Papillary Thyroid Carcinoma Presenting Research Articles

An Unusual Presentation of Parathyroid and Micro Papillary Thyroid Carcinoma

Abstract Background: Parathyroid carcinoma is a rare endocrine malignancy, that usually presents with parathyroid hormone elevations five to ten times higher than normal. It is rarely diagnosed in cases with a normal or mildly elevated PTH. Clinical Case: 68 yo female with history of Hypertension, Spontaneous Vocal Cord Paralysis, Multinodular Goiter, Breast cancer s/p right radical mastectomy/chemotherapy, and Osteoporosis who presented to outpatient Endocrine clinic for hypercalcemia. Medications include Coreg 12.5 mg BID. Patient was asymptomatic. Labs showed BUN 21 mg/dL [8 mg/dL - 27 mg/dL], Creatinine 0.82 mg/dL [0.57 mg/dL - 1 mg/dL], eGFR 74 ml/min/1.73 m2 [nl>59 ml/min/1.73 m2], Calcium 10.8 mg/dL [8.7 mg/dL - 10.3 mg/dL], Phosphorus 3 mg/dL [3 mg/dL - 4.3 mg/dL], Magnesium 2.2 mg/dL [1.6 mg/dL - 2.3 mg/dL], PTH 77 pg/mL [15 pg/mL - 65 pg/mL], Albumin 4.2 g/dL [3.8 g/dL - 4.8 g/dL], Vitamin D 1,25 Dihydroxy 47.2 pg/mL [19.9 pg/mL - 79.3 pg/mL], Vitamin D 25-OH 18.2 ng/mL Low [30 ng/mL - 100 ng/mL], TSH 1.599 uIU/mL (.450-5.330 uIU/mL), Hgb 13.4 g /dL (12.0 -16.0 g/dL). Most recent FNA in 2019 of a dominant thyroid nodule was benign. Bone Density Scan June 2020 showed a T score of -3.4 in the lumbar spine and -3.1 in the left hip. Sestamibi Scan showed a right inferior parathyroid adenoma. Following ENT consultation, patient underwent surgical exploration. Pathology showed parathyroid tissue with extensive fibrosis, consistent with Parathyroid Carcinoma (1.8 x 1 x .7cm), probable positive margins, nodular growth pattern with individual nodules separated by fibrous bands, capsular invasion, focally, into adjacent adipose tissue invading through the thyroid capsule, positive for perineural invasion and PTH. Ki67 approximately six percent. Right thyroid lobe excision should a micro focus of papillary thyroid carcinoma (.2 x .2 cm), capsulated, negative margins, pT1a. Conclusion: This case demonstrated an unusual presentation of Parathyroid carcinoma causing a mild elevation of PTH level that in pathology after excision unexpectedly revealed a right parathyroid carcinoma along with micro papillary thyroid carcinoma.

A Diagnostic Dilemma of Lateral Neck Cyst: A Lesson Learnt

Large cystic mass is an unusual presentation of papillary thyroid carcinoma, accounting for less than 10% of cases. To make a diagnosis of papillary thyroid carcinoma is challenging since the tumour can mimic a benign lateral neck mass. Therefore, a systematical approach to a patient with neck lump is required so that accurate diagnosis and appropriate treatment can be made. We present a case of a 25-year-old female presenting with an asymptomatic left neck cystic mass diagnosed as a metastatic lymph node of papillary thyroid carcinoma only after surgery.
 Bangladesh J Otorhinolaryngol; April 2021; 27(1): 92-95

Papillary and Medullary Thyroid Carcinomas Presenting as Collision Tumors: A Case Series of 21 Cases at a Tertiary Care Cancer Center.

