomy. A biopsy of the hepatic lesion confirmed it as a PTC metastasis. Due to worsening abdominal pain and anorexia, the patient underwent subacute hepatic segmental resection. Postoperatively, he developed iodine-refractory disease with disseminated metastasis and passed away 22 months after the initial admission.ConclusionsTo our knowledge, this is the first recorded case of metastasized papillary thyroid carcinoma presenting with spontaneous hepatic hemorrhage—adding to the list of rare causes for this condition.

Synchronous presentation of papillary thyroid carcinoma and Hodgkin lymphoma – a case report

Synchronous presentation of papillary thyroid carcinoma and Hodgkin lymphoma – a case report

Medullary and papillary thyroid carcinoma presenting as a collision tumors in the thyroid: report of seven cases

Medullary and papillary thyroid carcinoma presenting as a collision tumors in the thyroid: report of seven cases

Brain metastasis mimicking a cavernous angioma as initial presentation of papillary thyroid carcinoma.

Brain metastases as the first clinical presentation of a papillary thyroid carcinoma (PTC) are exceptional, while cavernous angiomas are common cerebral malformations. We report the case of a 36-year-old male with an incidental brain lesion mimicking a cavernous angioma on MRI. Gamma knife radiosurgery was performed, but after 6 months, the patient developed neurological symptoms, and a repeat brain MRI revealed a significant increase in the mass. The patient underwent neurosurgery, and the histological examination of the lesion revealed metastatic carcinoma of thyroid origin. PET-CT and neck ultrasound, subsequently performed, were concordant for the presence of a right lobe nodule and ipsilateral lymph nodes, both with ultrasound features suspicious of malignancy. Total thyroidectomy with central and right lateral neck dissection was performed, and histology confirmed an intrathyroidal multifocal PTC with lymph node metastases. Postoperative radioiodine was administered, and focal uptake within the thyroid bed, without distant metastases or brain remnants, was found on the post-therapeutic whole-body scan. At 2 years from diagnosis, the patient is in good health and undergoes clinical and imaging follow-up. Brain cavernous angiomas are common cerebral vascular malformations that are usually diagnosed by MRI. Despite the high accuracy of MRI, the exam is not pathognomonic, and misdiagnosis cannot be excluded. Brain metastases from PTC are very rare; however, they can mimic a cavernous angioma. Therefore, the differential diagnosis should always be considered.

Rare Presentation of Metastatic Papillary Thyroid Carcinoma with Cribiform Type in Pelvic Bones

Rare Presentation of Metastatic Papillary Thyroid Carcinoma with Cribiform Type in Pelvic Bones

THU674 Papillary Thyroid Carcinoma Presenting As A Benign Ectopic Thyroid Mass In The Anterior Mediastinum. A Case Report

Abstract Disclosure: M.V. David-santos: None. C. Narvacan-montano: None. Background: Ectopic Thyroid Tissue (ETT) is a rare developmental anomaly that is due to the failure of the thyroid gland to assume its position in front of the trachea. Ectopic Thyroid tissue in the mediastinum is very rare, with only a few cases reported in the literature. An incidental Papillary Thyroid Carcinoma presenting as a mediastinal mass that turns out to be benign ectopic thyroid cells is even rarer. Case: This is the case of a 33-year-old female who presented with sudden onset difficulty of breathing and chest heaviness. On workup, she was found to have an anterior mediastinal mass, which showed ectopic thyroid cells on biopsy. Further evaluation of the neck area revealed a 1.25 cm x 1 x 1.13 cm nodule on the thyroid gland which showed suspicious for Papillary Thyroid Carcinoma on Fine needle aspiration biopsy. The patient underwent Total Thyroidectomy and Excision of the Anterior Mediastinal Mass. The histopathologic report of the thyroid mass revealed a Conventional Unifocal Papillary Thyroid Carcinoma, while the excised tissues comprising the mediastinal mass were consistent with benign ectopic thyroid tissues with colloid goiter. Conclusion: The presence of the ectopic thyroid mass in the anterior mediastinum may be a potential area for metastasis. The final pathologic report nevertheless, categorizes this Papillary thyroid carcinoma as having a low risk of metastasis as per the American Thyroid Association Classification of 2015. Hence the conservative approach of Suppression therapy and active surveillance is the choice of management for this unusual case. Presentation: Thursday, June 15, 2023

An unusual case of papillary thyroid carcinoma presenting as Graves’ disease

ABSTRACT Thyroid cancer in patients with Graves’ disease (GD) was reported with incidences varying from 2.3% to 21.1%. The prognosis of thyroid cancer in patients with GD has been debatable. Here we present a rare case of papillary thyroid carcinoma associated with GD in a 23-year-old female presenting with goiter and thyrotoxicosis symptoms, diagnosed with GD, who because of suspicious findings, underwent further investigations and was found to have thyroid carcinoma. The patient underwent surgery preceded by antithyroid medications. Histopathological examination confirmed malignancy and further management was done.

