Thyroid Carcinoma Presenting Research Articles

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.

Thyroid carcinoma with papillary and squamous features: Report of a case with histogenetic considerations

We present a case of an 82-year-old female with a painless left latero-cervical swelling, which increased in size over the course of 6 months, compressing adjacent organs. The histopathological examination, following dissection of the left thyroid lobe and ipsilateral cervical lymph nodes, yielded two intermingled morphologically distinct histotypes that included conventional papillary thyroid carcinoma (PTC) and poorly differentiated squamous cell carcinoma (SCC) with cystic features. The clinical presentation, the immunophenotype, and the genotype, especially of the malignant squamous component with partial expression of TTF1, marked expression of p63 and mutation of BRAF, were consistent with the diagnosis of a papillary thyroid carcinoma with squamous component. The possibility of a squamous cell carcinoma of unknown origin metastasizing to a primary papillary thyroid carcinoma cannot be completely ruled out. This particular presentation of thyroid carcinoma carries a poor prognosis in 20% of cases, with high recurrence rates and distant metastasis.

Thyroid carcinoma presenting as a metastasis to the parapharyngeal space

Thyroid carcinoma presenting as a metastasis to the parapharyngeal space

Medullary thyroid carcinoma presenting as rectangular cell type on fine‐needle aspiration

Medullary thyroid carcinoma typically presents as dyscohesive plasmacytoid, spindled, or polygonal cells on fine-needle aspiration smears. We recently encountered a case of sporadic medullary thyroid carcinoma that presented as a hypercellular aspirate composed of cohesive aggregates of rectangle-shaped cells. The case was mistakenly reported as a hypercellular follicular neoplasm on cytology. Subsequent thyroidectomy revealed medullary carcinoma. We draw attention to this distinctive rectangular cell type as an additional morphology for medullary thyroid carcinoma.

Occult Papillary Thyroid Carcinoma Presenting as a Cystic Neck Mass

Occult Papillary Thyroid Carcinoma Presenting as a Cystic Neck Mass

Familial Thyroid Carcinoma

Thyroid carcinomas derived from follicular cells are the most common endocrine malignancies, and papillary thyroid carcinoma (PTC) is the most common type. Although, the majority of papillary and follicular thyroid carcinomas (FTCs) are sporadic, familial forms have been described in recent years. Familial syndromes are classified into familial medullary thyroid carcinoma and familial nonmedullary thyroid carcinoma. Multifocal papillary carcinoma is the most frequent presentation of familial nonmedullary thyroid carcinoma, and based on clinico-pathologic findings it is divided into 2 groups. The first includes familial syndromes characterized by a predominance of nonthyroidal tumors, such as familial adenomatous polyposis, PTEN-hamartoma tumor syndrome, Carney complex type 1, and Werner syndrome. The second group includes familial syndromes characterized by a predominance of NMTC, such as pure familial (f) PTC with or without oxyphilia, fPTC with papillary renal cell carcinoma, and fPTC with multinodular goiter. Medullary thyroid carcinoma is derived from calcitonin-producing C cells. The familial form accounts for 20% to 25% of cases, and is usually a component of multiple endocrine neoplasia (MEN) IIA or IIB, or presents as pure familial medullary thyroid carcinoma syndrome. C-cell hyperplasia is the precursor lesion of these heritable syndromes. Some characteristic morphologic findings should alert the pathologist of a possible familial cancer syndrome, which may lead to further molecular genetic evaluation.

New presentation of familial medullary thyroid carcinoma in 87-year-old patient with high-riskRETproto-oncogene codon 620 mutation

We report a case of familial medullary thyroid carcinoma in an 87-year-old woman, despite the patient having a high-risk codon 620 mutation. Medline and PubMed were searched for cases and literature reviews relating to the following keywords: 'codon 620', 'medullary thyroid carcinoma', 'multiple endocrine neoplasia' and 'RET proto-oncogene'. We report the case of an 87-year-old woman who presented with a goitre, later identified as medullary thyroid carcinoma. Genetic analysis revealed a RET proto-oncogene codon 620 mutation. Genetic testing has revolutionised the management of medullary thyroid carcinoma. The genetic basis of hereditary medullary thyroid carcinoma lies with the RET proto-oncogene. Several disease-causing mutations of this gene have been identified and their clinical prognosis described. The penetrance of these mutations is high; as such, carriers progress to develop medullary thyroid carcinoma at a young age. Mutations at the codon 620 position are classified as high-risk for early development of medullary thyroid carcinoma; thus, the current recommendation is for prophylactic thyroidectomy at five years of age. In this case, the progress of hereditary medullary thyroid carcinoma was unique, considering the late presentation of medullary thyroid carcinoma despite the presence of the high-risk RET proto-oncogene codon 620 mutation. The authors wish to highlight the importance of this case, as it may present a counter-argument to the current recommendations for early, prophylactic thyroidectomy in codon 620 mutation carriers in order to prevent early development of medullary thyroid carcinoma.