Collision tumor is the occurrence of two histologically and morphologically distinct tumors within the same organ with no histological admixture. Collision tumors of the thyroid are extremely rare constituting < 1% of all thyroid tumors. Clinical profiles and pathological features of Medullary thyroid carcinoma (MTC) and Papillary thyroid carcinoma (PTC) presenting as Collision tumors of thyroid, diagnosed between 2009 and 2019, at a tertiary care cancer center were retrospectively analyzed. Collision tumors comprised 4.7% of all MTC cases diagnosed over 10years. A total of 21 cases (11males, 11 females, M:F = 1) were retrieved with the mean age of patients being 45.33years (range 26-77years). More than half of PTCs involved the right lobe of the thyroid (66.6%). About half (53.4%) of MTCs affected the left lobe. Imaging done pre-operatively failed to identify the smaller second tumor in 60% of the cases with both tumours in separate lobes. Pre-operative FNAC showed only MTC in all 8 cases in which it was done. Papillary microcarcinoma (m-PTC) was seen in 85.7% cases, with one case of multifocal m-PTC. MTC (mean size 3.12cm), on an average, was 3 times larger than the PTC (mean size 0.91cm). The histological variants of MTC included-oncocytic (1/21, 4.7%), spindle cell (1/21, 4.7%), epithelial (3/21, 14.2%) and classical (16/21, 76.2%) and of PTC included classic PTC (12/21, 57.14%), Hurthle cell (2/21, 9.52%), tall cell (1/21, 4.76%) and follicular variant of PTC (6/21, 28.57%). The microscopic extrathyroidal extension (ETE) due to MTC and PTC component was 42.8% and 9.5% respectively. Lymph node metastasis was seen in 16 (76.2%) cases; 87.5% (14/16) of which were contributed by MTC, 12.5% (2/16) by PTC alone, and 12.5% (2/16) cases showed metastasis from both MTC and PTC. MTC had a higher stage than PTC in 85.5% of cases. Collision tumors of the thyroid are exceedingly rare, and possibly underdiagnosed due to variation in sampling techniques, especially of the grossly "normal lobe". The low incidence in our cohort is in favor of the "Chance theory" of co-occurrence. This diagnosis is important due to its therapeutic and prognostic implications.

Papillary thyroid carcinoma presenting as metastases at unexpected sites: Report of two cases

Papillary thyroid carcinoma (PTC) is the most common form of differentiated thyroid carcinoma (DTC). It is generally confined to the neck with or without spread to regional lymph nodes. Distant metastases is rare, if occurs, it usually involves lung and bone. Additional locations have only been sporadically reported and were identified during the course of follow-up, subsequently to a thyroid surgery. Distant metastases as the initial presentation of PTC is a rare event. We, herein, report two cases of PTC presenting initially as metastases at unusual sites and discuss the importance of meticulous histopathological and immunohistochemical examination in such situations. Our aim is to increase awareness of the unique possibility of PTC presenting as metastatic deposits at unexpected sites.

A synchronous papillary and follicular thyroid carcinoma presenting as a large toxic nodule in a female adolescent

Case presentationWe report for the first time a synchronous papillary and follicular thyroid carcinoma in a 12-year-old girl presenting with a large (5 cm diameter) left thyroid nodule, an increased left and right upper pole technetium tracer uptake at scintigraphy and hyperthyroidism. The uptake at the right lobe was explained by the crossing of the left nodule to the right site of the neck at Computed Tomography (CT) scanning.BackgroundAlthough thyroid nodules are less common in children than in adults, there is more vigilance required in children because of the higher risk of malignancy. According to literature, about 5% of the thyroid nodules in adults are malignant versus 20–26% in children. The characteristics of 9 other pediatric cases with a differentiated thyroid carcinoma presenting with a toxic nodule, which have been reported during the last 20 years, are summarized. A nodular size of more than 3.5 cm and female predominance was a common finding.ConclusionsThe presence of hyperthyroidism in association with a hyperfunctioning thyroid nodule does not rule out thyroid cancer and warrants careful evaluation, even in the absence of cervical lymph node invasion.

MON-442 Tall Cell Variant of Papillary Thyroid Carcinoma Presenting Acutely as a Right Thyroid Mass and Thyroiditis - an Unusual Presentation