Hypernatremia and hypokalemia with Entrectinib therapy: A case of possible nephrogenic diabetes insipidus

Introduction: Hypernatremia and hypokalemia have been reported with the use of Tropomyosin Receptor Kinase Inhibitors (TRKI) but the pathophysiology is not clear. We hereby describe a 72-year-old male with metastatic papillary thyroid carcinoma presenting with hypernatremia and hypokalemia after starting Entrectinib therapy. Case description: A 72-year-old male with metastatic papillary thyroid carcinoma was admitted to the hospital for failure to thrive and worsening mental status 6 weeks after starting Entrectinib therapy. He was found to have hypernatremia at 154 mmol/L and hypokalemia at 2.9 mmol/L. Serum and urine osmolalities were 320 and 293 mOsm/kg, respectively with an elevated 24 h urinary potassium of 132 mmol. Polydipsia and polyuria were reported raising the suspicion for underlying diabetes insipidus (DI). Twenty-four hour urine output was around 4.5 L. A DDAVP challenge was performed with no change in hourly urine output and a trivial change in urine osmolality toward 339 mOsm/kg indicating a possible partial nephrogenic DI. Potassium was supplemented and patient was treated with free water enterally and parenterally while stopping Entrectinib therapy. One week later, a water deprivation test failed to elicit a hypernatremic response. Unfortunately, urine osmolality variations with water deprivation were not checked but urine volumes dropped significantly suggesting resolution of presumed nephrogenic DI. Conclusion: Hypernatremia has been reported with Tyrosine Kinase Inhibitors but no pathophysiology has been proposed. Hypokalemia however has not been reported. This case reports hypokalemia and hypernatremia in association with Entrectinib therapy with renal potassium wasting and partial nephrogenic as possible pathophysiologic bases respectively. These pathologies seem to be reversible with drug cessation. With the growing use of targeted therapies in oncology and beyond, it seems prudent to better understand the unique electrolyte and water balance abnormalities that might occur so that patients can be counseled and managed appropriately.

Neck Masses as The First Presentation of Occult Papillary Thyroid Carcinoma: Case Series

Papillary Thyroid Carcinoma (PTC) is the most common thyroid cancer. It can be found incidentally during thyroidectomy or can present as an enlarged cervical lymph node which is difficult to be diagnosed unless confirmed by ultrasonography and fine needle aspiration cytology (FNAC).

Papillary Thyroid Carcinoma and Pregnancy: What Impact on Prognosis?

Introduction: The impact of pregnancy on the prognosis of papillary thyroid carcinoma (PTC) has been debated for several decades; however, no definitive conclusions have been reached. The main objective of this study is to demonstrate the short-term influence of pregnancy on the evolution and prognosis of PTC. Materials and Methods: A prospective descriptive and analytical study was conducted in the Endocrinology and Diabetology Department at the Hassan II University Hospital in Fez, including patients followed for papillary thyroid carcinoma presenting with a pregnancy during the year 2019 and 2020. The follow-up of these patients was continued until 1 year postpartum. We studied the clinical, paraclinical and therapeutic factors that could influence the prognosis of the disease. Results: We included 26 patients. Our study showed a significant correlation between recurrence and the presence of unfavorable histological signs (p = 0.02) as well as the initial Tg level (0.01). However, pregnancy was not an influencing factor (p = 0.41). Conclusion: Pregnancy does not seem to be a factor aggravating the prognosis of differentiated thyroid cancers.

A rare case of papillary thyroid carcinoma (PTC) presenting as multinodular goiter (MNG) successfully operated with total thyroidectomy (TT)

A rare case of papillary thyroid carcinoma (PTC) presenting as multinodular goiter (MNG) successfully operated with total thyroidectomy (TT)

PSAT388 A Rapidly progressive papillary thyroid carcinoma presenting 22 years after RAI therapy

Abstract The risk of thyroid cancer following RAI therapy remains controversial. We report a case of an aggressive papillary thyroid carcinoma presenting over twenty years after RAI therapy for Graves’ disease. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Histopathological Characteristics of N1b Papillary Thyroid Carcinoma are Associated with Risk of Recurrence.

The presence of cervical lymph node (LN) metastasis at the initial presentation of papillary thyroid carcinoma (PTC) constitutes an independent risk factor for disease recurrence, increases the risk for mortality, and impacts overall outcome. The 2016 American Joint Committee on Cancer raised the age cutoff for PTC staging from 45 to 55years for better prediction of overall survival. Age > 55years is considered a significant risk factor for a more aggressive and advanced disease with worse outcomes. We identified histopathological factors for disease recurrence in PTC patients younger and older than 55years of age. Data on all patients who underwent thyroid surgery due to PTC between 2006 and 2018 in the Tel Aviv Sourasky Medical Center were retrieved for this retrospective cohort study. Patients with lymph node (LN) metastases were further investigated for preoperative presentation, pathological characteristics, and recurrence. A multivariate analysis was used to detect predictors for recurrence and patient outcome for each age-group. Twenty-two of the 183 patients (12%) with PTC who met the inclusion criteria and had sufficient follow-up period sustained recurrence. The predictors of recurrence varied between the two age-groups. The size of thyroid lesions (p = 0.003) was identified as a risk factor in the older group, while the number of metastatic cervical LNs (p = 0.001) and the ratio of metastatic-to-total dissected cervical LNs (p = 0.027) were the main predictors of recurrence for the younger group. The histopathological factors predictive for disease recurrence differed among PTC patients younger and older than 55years of age.

