Most papillary thyroid cancers do not cause symptoms (i.e. Clinical information Palpable mass. Related data statistics about internal metastasis of PTC are still in short supply. Bilateral thyroid was slightly swollen. For internal spread of thyroid, resection scope does not vary greatly with MPTC. For skipping lymphatic metastasis, functional lymph node dissection should be performed. The number of small tubercles and cluster degree decrease with increased distance from large tubercles, which indicates internal spread of thyroid carcinoma. MPTC is one of the clinical characteristics of PTC and exists as multiple independent carcinoma lesions in thyroid. Result of intraoperative frozen pathology section showed that micropapillary carcinomas were dispersed in the isthmus of thyroid gland and right thyroid. Very large nodules may cause compressive symptoms which include difficulty swallowing, food or pills getting "stuck" when they swallow, and pressure or shortness of breath when lying flat. A spread lesion in the lymph-vessel blackened by nanometer carbon tracer and blackened lymph-vessels in the lesion were showed in Figure 4. Other clinical statistics also reflect PTC combined with HT has higher incidence of MPTC [4, 5]. Papillary thyroid cancer (as is the case with follicular thyroid cancer) typically occurs in the middle-aged, with a peak incidence in the 3rd and 4th decades. The number of satellite lesions in the right lobe is more than that in left lobe (Figure 5). Papillary thyroid carcinoma is the most common type of cancer to affect your thyroid -- a butterfly-shaped gland that sits just below your voice box. Thyroid gland - Papillary thyroid carcinoma. PTC with internal spread should be distinguished from multifocal PTC and poorly differentiated PTC in pathology. The result showed psammoma bodies and some heterocyst. According to historical clinical data analysis, if a tubercle is found to have any 3 features above, over 90% of pathology literature reports the specificity of malignant tubercle. Primary Clear cell carcinoma of thyroid is extremely rare. Especially when cancerous nodule had a large diameter, it was likely to have internal metastasis. The tumor cells do not have the thyroid follicles typical nuclear features of PTC, spread along the lymphatic vessels and thyroid follicles side clearance. a mass they can see). Preoperative CT and intraoperative frozen section are helpful for surgical volume selection of PTC with internal spread. I131 WB scan is negative though the patient has high Thyroglobulin (TG) level (2000 ng/mL) suggestive of recurrence or metastasis. Rationale: Compared with most malignant tumors, papillary thyroid carcinoma (PTC) is usually associated with favorable survival and low recurrence rate. In fact, many patients will not know that they are there. B Ultrasound. {"url":"/signup-modal-props.json?lang=us\u0026email="}. In this case, it can be observed from postoperative pathological sections that some small lesions are distributed around central lesion in radial form and the number of small lesions decreases with increased distance from central lesion. Case Discussion. It represents 80% of all thyroid malignancies [ 7 ]. Two major case series have been published in the histopathological literature.2 3 Four extensive case series of solid papillary thyroid carcinoma (SV-PTC)4–7 have been published in the cytopathological literature, plus some case reports.8–11 Several of these cases occur in the paediatric age and may have a history of ionising radiation exposure.1–3 11 Epidemiological … B ultrasound is a preferred medical imaging means to diagnose a thyroid disease. Papillary thyroid carcinoma with a hypoechoic mass and punctate calcifications. The other reason may be that US is not sensitive to this kind of small foci of intrathyroid spread of PTC. Thyroid lobectomy alone may be sufficient treatment for small (<1 cm), low-risk, unifocal, intrathyroidal papillary carcinomas in the absence of prior head and neck irradiation or radiologically or clinically involved cervical nodal metastasis. This case report describes the occurrence of PM in a patient with a history of papillary thyroid carcinoma that had previously recurred in cervical lymph nodes. FNA. We diagnosed it preoperatively as papillary thyroid carcinoma (PTC). If the case was diagnosed as internal spread of PTC, surgery scope should refer to MPTC. Clinical information Palpable mass Ultrasound Images & Clips Papillary thyroid carcinoma with a hypoechoic mass and punctate calcifications ... Share case. Papillary Thyroid Cancer in Patients 55 years and Older. Hui Jin, Huanhuan Yan, Huamei Tang, Miao Zheng, Chaojie Wu, Jun Liu, "Internal Spreading of Papillary Thyroid Carcinoma: A Case Report and Systemic Review", Case Reports in Endocrinology, vol. Therefore, the final pathological diagnosis was considered as PTC with intrathyroid spread. It is usually spread by the abundant lymphatic networks in thyroid. Laboratory Examination. The incidence of PTC is increasing faster than any other solid tumors worldwide with a concomitant increase in the mortality rate ( 3 ). MPTC can be classified into three types according to the locations: (1) MPTC in unilateral thyroid: preoperative diagnosis finds no tubercle in opposite thyroid; (2) MPTC in unilateral thyroid: preoperative diagnosis finds tubercles in opposite thyroid but considers them as benign tubercles; (3) MPTC are distributed in bilateral thyroid. While it is easy to make preoperative diagnosis of PTC, it is extremely difficult to diagnose internal spread of thyroid papillary carcinoma. It is more common in women with an M:F ratio of 1:2.5 (range 1:1.6-3:1) 2. There is a connection among lesions including a major one and small lesions in the surrounding parts. Immunohistochemistry showed CK19 (+), HBME-1 (+), TG (+), TTF-1 (+), TPO (+), CD56 (−), ki67 (about 3%), and beta-catenin (+). CT Scan. Papillary carcinoma in the right thyroid