INTRODUCTIONAggressive malignant thyroid tumors (AMTT) can rarely present with signs and symptoms mimicking that of acute suppurative thyroiditis (AST). In its early course, correct diagnosis may be difficult but a prompt recognition is crucial. We report an interesting case of an aggressive papillary thyroid cancer with presenting acute symptoms masquerading as AST.CLINICAL CASEA 50-year-old Caucasian male was admitted for 2 day history of sore throat, odynophagia, low grade fever with a tender and enlarging right neck swelling, not improving with oral antibiotics. CT neck showed a 5.8 x 4.5cm mass in right thyroid lobe with shallow retropharyngeal effusion. Labs showed elevated WBC 10.7 x 109/L (4–10.5), ESR 20 mm/hr (0–12), CRP 92.93 mg/L (0.2–10), with negative rapid strep and IgM for viruses EBV and CMV. Thyroid function tests were normal. Ultrasound neck showed an ill-defined 6.5 cm hypoechoic mass with cystic component and increased vascularity and calcification, replacing the right thyroid lobe. Due to concern for thyroid abscess he underwent urgent aspiration. Fluid analysis and cultures were negative for bacterial source. FNA (fine needle aspiration) of one specimen was suspicious for follicular neoplasm with predominant hurtle cells and suspicious for thyroid neoplasm with papillary architecture in the other. Core biopsy was suspicious for papillary carcinoma but limited due to scant amount of tissue. Affirma unavailable due to insufficient RNA yield. Flow cytometry was negative for abnormal lymphocyte population. Repeat CT neck 3 weeks later was concerning for metastatic lymphadenopathy. He underwent total thyroidectomy with lymph node (LN) dissection and pathology showed papillary thyroid cancer, tall cell variant, tumor size 6 cm, predominantly hemorrhagic, extending to perithyroidal strap muscles and involving 5/6 LN in right trachea-esophageal groove. It was a stage I, pT3bN1aMx cancer. Subsequently, he underwent thyrogen stimulated I-131 ablation of residual thyroid carcinoma with pretherapy scan showing increased uptake in thyroid bed and a satellite lesion suspicious for LN metastasis. Post-ablative scan showed no other new lesions. He is now on levothyroxine suppressive therapy.CONCLUSIONEarly course of AMTT can rarely present as AST, both being progressive and fatal diseases. Our case had a typical presentation of AST, causing delay in diagnosis of his very aggressive form of thyroid cancer. Gross pathology showed predominantly hemorrhagic areas in the tumor with central necrosis, which was likely the cause of acute mass with systemic signs suspicious for infection. One should consider an alternative diagnosis in suspected cases of AST in the absence of positive cultures or lack of improvement with parenteral antibiotics. It is imperative to make a diagnosis without any delay as prognosis for either condition depends on prompt recognition and treatment.

Abstract #804249: Solitary Lung Metastasis from Papillary Thyroid Carcinoma Presenting 40 Years After Total Thyroidectomy

Abstract #804249: Solitary Lung Metastasis from Papillary Thyroid Carcinoma Presenting 40 Years After Total Thyroidectomy

Clinical outcomes and risk stratification for papillary thyroid carcinoma presenting with distant metastasis before the era of tyrosine kinase inhibitors.

Radioactive iodine (RAI) therapy has been the mainstay of treatment for papillary thyroid carcinoma (PTC) patients with distant metastasis (DM). Although tyrosine kinase inhibitors (TKIs) were introduced for the treatment of RAI refractory metastatic thyroid carcinoma several years ago, clinical outcomes for PTC patients with DM treated using RAI therapy remain unclear. We retrospectively examined 64 PTC patients (9 men, 55 women) with DM at diagnosis treated using RAI therapy without administration of any kind of chemotherapy or TKIs. Median age of patients was 58 years. Site of DM was the lungs (n = 59), bone (n = 3), and pleural dissemination (n = 2). No patients showed multiple-organ metastases at diagnosis. By the end of the study period, 21 patients had died of PTC. Cause-specific survival rates at 10, 15, and 20 years after initial surgery were 68.2%, 63.6% and 61.1%, respectively. Uni- and multivariate analyses identified age ≥55 years (HR 3.1, p = 0.023), site of DM other than the lungs (HR 13.4, p < 0.0001), and DM with no RAI avidity (HR 5.1, p = 0.0098) as factors independently associated with disease-related death. When analyses were restricted to patients with lung metastasis (n = 59), surgical non-curability was another independent risk factor (HR 5.2, p = 0.0047) in addition to age and RAI avidity. According to risk stratification analysis based on these risk factors, patients with site of DM other than the lungs or with lung metastasis showing ≥2 risk factors among age ≥55 years, DM with no RAI avidity, and surgical non-curability are expected to show higher mortality rates.

