Case Report: Large Follicular Thyroid Carcinoma with Multiple Cervical Lymph Node Metastases

Overview

Journal Front Surg

Specialty General Surgery

Date 2022 Sep 9

PMID 36081589

Authors

Fei Ye

Liyan Liao

Wanlin Tan

Yi Gong

Xiaodu Li

Chengcheng Niu

Affiliations

Soon will be listed here.

Abstract

Introduction: Follicular thyroid carcinoma (FTC) rarely metastasizes to regional lymph nodes, as they mainly metastasize through hematogenous route; in particular, a large FTC with only lateral lymph node metastasis and without distant metastasis has rarely been reported.

Case Report: We present a 66-year-old male patient with a progressively growing thyroid for more than 20 years, causing tracheal compression and narrowing. Neck ultrasonography, computed tomography (CT), magnetic resonance (MR) imaging and positron emission tomography-computed tomography (PET/CT) were carried out to obtain images of the thyroid and surrounding tissues. Total thyroidectomy and cervical lateral and central lymph node dissection were undertaken, and histopathological, and immunohistochemical evaluations and molecular pathology confirmed the diagnosis of FTC with multiple cervical lymph node metastases.

Conclusion: We have reported a rare case of large FTC with diffuse nodal involvement but no distant metastases. We present the thyroid ultrasound, neck CT, MR and whole body PET/CT.

Citing Articles

Successful localisation of recurrent thyroid cancer using preoperative patent blue dye injection.

Evranos B, Ince N, Atas H, Polat S, Ahsen H, Imga N J Endocrinol Invest. 2024; 47(8):1941-1951.

PMID: 38353922 PMC: 11266229. DOI: 10.1007/s40618-024-02301-w.

Metastatic thyroid follicular carcinoma presenting as pathological left clavicle fracture: An unusual skeletal metastasis at the time of diagnosis.

Nilojan J, Raviraj S, Madhuwantha U, Mathuvanthi T, Priyatharsan K Int J Surg Case Rep. 2023; 114:109131.

PMID: 38128290 PMC: 10800592. DOI: 10.1016/j.ijscr.2023.109131.

References

Alexander E, Kennedy G, Baloch Z, Cibas E, Chudova D, Diggans J . Preoperative diagnosis of benign thyroid nodules with indeterminate cytology. N Engl J Med. 2012; 367(8):705-15. DOI: 10.1056/NEJMoa1203208. View

Wu Q, Qu Y, Li Y, Liu Y, Shen J, Wang Y . Logistic regression analysis of contrast-enhanced ultrasound and conventional ultrasound of follicular thyroid carcinoma and follicular adenoma. Gland Surg. 2021; 10(10):2890-2900. PMC: 8575700. DOI: 10.21037/gs-21-535. View

Pisanu A, Deplano D, Pili M, Uccheddu A . Larger tumor size predicts nodal involvement in patients with follicular thyroid carcinoma. Tumori. 2011; 97(3):296-303. DOI: 10.1177/030089161109700307. View

Lamartina L, Grani G, Arvat E, Nervo A, Zatelli M, Rossi R . 8th edition of the AJCC/TNM staging system of thyroid cancer: what to expect (ITCO#2). Endocr Relat Cancer. 2017; 25(3):L7-L11. DOI: 10.1530/ERC-17-0453. View

Paulsson J, Zedenius J, Juhlin C . TERT Promoter Mutated Follicular Thyroid Carcinomas Exhibit a Distinct microRNA Expressional Profile with Potential Implications for Tumor Progression. Endocr Pathol. 2021; 32(4):513-516. PMC: 8608760. DOI: 10.1007/s12022-021-09695-w. View

Park H, Shin H, Yang H, Heo J, Ki C, Kim H . Molecular classification of follicular thyroid carcinoma based on TERT promoter mutations. Mod Pathol. 2021; 35(2):186-192. PMC: 8786663. DOI: 10.1038/s41379-021-00907-6. View

Aschebrook-Kilfoy B, Grogan R, Ward M, Kaplan E, Devesa S . Follicular thyroid cancer incidence patterns in the United States, 1980-2009. Thyroid. 2013; 23(8):1015-21. PMC: 3752506. DOI: 10.1089/thy.2012.0356. View

