Thyroid Carcinoma Presenting Research Articles

Follicular Thyroid Carcinoma Presenting as Bilateral Cheek Masses

Mandibular metastasis of thyroid carcinoma is extremely rare. We present the case of a 46-year-old woman who had bilateral huge cheek masses that had grown rapidly over several years. Intra-oral mucosal tissue biopsy and imaging work-up including computed tomography scan and magnetic resonance imaging were performed and the initial diagnosis was presumed to be central giant cell granuloma. Incidentally detected thyroid lesions were studied with ultra-sonography guided fine needle aspiration and diagnosed as simple benign nodules. Due to continuous oral bleeding and the locally destructive feature of the lesions, we decided to excise the mass surgically. To avoid functional deficit, a stepwise approach was performed: Firstly, the larger left mass was excised and the mandible was reconstructed with a fibular free flap. The final pathologic diagnosis was follicular thyroid cancer. Postoperative I-131 thyroid scan and whole body positron-emissions-tomography were performed. Right side mass was revealed as a thyroid malignancy. Multiple bony metastases were detected. Since further radioactive iodine therapy was required, additional total thyroidectomy and right side mandibulectomy with fibular free flap reconstruction was performed. The patient also underwent high dose radioactive iodine therapy and palliative extra-beam radiotherapy for the metastatic lumbar lesion. Follicular thyroid carcinoma should be considered as a differential diagnosis for mandibular mass lesions.

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].

Thyroid and Parathyroid Surgery: The General Otolaryngologist Experience

Objectives/Hypothesis Previous studies on complication rates of thyroid and parathyroid surgery focus on cases performed by general surgeons and fellowship trained head and neck or endocrine surgeons. This study examines the complication rate of thyroid and parathyroid surgery performed by a non-fellowship trained general otolaryngologist and compares it to rates reported by general surgeons and fellowship trained endocrine surgeons. Study Design Retrospective chart review. Methods We reviewed 96 cases of thyroidectomy and/or parathyroidectomy performed between 2002 and 2010 by a general otolaryngologist. Data collected included patient age, sex, ultrasound scans, fine needle aspiration results, surgical time, nerve monitor use, drain use, estimated blood loss, pathology, calcium levels, recurrence, vocal cord paresis, complications and mortality. Results We found comparable rates of hypocalcemia, vocal cord paralysis, scar formation and hematoma when compared to previously published studies. Nine patients (9.3%) had transient hypocalcemia and no patients developed permanent hypocalcemia. One patient (1.0%) had temporary vocal cord paresis lasting less than 6 months, and one patient (1.0%) had permanent unilateral vocal cord paralysis secondary to sacrifice of the recurrent laryngeal nerve. Two patients (2.0%) developed keloid scars. One patient (1.0%) underwent reoperation for evacuation of a postoperative hematoma. These rates are within or below the ranges reported in the aforementioned literature. One patient (1.0%) developed a wound infection treated with antibiotics. There were no airway complications, chyle leaks, or deaths. Conclusions This study reports a favorable complication rate and supports the safety of thyroid and parathyroid surgery performed by a general otolaryngologist. INTRODUCTION Complications of thyroid and parathyroid surgery include metabolic derangements, superior and recurrent laryngeal nerve injury, infection, airway compromise and bleeding. Various factors have been implicated as risks for complication in thyroid and parathyroid surgery. Studies performed by general surgeons or fellowship trained endocrine surgeons have suggested that surgeon volume1-3, size of goiter, presence of thyroid carcinoma, stage of disease, and extent of resection may be related to risk of complications.4,5 In recent years, a greater percentage of thyroid and parathyroid operations are being performed by otolaryngologists as opposed to general surgeons.6,7 This study examines the complication rate of thyroid and parathyroid surgery performed by a general otolaryngologist who performs, on average, 12 cases per year over an eight year period. This study was completed in order to provide further guidance as to the safety of thyroid and parathyroid surgery performed by a general otolaryngologist. MATERIALS AND METHODS After obtaining approval from the institutional review board, we performed a retrospective chart review of patients who underwent thyroidectomy and/or parathyroidectomy by Dr. Erich Voigt at the New York Otolaryngology Institute and the Department of Otorhinolaryngology/Head & Neck Surgery of Weill Cornell Medical College between January 2002 and September 2010. Patients all had at least one postoperative visit. Information such as diagnosis, type of surgery performed, age, sex, pathologic diagnosis, surgical time, use of nerve monitor, use of drains, estimated blood loss, parathyroid hormone levels, preoperative and postoperative calcium levels, calcium and vitamin D supplementation, readmission, recurrence, vocal cord paresis, complications and mortality were recorded.