An Unusual Imaging and Clinical Presentation of Papillary Thyroid Carcinoma

Papillary thyroid carcinoma is the most common thyroid malignancy, accounting for 88% of all thyroid cancers in the United States.' The most common clinical presentation is a solitary thyroid nodule. On high-resolution sonography, features suggestive of papillary thyroid carcinoma include a hypoechoic solid lesion with microcalcifications and intrinsic vascularity. 2-5 We report an atypical case of metastatic papillary thyroid carcinoma that presented as a left hip mass with unusual sonographic findings of a predominantly cystic primary thyroid lesion.

Unresectable Huge Sternal and Mediastinal Metastasis of Follicular Thyroid Carcinoma; Radiotherapy as First-line and Palliative Therapy

Distant metastases as initial manifestation of follicular thyroid carcinoma is rare. We report a case of an unusual initial presentation of follicular thyroid carcinoma on follow-up. A 52- year-old woman presented with a 12-month history of progressively enlarging mass in the anterior chest wall. The mass was fixed to the chest wall, measuring 12 x 10 cm in diameter. Computed tomography demonstrated a lobulated soft-tissue mass (17 x 11 x 6 cm) destructing sternum and extending into the anterior mediastinum. There was no lung metastasis. Invasion of tumor to the ascending aorta, superior vena cava, and right atrium could not be excluded. Multiple lymph nodes were observed in the supraclavicular regions. Ultrasonography of the thyroid gland showed 46 x 37 mm nodule in the left lobe with milimetric gross calcifications and cystic-necrotic areas. Hyperthyroidism was detected. Biopsy from this nodule and the sternal mass revealed typical histology of follicular carcinoma. She was considered inoperable. Since there was huge tumor burden and iodinated contrast exposure for several times during evaluation, we decided to treat the patient with external beam radiotherapy (EBRT) rather than radioiodine as first-line therapy. After a course of conventional radiation with 50 Gy in 25 fractions over 4 weeks, encompassing the thyroid bed and the gross disease, tumor regressed remarkably in 6 months. In conclusion, when surgical resection is not possible, EBRT may be used for palliative purpose to obtain local control for extensive disease as first-line therapy. The indications of EBRT for differentiated thyroid cancer still remain poorly defined.

Occult Papillary Thyroid Carcinoma Presenting as Huge Cervical Metastasis with Cystic Pattern

Cervical cysts are usually benign in the population younger than 40 years. However, neck metastasis from malignancies of the head and neck may present as cervical cysts. Here, we report a case of papillary thyroid carcinoma with cervical metastasis and cystic change. A 35-year-old man visited our clinic, and his chief complaint was related to the presence of a huge neck mass for 15 years. Computed tomography scans revealed cystic masses and abnormal calcification in the thyroid gland. Fine needle aspiration cytology of the left thyroid gland revealed atypical cells with a few cells harboring intranuclear pseudoinclusion. We then performed dissection of the left side of the neck to remove the cystic masses and a left thyroid lobectomy. Intraoperative frozen section biopsy of the cystic masses showed benign cystic lesions. However, the results of the final pathologic examination proved thyroid papillary carcinoma in the thyroid gland and the cystic masses. The patient received dissection of the right side of the neck accompanied by right thyroid lobectomy. After the operation, 131I ablation therapy was performed. There was no recurrence noted during the regular 2-year follow-up period.

Papillary carcinoma in submandibular region — a diagnostic dilemma

Papillary carcinoma is the most common variant of thyroid carcinoma. It accounts for 50–70% of thyroid malignancies in patients under the age of 40 yrs [1, 2]. Thyroid carcinoma usually presents as midline neck mass. Nodal metastasis to the neck may be the fi rst presenting symptom in papillary carcinoma thyroid. Such occult presentation of well differentiated thyroid carcinoma is seen in 10–26% of thyroid malignancies [3, 4]. In these patients, the sole presenting symptom is lateral neck mass with no evidence of primary in thyroid gland. However thyroid carcinoma presenting as submandibular swelling is not common. We report a patient of papillary carcinoma thyroid, who presented with metastatic neck swelling in the submandibular region without evidence of primary in the thyroid region.

Otolaryngologist–Head and Neck Surgeon‐Performed Ultrasonography for Parathyroid Adenoma Localization

To demonstrate the efficacy of otolaryngologist-head and neck surgeon-performed ultrasonography (US) for the preoperative localization of parathyroid adenomas. A retrospective chart review of all patients evaluated by office-based US for the localization of surgery-proven parathyroid adenomas from October 2004 through February 2007. A total of 29 patients underwent preoperative US localization. Twenty-three (79%) were females, and six (21%) were males. The age of patients ranged from 27 to 85 years of age. The size range of adenomas detected as measured by US was 0.5 to 2.7 cm. Pathology specimen measurements ranged from 0.3 to 3.4 cm. A total of 30 parathyroid adenomas were found. US identified 90% of the parathyroid adenomas to the correct side, left or right. In addition, US localized the parathyroid adenomas to the correct quadrant, superior or inferior, 83% of the time. Challenges in accurate localization were associated with patient obesity, presence of thyroid carcinoma, and multinodular thyroid disease. For comparison, sestamibi scans performed on the same patients localized the parathyroid adenoma to the correct side only 71% of the time and to the correct quadrant 61% of the time. Otolaryngologist-head and neck surgeon-performed US can accurately identify the location of parathyroid adenomas and is a useful tool for preoperative planning.

