Thyroid Carcinoma Presenting Research Articles

Unusual presentation of occult follicular carcinoma of thyroid: As thoracic wall lump

Occult thyroid carcinoma presenting with clinically apparent metastasis is rare and is a diagnostic challenge. Here we report a 68-year-old male who presented with a left side chest wall mass of one year duration. The mass showed rapid enlargement at the latter end of its course, following an initial asymptomatic period. Imaging studies showed a soft tissue mass eroding into several ribs. Wide local excision with primary reconstruction was performed. Histological studies and immune staining revealed metastasis from a follicular thyroid carcinoma. Total thyroidectomy followed, confirming the diagnosis. Post-operatively radio isotope ablation (I131) was done. A suppression dose of thyroxin was continued with regular thyroglobulin assays. Painful bone metastasis responded well to analgesics, bisphosphonates and external beam radiotherapy. Follicular carcinoma comprise 10–15% of thyroid malignancies. Localized thyroid carcinoma has a very good prognosis, 10 year survival rates reducing by 50% with metastatic disease. Commonly thyroid cancer presents as detectable thyroid nodules, 25% having metastasis. In contrast metastatic manifestations are reported in less than 5% of occult thyroid cancers.

Papillary thyroid carcinoma presenting with cutaneous fungating mass complicated with myiasis: a case report

<p class="abstract">Papillary Thyroid Carcinoma (PTC) is the most common type of thyroid malignancy making upto 70-80% of all thyroid malignancies. PTC presenting with extrathyroidal cutaneous fungating mass is unusual. We report the management of a neglected fungating PTC which was complicated with myiasis. Such a case has not been reported earlier in the English literature. Preoperatively myiasis was managed conservatively following which she underwent total thyroidectomy with en-bloc resection of the fungating mass along with adequate skin margin and ipsilateral selective neck dissection. Postoperative period was uneventful and the patient was given radioiodine ablation therapy 4 weeks later.</p>

Postoperative recurrence of papillary thyroid carcinoma with lymph node metastasis.

Background and Objectives: The purpose of this study was to retrospectively analyze the features of patients with papillary thyroid carcinoma (PTC) presenting with neck lymph node (LN) metastasis.Methods: The study enrolled 909 patients with PTC who had undergone total thyroidectomy. After a median follow‐up of 14.6 years, 73 (8.0%) patients died of thyroid cancer. A total of 536 patients had the tumor confined to the thyroid (intra‐thyroid), 111 had lymph node (LN) metastasis, 225 showed soft tissue invasion, and 37 had distant metastasis.Results: Compared with the intra‐thyroid group, the group with LN metastases showed larger tumor size, higher postoperative thyroglobulin levels, advanced TNM stage, higher recurrence rates (5.2% vs. 31.5%), and higher disease‐specific mortality (1.3% vs. 12.6%). Of the 111 patients with PTC and LN metastases, 35 (31.5%) were diagnosed with recurrence during a mean follow‐up period of 16.9 ± 0.6 years. Among the 35 patients with recurrent PTC, 14 (40.0%) died of thyroid cancer. The mortality group was characterized by older, mostly male patients who presented with larger initial tumor size compared with survivors.Conclusions: In patients with PTC, the rates of recurrence and cancer mortality were higher in the group with LN metastasis than that in the intra‐thyroid tumor group. J. Surg. Oncol. 2015 111:149–154. © 2015 The Authors. Journal of Surgical Oncology Published by Wiley Periodicals, Inc.