Thyroid carcinoma presenting as a dural metastasis mimicking a meningioma: A case report

Context:Follicular thyroid cancer rarely manifests itself as a distant metastatic lesion.Case Report:We report a case of a 41-year old man presented with a solid mass located in the left temporo-occipital region. The 3D computed tomography showed a large solid mass with high vascularity, skull erosion and supra-infratentorial epidural mass effect. After magnetic resonance imaging (MRI) a suspect diagnosis of meningioma was made. The patient underwent surgery where a soft mass with transverse sinus invasion was encountered; the tumour was successfully resected employing microsurgical techniques. Histological examination revealed a thyroid follicular neoplasm with positive staining for follicular carcinoma in immunohistochemical analysis. Postoperatively levels of thyroid hormones were normal. Treatment was planned for the thyroid gland, patient receiving 6 courses of chemotherapy including paclitaxel.Conclusions:The present case emphasizes that although they are uncommon, dural metastasis can be mistaken for meningiomas. The definitive diagnosis of a meningioma should be established only after the histopathological analysis. Thyroid follicular carcinoma should be included in the differential diagnosis in cases of extrinsic tumoral lesions.

The Management of Metastatic Thyroid Carcinoma: An Initial Presentation with Bony Metastasis

Introduction: Metastatic thyroid carcinoma presenting at the initial time of diagnosis is uncommon and the prognosis is unclear. Long term survival rates are variable ranging from 13% to 100%. This case report is presented to illustrate potential management and lend statistical power to future analysis of the correct treatment planning, mortality rates, and prognostic indications for an uncommon presentation of thyroid cancer. Case presentation: This patient is a 63 year old female who presented with new onset of progressive right hip pain. She was treated with a cortisone injection for presumed osteoarthritis but did not improve. Physical exam at the time was pertinent for a body mass index (BMI) of 38.4, mild systolic hypertension, difficulty walking secondary to the right hip pain, limited range of motion at the hip, and fullness of right thyroid gland with no palpable nodules. Laboratory evaluation including thyroid function tests was normal. However, CT and MRI scans revealed a 6.5 cm × 5 cm osteolytic expansive lesion on the right iliac crest with a soft tissue mass. In addition, an enlarged right thyroid lobe and small nodular densities in the lungs suspicious for metastatic disease were noted. A fine needle aspiration of the right ileum revealed metastatic follicular adenocarcinoma consistent with a thyroid primary. The patient was not a surgical candidate due to the extent of disease. She received 37.5 Gy to both the right iliac crest mass and the neck to include the thyroid lesion, followed by iodine-131 ablation and bisphosphonate therapy. Her disease was stable on her last follow up at 48 months. Conclusion: Further studies identifying independent variables such as age of the patient, site and extent of the disease and histology of the tumor are needed to help determine the true prognosis and proper management patients with this presentation. The optimal treatment with potential chance for cure in patients with metastatic thyroid carcinoma has yet to be elucidated.