ONeill C, Vaughan L, Learoyd D, Sidhu S, Delbridge L, Sywak M . Management of follicular thyroid carcinoma should be individualised based on degree of capsular and vascular invasion. Eur J Surg Oncol. 2010; 37(2):181-5. DOI: 10.1016/j.ejso.2010.11.005. View

Guan H, Toraldo G, Cerda S, Godley F, Rao S, McAneny D . Utilities of Mutations in Preoperative Fine Needle Biopsies for Decision Making for Thyroid Nodule Management: Results from a Single-Center Prospective Cohort. Thyroid. 2020; 30(4):536-547. DOI: 10.1089/thy.2019.0116. View

10.

Bournaud C, Descotes F, Decaussin-Petrucci M, Berthiller J, De La Fouchardiere C, Giraudet A . TERT promoter mutations identify a high-risk group in metastasis-free advanced thyroid carcinoma. Eur J Cancer. 2019; 108:41-49. DOI: 10.1016/j.ejca.2018.12.003. View

11.

Li W, Song Q, Lan Y, Li J, Zhang Y, Yan L . The Value of Sonography in Distinguishing Follicular Thyroid Carcinoma from Adenoma. Cancer Manag Res. 2021; 13:3991-4002. PMC: 8139727. DOI: 10.2147/CMAR.S307166. View

12.

Biondi B, Cooper D . Benefits of thyrotropin suppression versus the risks of adverse effects in differentiated thyroid cancer. Thyroid. 2010; 20(2):135-46. DOI: 10.1089/thy.2009.0311. View

13.

Grani G, Lamartina L, Durante C, Filetti S, Cooper D . Follicular thyroid cancer and Hürthle cell carcinoma: challenges in diagnosis, treatment, and clinical management. Lancet Diabetes Endocrinol. 2017; 6(6):500-514. DOI: 10.1016/S2213-8587(17)30325-X. View

14.

Parghane R, Basu S . Follicular thyroid carcinoma metastasizing to rare sites and exhibiting variable inter-lesional heterogeneity on F-fluorodeoxyglucose positron emission tomography/computed tomography and I. World J Nucl Med. 2021; 20(3):312-315. PMC: 8488881. DOI: 10.4103/wjnm.WJNM_79_20. View

15.

Alfalah H, Cranshaw I, Jany T, Arnalsteen L, Leteurtre E, Cardot C . Risk factors for lateral cervical lymph node involvement in follicular thyroid carcinoma. World J Surg. 2008; 32(12):2623-6. DOI: 10.1007/s00268-008-9742-2. View

16.

Riley D, Barber M, Kienle G, Aronson J, von Schoen-Angerer T, Tugwell P . CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol. 2017; 89:218-235. DOI: 10.1016/j.jclinepi.2017.04.026. View

17.

Acquaviva G, Visani M, Repaci A, Rhoden K, de Biase D, Pession A . Molecular pathology of thyroid tumours of follicular cells: a review of genetic alterations and their clinicopathological relevance. Histopathology. 2017; 72(1):6-31. DOI: 10.1111/his.13380. View

18.

Decaussin-Petrucci M, Descotes F, Depaepe L, Lapras V, Denier M, Borson-Chazot F . Molecular testing of BRAF, RAS and TERT on thyroid FNAs with indeterminate cytology improves diagnostic accuracy. Cytopathology. 2017; 28(6):482-487. DOI: 10.1111/cyt.12493. View

19.

Haugen B, Alexander E, Bible K, Doherty G, Mandel S, Nikiforov Y . 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2015; 26(1):1-133. PMC: 4739132. DOI: 10.1089/thy.2015.0020. View

20.

Xing M, Liu R, Liu X, Murugan A, Zhu G, Zeiger M . BRAF V600E and TERT promoter mutations cooperatively identify the most aggressive papillary thyroid cancer with highest recurrence. J Clin Oncol. 2014; 32(25):2718-26. PMC: 4145183. DOI: 10.1200/JCO.2014.55.5094. View