Five Patients with Medullary Thyroid Carcinoma Presenting as Asymptomatic Elevation of Carcinoembryonic Antigen Level

Five Patients with Medullary Thyroid Carcinoma Presenting as Asymptomatic Elevation of Carcinoembryonic Antigen Level

Abstract #1009: Spinal Compression Fracture and Widespread Metastatic Lesions: A Rare Presentation of Follicular Thyroid Carcinoma

Abstract #1009: Spinal Compression Fracture and Widespread Metastatic Lesions: A Rare Presentation of Follicular Thyroid Carcinoma

Abstract #1013: A Case of Micro-Medullary Thyroid Carcinoma Presenting with Bone Metastasis

Abstract #1013: A Case of Micro-Medullary Thyroid Carcinoma Presenting with Bone Metastasis

Abstract #1041: Rare Case of Poorly Differentiated Thyroid Carcinoma Presenting as Unilateral Exophthalmos

Abstract #1041: Rare Case of Poorly Differentiated Thyroid Carcinoma Presenting as Unilateral Exophthalmos

Papillary thyroid carcinoma: prognostic significance of cancer presentation

BackgroundThe objective of this study was to evaluate whether the clinical presentation of papillary thyroid carcinoma (PTC) has prognostic significance. MethodsRetrospective evaluation was carried out of sequential, primary presentation, >1 cm diameter, PTC cases treated at a single center. PTC cases were grouped into 3 groups: (1) incidental detection by imaging, (2) incidental detection by physical examination, and (3) detection because of complaints related to a thyroid mass. The MACIS (metastasis, age, completeness of resection, invasion, and size) system was used to determine cancer prognosis for each group. ResultsOf the 168 PTC cases, 28 patients (17%) were in group 1, 60 patients (36%) were in group 2, and 80 patients (47%) were in group 3. Overall, 53% of differentiated thyroid cancers were detected incidentally. The difference in the proportion of patients in each MACIS score groups among the 3 clinical presentation categories, and for each component of the MACIS score, was not statistically significant (P = .36). ConclusionThe manner in which PTC initially clinically presents has no relationship with cancer prognosis.

Morphological and clinical presentation of papillary thyroid carcinoma in children and adolescents of Belarus: The influence of radiation exposure and the source of irradiation

ObjectiveThe aims were to analyse the features of papillary thyroid carcinoma in a large cohort of children and adolescents in Belarus and to study the influence of radiation exposure as well as the source of irradiation on the morphological and clinical presentations of tumours. Design and patientsThe clinical and pathological features of 1086 young patients (age range=4 to 18 inclusive, followed up for ≥18years) with papillary thyroid carcinoma diagnosed during the years 1990 to 2010 were reviewed. The patients were divided into three groups: “external radiation-related”, “post-Chernobyl” (internal irradiation-related) and “sporadic”. Besides, patients from “post-Chernobyl” cohort (n=936) were further divided into the three equal subgroups according to the dates of surgery, which were corresponding to the early (4–9years), intermediate (10–12years) and long (14–18years) latency periods. ResultsPatients in the “external radiation-related” group often showed extra-thyroidal extension in tumours sized ≤10mm (p=0.002). Distant metastases were more frequently (p=0.006) discovered in patients with papillary thyroid carcinoma in post-Chernobyl group (104 of 936, 11.1%) when compared to juveniles from other two groups. Lateral nodal disease and distant metastases were often noted in post-Chernobyl patients operated during the early and intermediate latency periods only. ConclusionYoung patients in Belarus with papillary thyroid carcinoma in the “post-Chernobyl” group differed in many clinical and pathological parameters from those in the “sporadic” group. “External radiation related” papillary thyroid carcinomas were distinguished from other two groups of carcinoma in more advanced local spread and more aggressive behaviour of micro-carcinomas.

Unusual Presentation of Papillary Thyroid Carcinoma

ABSTRACT Papillary thyroid carcinoma (PTC) has the highest incidence of cervical lymph node metastasis among thyroid malignancies. Lateral neck swelling as the only manifestation of PTC in the absence of palpable thyroid lesion is not common. Here, we report a case of an adult female who presented with right cervical mass and excision biopsy revealed metastatic papillary carcinoma of thyroid. Total thyroidectomy with central compartment neck dissection was performed, and histopathology showed multifocal PTC. How to cite this article Saldanha M, Biniyam K, Permi HS, Bhat VS. Unusual Presentation of Papillary Thyroid Carcinoma. Int J Head Neck Surg 2015;6(1):32-34.