lobe with a hypoechoic mass with microcalcifications and irregular vascularity. Sometimes, even though B ultrasound report showed no abnormality of multiple lesions, we could not eliminate the possibility of internal metastasis of PTC. The patient was discharged 3 days after operation without any symptoms of hypoparathyroidism and recurrence of laryngeal nerve injury. However, the intraoperative frozen section not only confirmed the preoperative diagnosis of PTC on the thyroid isthmus, in which disordered and branched papillary structure, scattered psammoma bodies, frosted-glass-like cell nucleus, larger nucleus, nucleus grooves, and intranuclear pseudoinclusions were found (Figure 2(b)), but also showed multifocal papillary thyroid carcinoma (MPTC) in right thyroid lobe as multiple psammoma bodies and papillary structure could be found in it (Figure 2(a)). Open Access Macedonian Journal of Medical Sciences. Under microscope, larger cancerous tubercles surrounded by tens or hundreds of small cancerous nests in radial form can be observed. It can be found from this case that CT is very significant to comprehensive diagnosis of thyroid diseases. Interestingly, it can be observed that some small lesions are distributed around central lesion in radial form and the number of small lesions decreases with increased distance from central lesion on postoperative pathological sections. (c) Pathology section of left thyroid lobe: red arrow for psammoma body. The Revised 2009 American Thyroid Association guidelines for papillary thyroid cancer state that the initial procedure should be near-total or total thyroidectomy. Patients with large nodules may notice a palpable mass (i.e. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Copyright © 2018 Hui Jin et al. It finally results as diffuse destroyed thyroid cells and higher TSH level, and the latter may stimulate the proliferation of papillary cancer cells. Bookmark . A larger carcinoma lesion has increased possibility of internal spread. It has not spread to nearby lymph nodes (N0) or distant sites (M0). Meanwhile, considering the age of the patient, the primary plan was to resect right thyroid and its isthmus and perform central lymph node dissection. The result of intraoperative frozen pathology section guided us to resect all thyroid tissue and central lymph node. Preoperative CT and intraoperative frozen section are helpful for surgical volume selection of PTC with internal spread. In this case, B ultrasound report hinted a tubercle is at the right side of isthmus while CT showed multiple low-density tubercle shadows. Combined imaging before surgery should be valued to diagnose PTC with internal spread. CASE SUMMARY: The current study presents a case of synchronous papillary thyroid carcinoma and breast ductal carcinoma in an elderly patient. Internal Spreading of Papillary Thyroid Carcinoma: A Case Report and Systemic Review, Shanghai General Hospital of Nanjing Medical University, Shanghai 201620, China, Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai 201620, China, Pathological Center of School of Medicine, Shanghai Jiaotong University, Shanghai 201620, China, G. Pellegriti, F. Frasca, C. Regalbuto, S. Squatrito, and R. Vigneri, “Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors,”, T. M. Shattuck, W. H. Westra, P. W. Ladenson, and A. Arnold, “Independent clonal origins of distinct tumor foci in multifocal papillary thyroid carcinoma,”, S. Y. It is closely associated with lymphatic metastasis, recurrence, and prognosis. (b) Pathology section of thyroid isthmus: red triangle for large carcinoma lesions; red arrow for small lesions composed of dozens of heterocyst. At first, the right thyroidectomy + isthmectomy with right central node dissection was performed. Its malignancy is higher than single lesion carcinoma of thyroid. As proved by multiple statistics, the coincidence rate of FNA diagnosis and postoperative pathological sections is above 90% [8]. We tried to analyze that, in the early stage of internal spread of thyroid papillary carcinoma, a macroscopic tubercle was not yet formed in the surrounding but the gather of cells only. One lump was found on the thyroid isthmus by physical examination and B ultrasound, and multiple nodular shadows were found by CT. a mass they can feel) or a visible mass (i.e. Thyroid squamous cell carcinoma is very rare. Papillary thyroid cancer is the most common subtype of thyroid cancer. If internal spread of thyroid papillary carcinoma was not certain, we should pay attention to the result of intraoperative frozen pathology section. Case Discussion. It is safe to perform whole cutting and central lymph node dissection. Esophageal squamous cell carcinoma (ESCC) is the most common histopathological … The term papillary carcinoma describes pure papillary metastases and mixed papillary/follicular lesions. Cells were arranged closely and overlapped presenting papillary structure. The tumor is composed of papillary structures lined by atypical polyhedral cells with large … Like primary thyroid carcinoma, papillary thyroid-type carcinoma arising from struma ovarii has good prognosis with 5- and 25 -year survival rate of 92% and 79%, respectively.8 The average time to first tumour recurrence for papillary carcinoma is 4 years but may appear as late as 21.4 years after the surgery.2 Factors predictive of aggressive clinical course are the … Clinically, PTMC is frequently accompanied by lymph node metastasis, however, the mortality rate is relatively low (1,2). It accounts for the majority (~70%) of all thyroid neoplasms and 85% of all thyroid cancers 2,4. I131 WB scan is negative though the patient has high Thyroglobulin (TG) level (2000 ng/mL) suggestive of recurrence or metastasis. A larger carcinoma lesion (lower and right corner) with some small lesions composed of tens of heterocysts (upper-left section) can be observed in Figure 3.
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