Risk profiles and penetrance estimations in multiple endocrine neoplasia type 2A caused by germline RET mutations located in exon 10

Multiple endocrine neoplasia type 2 is characterized by germline mutations in RET. For exon 10, comprehensive molecular and corresponding phenotypic data are scarce. The International RET Exon 10 Consortium, comprising 27 centers from 15 countries, analyzed patients with RET exon 10 mutations for clinical-risk profiles. Presentation, age-dependent penetrance, and stage at presentation of medullary thyroid carcinoma (MTC), pheochromocytoma, and hyperparathyroidism were studied. A total of 340 subjects from 103 families, age 4-86, were registered. There were 21 distinct single nucleotide germline mutations located in codons 609 (45 subjects), 611 (50), 618 (94), and 620 (151). MTC was present in 263 registrants, pheochromocytoma in 54, and hyperparathyroidism in 8 subjects. Of the patients with MTC, 53% were detected when asymptomatic, and among those with pheochromocytoma, 54%. Penetrance for MTC was 4% by age 10, 25% by 25, and 80% by 50. Codon-associated penetrance by age 50 ranged from 60% (codon 611) to 86% (620). More advanced stage and increasing risk of metastases correlated with mutation in codon position (609→620) near the juxtamembrane domain. Our data provide rigorous bases for timing of premorbid diagnosis and personalized treatment/prophylactic procedure decisions depending on specific RET exon 10 codons affected.

Medullary thyroid carcinoma presenting with an initial CEA elevation

Carcinoembryonic antigen (CEA) is a tumour marker commonly associated with gastrointestinal malignancy. Patients presenting with an elevated CEA will therefore often undergo extensive investigations in order to elucidate an underlying gastrointestinal malignancy that may not be clinically apparent. However the GI tract is not the only source of CEA elevation. We present a series of patients presenting with raised CEA levels that were initially investigated for a gastrointestinal cause, but after work up were detected to have medullary thyroid cancer. Four patients with raised CEA were evaluated for a gastrointestinal cause for the elevation. We discuss the non gastrointestinal causes for an elevated CEA. The paper highlights that in patients presenting with an elevated CEA, in whom a gastrointestinal cause has been ruled out, a tumour of neuroendocrine origin needs to be considered as a cause for the elevated CEA.

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

Markedly Elevated Serum Calcitonin Concentrations Associated with Initial Presentation But Not the Recurrent Presentation of Medullary Thyroid Carcinoma

Markedly Elevated Serum Calcitonin Concentrations Associated with Initial Presentation But Not the Recurrent Presentation of Medullary Thyroid Carcinoma

Metastatic Thyroid Carcinoma Presenting as Hypervascular Lesion of the Mandible: A Case Report and Review of Literature

Mandibular metastasis with the thyroid gland as the primary site is a rare event, and the reported incidence is estimated at approximately 1%. 1 Meyer I. Shklar G. Malignant tumors metastatic to mouth and jaws. J Oral Surg. 1965; 20: 350 Abstract Full Text PDF Scopus (265) Google Scholar In 29% to 33% of cases, the metastatic lesion might be the first indication of an undiscovered primary malignancy at a distant site. 2 Lim S.Y. Kim S.A. Ahn S.G. et al. Metastatic tumors to the jaws and oral soft tissues; A retrospective analysis of 41 Korean patients. Int J Oral Maxillofac Surg. 2006; 35: 412 Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar , 3 Hirshberg A. Leibovich P. Buchner A. Metastatic tumors to the jaw bones: Analysis of 390 cases. J Oral Pathol Med. 1994; 23: 337 Crossref PubMed Scopus (228) Google Scholar , 4 Peacock T.R. Fleet J.D. Condylar metastasis from bronchogenic carcinoma. Br J Oral Maxillofac Surg. 1982; 20: 39 Abstract Full Text PDF Scopus (22) Google Scholar Because of the bloodstream dissemination of these lesions, most are a consequence of the follicular variant of thyroid carcinomas, which are highly prone to cause vascular invasion and may present as hypervascular lesions mimicking arteriovenous malformations. We present one such rare case of a hypervascular osteolytic lesion of the mandible that proved to be a metastatic follicular thyroid carcinoma (FTC).

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.