Occult papillary thyroid carcinoma presenting with cervical neck lymph node metastasis

Occult papillary thyroid carcinoma presenting with cervical neck lymph node metastasis

Fracture of the Humeral Bone as the First Clinical Presentation of Metastatic Papillary Thyroid Carcinoma in Ibadan

Papillary thyroid carcinoma is the commonest type of thyroid cancer representing 75 to 85 per cent of all thyroid cancer cases. It is often well-differentiated, slow-growing, and localized, although it can metastasize. This is a case of a 49-year-old male who presented with a pathological fracture of the left humerus. A bone biopsy was done at the surgery which had a histological diagnosis of metastatic thyroid carcinoma. A total thyroidectomy was subsequently done and was histologically reported as a follicular variant of papillary thyroid carcinoma. The patient was clinically stable post-thyroidectomy and was discharged home on the 10th postoperative day and he is currently being followed-up in the surgical outpatient clinic. Pathological fracture as the initial clinical presentation is an unusual manifestation of metastatic thyroid carcinoma; therefore a high index of suspicion is needed to make this diagnosis. In any patient presenting with a pathologic fracture, the possibility of metastatic carcinoma from the thyroid gland should always be considered.

Metastatic papillary thyroid cancer presenting with a recurrent necrotic cystic cervical lymph node

SummaryWe report a case of metastatic papillary thyroid carcinoma presenting with a recurrent right-sided cervical lymph node necrotic cyst. A 55-year-old woman presented with a 3-month history of a right-sided upper neck mass following an upper respiratory tract infection. Past medical history includes a right-sided nephrectomy secondary to a benign renal tumor and hypertension. She was evaluated by Otolaryngology, and fine-needle aspiration was performed. The mass recurred 2 months following aspiration. Ultrasound of the neck showed a 2.2 × 1.4 × 1.9 cm right cervical lymph node with a small fatty hilum but a thickened cortex. Neck computed tomography (CT) scan showed a well-defined 2.3 cm mass in the right upper neck corresponding to a necrotic cervical lymph node at level IIA. It also revealed a 7 mm calcified left thyroid nodule. Cytology revealed a moderate collection of murky fluid with mildly atypical cells presumed to be reactive given the clinical history of infection. The cyst had re-grown 2 months following aspiration. Excisional biopsy was performed and revealed metastatic classic papillary thyroid carcinoma (PTC). Subsequently, a total thyroidectomy and right neck dissection was performed. Pathology confirmed metastatic unifocal classic PTC of the right thyroid lobe and two lymph node metastases out of a total of 17 resected lymph nodes. The patient underwent radioactive iodine ablation. Subsequent I-131 radioiodine whole-body scan showed no evidence of metastases. In conclusion, metastatic PTC should be considered in the differential diagnosis of a recurrent solitary cystic cervical lymph node.Learning points:Metastatic PTC should be considered in the differential diagnosis of a recurrent solitary cystic cervical lymph node.A dedicated thyroid ultrasound is the preferred modality for identifying thyroid lesion over computed tomography.There is a risk of non-diagnostic cytology following FNA for cystic neck lesions, largely predicted by the cyst content of the nodule.

Huge posterior triangle lymphadenopathy as a rare sole presentation of papillary thyroid carcinoma

Huge posterior triangle lymphadenopathy as a rare sole presentation of papillary thyroid carcinoma

Papillary thyroid carcinoma presenting as a primary renal tumor with multiple pulmonary and bone metastases: a case report

BackgroundPapillary thyroid carcinoma is the most common endocrine malignancy. Distant metastasis from differentiated thyroid carcinoma is infrequent and the metastasis rate of papillary thyroid carcinoma is lower than that of follicular thyroid carcinoma. Distant metastases from differentiated thyroid carcinoma are usually seen in the lungs and bones; however, renal metastasis is very rare.Case presentationHere we describe an 85-year-old Caucasian woman who presented with right flank pain 10 years ago. We describe a case of papillary thyroid carcinoma presenting as a primary renal tumor with extensive pulmonary and bone metastases. Abdominal screening with computed tomography revealed a mass on her right kidney, which was considered a primary renal cell carcinoma and she underwent a right nephrectomy. Unexpectedly, papillary thyroid carcinoma metastasis was diagnosed from demonstrative histopathological findings, such as positive immunoperoxidase staining for thyroglobulin. A total thyroidectomy was performed. Unenhanced thoracic computed tomography and skeletal scintigraphy revealed bilateral multiple nodules in her lungs and bone metastasis on T10 vertebra and right sacroiliac joint. Initially, 30 Gy radiotherapy was implemented to her T9–10 vertebrae and then she was treated with a total of 800 mCi radioactive iodine for ablation. A radioactive iodine whole body scan was performed after each 200 mCi and continuous progression was shown in each scan. After she was lost to follow-up for 3 years, she referred to our clinic again with a draining mass on her neck and we planned radiotherapy to this giant mass.ConclusionOur patient was surprisingly still alive after metastatic disease was diagnosed 10 years ago and she had no major complaint other than a draining mass on her neck. Our primary aim by sharing this case is to underline potential renal metastasis from papillary thyroid carcinoma. In other words, when approaching primary renal tumors, possible distant metastases of other organs need to be kept in mind for differential diagnosis. In addition, it should be noted that if managed appropriately, the long-term survival in patients with papillary thyroid carcinoma with multiple organ metastases could be encouraging.