Endobronchial metastasis of follicular thyroid carcinoma presenting as hemoptysis: A case report

Endobronchial metastasis secondary to follicular thyroid carcinoma is extremely rare. Here, we report a case of follicular thyroid cancer in 58-year-old male who presented with hemoptysis. Computed tomography of the chest revealed multiple lung metastases. Flexible fiberoptic bronchoscopy revealed a fragile polypoid mass 5 cm distal to the vocal cords; biopsy taken from this mass revealed follicular thyroid carcinoma.

Lingual Thyroid Carcinoma With Nodal Metastasis

To discuss treatment options and surgical management of lingual thyroid carcinoma with cervical metastasis. Lingual thyroid is relatively uncommon, and carcinoma of the lingual thyroid is extremely rare, with only 40 cases reported. We report a new case of a young female who presented with a cervical neck mass found to represent metastatic papillary thyroid carcinoma. Further workup revealed the patient's only thyroid tissue was located at the tongue base and was the site of the primary tumor. Management of lingual thyroid carcinoma and review of the literature is discussed. A case report and review of the literature of lingual thyroid carcinoma. A young female presented with a left neck mass diagnosed as metastatic papillary thyroid carcinoma. Review of the computed tomography scan of the neck revealed a tongue base mass, absence of an othotopic thyroid gland and bilateral cervical lymphandenopathy. Bilateral selective neck dissections with removal of the tongue base lesion confirmed the diagnosis of lingual thyroid carcinoma with multiple left cervical nodal metastases. A case of lingual papillary thyroid carcinoma with cervical metastasis is reported. Treatment is best managed with surgical excision of all thyroid tissue followed by radioactive iodine ablation. Surgical approaches to the tongue base need to be considered based on the size of the lingual primary tumor and the need to address lymph node metastases gland. This is the first reported case in the literature of lingual papillary thyroid carcinoma presenting with cervical nodal metastasis in a female with absence of an orthotopic thyroid gland. This is also the first report to show that papillary and not follicular cell carcinoma is the predominating histopathology in lingual thyroid carcinoma.

Aggressive Presentation of Papillary Thyroid Carcinoma: Where Has the Vertebra Gone?

Aggressive Presentation of Papillary Thyroid Carcinoma: Where Has the Vertebra Gone?

Metastatic Papillary Thyroid Carcinoma Presenting as a Long-Standing Calcified Neck Mass

Metastatic Papillary Thyroid Carcinoma Presenting as a Long-Standing Calcified Neck Mass

Management Considerations for Differentiated Thyroid Carcinoma Presenting as a Metastasis to the Skull Base

To characterize the salient features of skull base metastasis from differentiated thyroid carcinoma, discuss the diagnostic and treatment strategies, and propose rational management guidelines for such tumors. Case report. Review of English literature from MEDLINE with the addition of our case. Skull base metastasis from differentiated thyroid carcinoma is rare, with only 20 cases reported to date, including our case report. On the basis of a review of all reported cases, both follicular and papillary thyroid cancers can metastasize to the skull base. Our case is unique because the lesion extends locally into the cavernous sinus and beyond. Histopathologic diagnosis is limited by the remote location of lesions. Most tumors are highly vascular, and there is potential for significant morbidity and mortality associated with surgical resection. The overall survival ranges from less than one year to 10+ years from the discovery of the metastasis and is similar in both tumor subtypes. There is no clear consensus on the management strategy for skull base metastasis from differentiated thyroid carcinoma. Interestingly, surgical resection of both the primary and metastatic lesions yields similar survival when compared with resection of the primary tumor alone. Distant metastasis from differentiated thyroid carcinoma needs to be considered in the differential diagnosis of destructive skull base lesions, regardless of the patient's age. Histopathologic tissue diagnosis should always be attempted, followed by total thyroidectomy, radioiodine, or external beam radiation, and chronic thyroid-stimulating hormone suppression. Surgical resection of the metastatic lesion should only be performed in carefully selected cases because it is associated with significant morbidity.

Spinal Cord Compression as Initial Presentation of Follicular Thyroid Carcinoma

Follicular thyroid carcinoma with metastasis rarely manifests as spinal cord compression without any previous symptoms of its malignancy. This report describes a 64-year-old man with follicular thyroid carcinoma who presented initially with left arm motor weakness. Magnetic resonance images demonstrated severe cervical cord compression by a mass with destruction of C4 vertebra. Corpectomy of C4 and anterior interbody fusion was carried out. Histopathological study revealed a metastatic follicular carcinoma of the thyroid. We present our case, especially focused of its possible pathophysiology, with review of pertinent literatures.

Papillary carcinoma of thyroid presenting with skin ulceration

Papillary carcinoma of thyroid presenting with skin ulceration