Superior Vena Cava Syndrome: A Presentation of Anaplastic Thyroid Carcinoma

Superior Vena Cava Syndrome: A Presentation of Anaplastic Thyroid Carcinoma

Esophageal Metastasis from Carcinoma Thyroid

AbstractThe incidence of hematogenous spread at the time of presentation of well-differentiated thyroid carcinoma is the range of 4 to 15%. Distant metastases in the most common cause of death from well-differentiated thyroid cancers. About 5% of papillary carcinoma and 25% of follicular carcinoma develop distant metastases. Distant metastases occur largely in the lungs and to a lesser extent in the bones, brain and soft tissues. We report and discuss the management of an elderly gentleman with papillary carcinoma thyroid metastatic to the esophagus on follow-up. Only one similar published report is described which was from a follicular carcinoma thyroid. Our case of a papillary carcinoma thyroid metastatic to the esophagus seems to be the first if its kind.

Differentiated Thyroid Carcinoma Presenting With Distant Metastasis at Initial Diagnosis

Distant metastasis (DM) is seldom observed at initial presentation of differentiated thyroid carcinoma (DTC), making it difficult to assess the clinical characteristics and treatment outcomes of DTC patients with DM. We therefore retrospectively assessed these parameters in DTC patients who presented with DM between July 1994 and December 2007. In addition, we compared biologic behaviors and prognostic factors between patients presenting with DM and those developing DM after initial treatment. Among 1560 DTC patients who underwent thyroidectomies during the 13.5-year study period, 91 patients were included in this study; 52 patients (3.4%) displayed DM at initial presentation and 39 (2.5%) developed DM after initial 131 radiacitive iodine (RI) treatment. Metastatic lesions were treated with high dose RI (94.5%), surgical resection (14.3%), external beam radiation therapy (31.9%), embolization of feeding vessels (1.1%), and/or chemotherapy (1.1%). Median duration of follow-up was 75 months (range, 12-158 months). Mean patient age was 57 years (range, 13-80 years), and the female-to-male ratio was 2.03:1. Metastases were detected in the lung only (68.1%), bone only (16.5%), and multiple sites (15.4%). When clinical and tumor characteristics were considered, metastatic lesion iodine avidity was significantly higher in patients presenting with DM. At 5 and 10 years, the overall survival (OS) rates in patients presenting with DM were 83.8% and 72.1%, respectively, and the disease-specific survival (DSS) rates were 68.5% and 26.8%. OS did not differ significantly between patients presenting with DM and those developing DM after initial treatment. However, those with initial DM enjoyed significantly improved DSS compared with patients who developed DM after initial treatment. At last follow-up, 22 patients (24.2%) were alive without disease, 48 (52.7%) were alive with disease, and 21 (23.1%) had died of disease in study patients. Multivariate Cox's regression analyses showed that complete local control was a significant predictor of OS and DSS in all study patients. In patients developing DM after initial treatment, metastatic lesion iodine avidity was also associated with both OS and DSS. In contrast, avidity was associated only with DSS in patients presenting with DM. Our study showed that DTC patients presenting with initial DM appear to have relatively favorable outcomes compared with DTC patients who developed DM after initial treatment. Complete local control may be the most important prognostic indicator in all DM patients. Metastatic lesion iodine avidity had a significant impact on both OS and DSS in patients developing DM after initial treatment, but significantly influenced only DSS in patients presenting with initial DM.

Superior vena cava (SVC) reconstruction using autologous tissue in two cases of differentiated thyroid carcinoma presenting with SVC syndrome

Herein, we report two extremely rare cases of differentiated thyroid carcinoma (DTC) with extended tumor thrombus or mediastinum lymph node metastasis (LNM) involving the superior vena cava (SVC), causing SVC syndrome. Both of these patients were successfully treated with radical resection and reconstruction of the SVC using autologous tissue instead of an expanded polytetrafluoroethylene (ePTFE) graft. The left brachiocephalic vein was used to reconstruct the SVC in a papillary thyroid carcinoma patient with mediastinum LNM and a pericardial patch was used in a follicular thyroid carcinoma patient with tumor thrombus. Our search of the English-language literature found sporadic reports of SVC resection with reconstruction by vascular graft (ePTFE), interposed between the brachiocephalic vein and the right atrium. However, SVC reconstruction using autologous tissue in thyroid carcinoma has not been reported to date. To our knowledge, this is the first report describing such an unusual technique in DTC patients.