A Case of Miliary Nodules, Hemoptysis and Hot Thyroid Cancer: Unusual Presentation of Papillary Thyroid Cancer

ABSTRACT Background Papillary thyroid carcinoma is the commonest thyroid cancer. Patients usually present with thyroid nodule and rarely with hyperthyroidism such that 2009 ATA guidelines recommended that cytological evaluation is not necessary in patients with hyperfunctioning nodules as they rarely harbor malignancy. We report a case of an unusual presentation of metastatic papillary thyroid carcinoma in a young patient. Case presentation A 17-year-old girl, presented to our hospital with 3 days of fever, cough and hemoptysis. Chest X-ray showed extensive miliary nodules and was treated for presumed miliary tuberculosis. Biochemical investigations revealed a hyperthyroid state (fT4 55.7 TSH < 0.02), with negative antibodies (TRAB and TSI). Radioisotope scan showed increased uptake on right lobe. She underwent bronchoscopy and biopsy which revealed metastatic papillary thyroid carcinoma. Clinical examination revealed a small goiter with palpable cervical node at level III on the left. There were no clinical signs of Graves’ disease and she had no history of previous radiation or family history of endocrine disease. Ultrasound revealed multiple hypodense thyroid nodules with microcalcification and increased vascularity. Ultrasound of the neck showed the presence of abnormal lymphadenopathy. She underwent total thyroidectomy, bilateral central neck dissection and left lateral modified neck dissection. Histology showed 1.3 cm papillary thyroid carcinoma involving the left lobe and multifocal papillary thyroid microcarcinomas involving both lobes. Ten out of 27 nodes were involved. She was BRAF mutation positive. She recovered well postoperatively and was rendered hypothyroid. She underwent radioiodine ablation which showed no more disease in the neck but unfortunately there was no uptake in the lung metastases. Conclusion Metastatic papillary thyroid cancer developing in a young patient with hyperthyroidism is extremely rare and suggests a more aggressive behavior as confirmed by BRAF mutation. How to cite this article Hu JSL, Parameswaran R. A Case of Miliary Nodules, Hemoptysis and Hot Thyroid Cancer: Unusual Presentation of Papillary Thyroid Cancer. World J Endoc Surg 2015;7(3):72-75.

Epidemiology and Clinical Presentation of Medullary Thyroid Carcinoma.

Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor originating from the thyroid C cells producing mainly calcitonin (CTN) used as tumor marker. MTC occurs either sporadic (75%) or in a hereditary form (multiple endocrine neoplasia type 2, MEN2), due to germline mutations in the RET proto-oncogene. The discovery of an MTC in a patient has several diagnostic implications involving a specific strategy: preoperative evaluation of the tumor marker CTN and the extent of the disease, classification of MTC as sporadic or hereditary by DNA testing, and screening for associated endocrinopathies in hereditary MTC. Elevated CTN is a highly sensitive and specific tumor marker for diagnosis and follow-up of MTC. CTN is directly related to the tumor mass. In patients with nodular thyroid disease, diagnosis of MTC could be made by CTN determination as an indicator of tumor burden in conjunction with fine-needle aspiration. Patients with confirmed sporadic or hereditary MTC should have a total thyroidectomy and depending on the preoperative CTN value and the extent of disease additional dissection of the lymph nodes in the central and lateral neck compartment. In MEN 2 patients diagnosed by screening, the time of prophylactic thyroidectomy depends on RET mutation and CTN level.

Cutaneous metastasis of Papillary thyroid carcinoma to the neck: a case report and review of the literature

Papillary thyroid carcinoma, the most common subtype of thyroid malignancy, rarely presents with cutaneous metastatic spread. Despite metastatic cutaneous lesions presenting as slow and indolent growing nodules of the head and neck, such lesions most frequently appear in the setting of diffuse and dramatic metastatic disease and a bleak prognosis. Given the rarity of these metastatic lesions, the diagnosis may be delayed, and often the initial diagnosis is incorrect. Several case reports have been published in the literature noting unusual or interesting presentations of thyroid carcinoma with cutaneous metastasis. Here we present a classic case of a patient with a prior diagnosis of thyroid carcinoma presenting with a slowly growing ulcerated lesion on the neck nine years after partial thyroidectomy and characteristic histopathology on microscopic examination. Furthermore we review the literature regarding papillary thyroid carcinoma with cutaneous metastasis and the diagnostic challenge these lesions present to practitioners.