Metastatic papillary thyroid carcinoma presenting with elevated serum levels of carbohydrate antigen 19-9 (CA19-9): a case report

BackgroundThe major sites of distant metastases of papillary thyroid carcinoma (PTC) are the lung and bone; metastasis to the liver is rare. Although the postoperative serum thyroglobulin (Tg) level after total thyroidectomy is a good prognostic indicator for PTC when anti-thyroglobulin antibody (TgAb) is negative, the presence of TgAb interferes with the Tg assay, making serum Tg levels unreliable. Here we report a case of liver metastasis of PTC that presented with elevated serum levels of carbohydrate antigen 19-9 (CA19-9), which is usually a serum marker of pancreatic and gastrointestinal neoplasias.Case presentationA 69-year-old man was diagnosed with PTC and underwent total thyroidectomy 16 years ago. The patient’s serum Tg levels increased progressively during follow-up and his serum TgAb was negative. Positron emission tomography (PET) and computed tomography (CT) revealed metastases of the lung, cervical spine, mediastinum and liver. The liver lesion was a solitary tumor measuring 4.0 cm in the greatest dimension. His serum CA19-9 level was very high (326 U/mL), and intrahepatic cholangiocarcinoma was suspected from the results of various examinations including gastrointestinal endoscopic imaging and CT. Laparoscopic partial liver resection for segment 4 was performed. The histopathological diagnosis was a metastatic liver tumor from PTC. The immunohistological examination revealed that the liver tumor was positive for CA19-9 and Tg. The primary PTC, recovered from paraffin-embedded specimen, was also positive for CA19-9. After the surgery, his serum CA19-9 level as well as serum Tg level markedly decreased.ConclusionsWe presented the first reported case of liver metastasis of a PTC presenting with elevated serum levels of CA19-9 after total thyroidectomy. This case suggests that the serum CA19-9 levels may serve as a surrogate marker for PTC in place of the serum Tg level in patients with positive serum TgAb if the PTC and/or the metastatic lesions are positive for CA19-9 staining.

Papillary thyroid carcinoma presenting at entopic and ectopic sites: A diagnostic conundrum

Papillary thyroid carcinoma (PTC) mostly occurs within the thyroid gland (entopic site), with its occurrence within an ectopic thyroid tissue being rare comprising less than 1% of all thyroid cancers. The coexistence of PTC in entopic and ectopic sites is even rarer, and differentiating ectopic PTC from a metastatic cervical lymph node may pose a diagnostic conundrum. This report is aimed at highlighting the diagnostic challenges and treatment of this rare condition.

An unusual case of papillary thyroid carcinoma presenting as Graves’ disease

ABSTRACT The detection of thyroid cancer in patients with Graves’ disease (GD) is rare. The prognosis of thyroid cancer in patients with concomitant GD is controversial. Here, we present a rare case of papillary thyroid carcinoma (TC) associated with GD in a 23-year-old woman who presented with goiter and thyrotoxicosis symptoms and was initially diagnosed as GD. However, she underwent further investigations in view of suspicious findings and was found to have TC. The patient was subjected to surgery after controlling thyrotoxic features with the help of antithyroid medications.

Occult multifocal papillary thyroid carcinoma presenting as anaplastic carcinoma in the metastatic neck deposit – A rare case report along with review of literature

Papillary thyroid carcinoma (PTC) is the most common type of thyroid carcinoma that carries a favourable prognosis. However, a small subset unfortunately shows transformation to least differentiated anaplastic carcinoma (AC) having a highly aggressive behavior. This process usually occurs within thyroid but is rare in metastatic cervical lymph node or soft tissue neck and exceedingly rare at distant sites. We report a unique case of a 75 years female who presented with anaplastic carcinoma in metastatic neck deposit with occult papillary thyroid carcinoma. To the best of our knowledge, this is the first case in the world literature having anaplastic transformation (AT) in the metastatic neck deposit, right at the presentation with a totally unnoticed PTC clinically. We present this case to emphasize that the transformation process can occur even when the differentiated malignancy in thyroid is small, insignificant or hidden and that metastasis solely can be the presenting feature which can be misleading clinically and even histopathologically. As AC is very aggressive, there is need for early and precise diagnosis & prompt therapeutic intervention.