Cystic lateral neck mass: Papillary thyroid carcinoma metastases with concomitant lymphangioma

The most common presentation of papillary carcinoma thyroid is a solitary thyroid nodule but it is also known to present as cystic metastatic deposits in the neck. It has an indolent course and good prognosis. Although ultrasound is a commonly used modality to detect thyroid nodules, it should be followed by Fine needle aspiration cytology (FNAC) of the thyroid, especially when they are associated with cystic lesions of the neck. We report a rare case of papillary thyroid carcinoma presenting as a cystic mass in the neck and associated with lymphangioma.

Occult Metastatic Papillary Thyroid Carcinoma Presenting as Submandibular Mass: An Unusual Case

Occult Metastatic Papillary Thyroid Carcinoma Presenting as Submandibular Mass: An Unusual Case

Papillary Thyroid Carcinoma Presenting as Fungating Cutaneous Mass

Papillary Thyroid Carcinoma Presenting as Fungating Cutaneous Mass

Case Report: Metastatic Papillary Thyroid Cancer Presenting with a Recurrent Necrotic Cystic Cervical Lymph Node

Objective: To report a case of metastatic papillary thyroid carcinoma presenting with a recurrent right-sided cervical lymph node necrotic cyst.

Papillary Thyroid Carcinoma Presenting with Ulcerated Lymph Node Mass

Papillary Thyroid Carcinoma Presenting with Ulcerated Lymph Node Mass

Effects of Chronic Lymphocytic Thyroiditis on the Clinicopathological Features of Papillary Thyroid Cancer

Background: The effects of chronic lymphocytic thyroiditis (CLT) on the presentation and outcome of papillary thyroid carcinoma (PTC) have long been a topic of controversy. Objective: To evaluate the effect of coexistent CLT on the clinicopathological features of PTC. Design: Retrospective study. Patients: All patients with PTC who had been followed by the 2 co-investigators (Juan Rivera and Richard J. Payne) between 2006 and 2011 were included. Results: CLT was present in 35% (166) of the included patients and was associated with a higher proportion of patients with TNM stage I (p = 0.027) and fewer patients with persistent disease (p = 0.014) in comparison with the PTC-only group. Analysis of the data based on age (<45 or >45 years) revealed that in the older group, the presence of CLT was associated with fewer patients with persistent disease (p = 0.03) and capsular invasion (p = 0.05). However, in patients <45 years of age, the presence of CLT was associated with more capsular invasion (p = 0.003) and extrathyroidal extension (p = 0.004) compared with the PTC-only group. Conclusions: CLT in patients with PTC was associated with lower-stage disease and less disease persistence in patients >45 years of age. In patients <45 years, the presence of CLT appeared to be associated with unfavorable pathological features.

Renal metastases as the initial presentation of papillary thyroid carcinoma: A case report and literature review.

Distant metastasis of thyroid carcinoma is rare, and it occurs particularly rarely in renal regions, which represent ~3% of all thyroid distant metastases, with fewer than 30 single case study reports existing in the literature. The present study (and subsequent literature review) of papillary thyroid carcinoma (PTC) reports the case of a 53-year-old male patient who presented with a left renal mass and who had no previous history of thyroid disease. Following renal and thyroid surgery, postoperative pathology confirmed the case to be a follicular variant of PTC, accompanied by renal metastasis. The patient exhibited brain metastasis during a later follow-up. In conclusion, thyroid metastases to the renal site are extremely rare events, particularly for men who present initially with renal neoplasms, which may easily be misdiagnosed as renal cell carcinoma. PTC tends to have a good prognosis; however, when it is accompanied by distant metastasis, the prognosis becomes less favorable.