Chronic Diarrhea and Multiple Lung Masses: Unusual Clinical Presentations of Medullary Thyroid Carcinoma

Chronic Diarrhea and Multiple Lung Masses: Unusual Clinical Presentations of Medullary Thyroid Carcinoma

Metastatic Papillary Thyroid Carcinoma Presenting as Progressive Dyspnea From ILD

SESSION TITLE: ILD Student/Resident Case Report Posters

Metastatic thyroid carcinoma presenting as pathological fracture

Introduction: There are various surgical options for reconstruction of intraoral defects following resection of maxillary SCC. Options are limited when the general condition of the patient is altered. In this cases a useful option and simple alternative to pedicled and free flaps is the nasolabial flap, which can cover small, medium and even large maxillary defects. Materials: We presenting a patient diagnosticated with maxillary SCC and multiple comorbidities which had a medium to large defect from tumour ablation and reconstruction with bilateral nasolabial flaps. Results: Maxilla closure was remarkable with patient recovery of speech and swallowing. Good functional result with social integration of the patient. Unfortunately patient past away from distant metastasis. Conclusions: The nasolabial flap is a viable and valuable alternative for reconstruction of various maxillary defects, even larger, regarding patients with many comorbidities.

Follicular Thyroid Carcinoma Presenting With Endobronchial Metastases: Case Report and Review of Literature.

Endobronchial metastasis is a rare manifestation of differentiated thyroid cancer. A 79-year-old male was admitted to the hospital with shortness of breath, chest pain, anemia, and weight loss. Computed tomography of chest revealed multiple lung nodules. Bronchoscopy showed an endobronchial lesion in the right upper lobe. The biopsy of the lesion demonstrated neoplastic cells stained positive for thyroglobulin, thyroid transcription factor-1, and cytokeratin-7, consistent with metastatic follicular thyroid cancer. Physical examination revealed a firm fixed thyroid nodule, which was confirmed by thyroid ultrasound. He subsequently underwent total thyroidectomy and neck exploration. Thyroid gland pathology revealed a nodule with features of high-grade follicular thyroid carcinoma. Metastatic thyroid cancer should be considered in workup of pulmonary nodules. We recommend an examination of thyroid gland in patients who present with pulmonary nodules associated with signs and symptoms of malignancy.

Laryngotracheal presentation of anaplastic thyroid carcinoma with squamous differentiation: seven cases demonstrating an under‐recognized diagnostic pitfall

To describe a series of anaplastic thyroid carcinomas that mimicked primary head and neck squamous cell carcinoma (HNSCC) by virtue of both morphology and clinical presentation. Seven cases were identified in a 15-year period where a biopsy of an airway lesion that appeared to be squamous cell carcinoma was, in fact, anaplastic thyroid carcinoma. The tumours had squamous and/or spindle cell morphology, with only the squamous component being apparent in the airway biopsy. Some tumours arose within metaplastic (n=3) or atypical (n=3) epithelium, supporting the diagnosis of a primary mucosal tumour. Positive PAX8 (n=5) and TTF-1 (n=4) staining was identified. An endotracheal presentation of anaplastic thyroid carcinoma with squamous morphology may be misdiagnosed as a primary head and neck squamous cell carcinoma. PAX8 and TTF-1 expression are helpful in making the distinction, but the problem lies in suspecting a thyroid carcinoma in what appears to be a straightforward diagnosis of HNSCC.

The role of ATM-CHEK2-BRCA1 axis in determination of genetic predisposition and clinical presentation of papillary thyroid carcinoma

The role of ATM-CHEK2-BRCA1 axis in determination of genetic predisposition and clinical presentation of papillary thyroid carcinoma

Follicular thyroid carcinoma presenting with occipital bone and lung metastasis

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