J Korean Thyroid Assoc.  2015 May;8(1):103-107. 10.11106/cet.2015.8.1.103.

Poorly Differentiated Thyroid Carcinoma with Gross Internal Jugular Vein Invasion and Multiple Lung Metastases

• Lee YM
• Park JH
• Choi J
• Bae KS
• Kang SJ

• KMID: 2149627
• DOI: http://doi.org/10.11106/cet.2015.8.1.103

Abstract

A rare case of poorly differentiated thyroid carcinoma (PDTC) with gross intraluminal invasion to the internal jugular vein whose clinical manifestation was multiple lung metastases is described. A 66-year-old man was referred to the outpatient clinic of the Department of Internal Medicine, hemato-oncology subdivision for multiple lung nodules found by his regular health check-up. These lung nodules showed variable sizes with irregular shapes, and typical distributions throughout the parenchyma, which were consistent with metastatic nodules. Ultrasonography revealed a 4.5 cm sized hypoechoic mass with irregular shape in his left thyroid lobe and a huge thrombus in the left internal jugular vein. PDTCs associated with gross intraluminal invasion to the great cervical vein and multiple lung nodules as their first clinical manifestation are extremely rare. We would emphasize the importance of preoperative detailed evaluation of the disseminated disease by ultrasonography in suspected patients.

Keyword

Poorly differentiated thyroid carcinoma; Internal jugular vein; Lung; Invasion; Metastasis

MeSH Terms

Aged
Ambulatory Care Facilities
Humans
Internal Medicine
Jugular Veins*
Lung*
Neoplasm Metastasis*
Thrombosis
Thyroid Gland
Thyroid Neoplasms*
Ultrasonography
Veins

Figure

• 

  Fig. 1. Radiologic evaluations. Multiple small nodules (arrows) were found in lung parenchyma, which showed irregular shape, but well-defined border on simple chest X-ray (A) and chest CT scan (B). (C) Ultrasonography of transverse section of the left internal jugular vein. A solid tumor thrombus (arrow) in the lumen are shown. (D) With color Doppler ultrasonography of a transverse section applied, Doppler signal of moving blood flow can be observed around the tumor thrombus (arrow) in the lumen of the left internal jugular vein.

• 

  Fig. 2. Intraoperative and microscopic features. (A) A gross intraluminal tumor thrombus (arrow) are shown with hard and whitish tumor mass in the left thyroid lobe. (B) After dissection, tumor thrombus (arrow) are clearly found in the lumen of left internal jugular vein. (C) The tumor has an insular pattern of growth with absence of conventional nuclear features of papillary carcinoma. Atypical mitoses (up to 4/10 HPF, arrow) and (D) microscopic vascular invasion are detected (x400).

Reference

References

1. Patel KN, Shaha AR. Poorly differentiated thyroid cancer. Curr Opin Otolaryngol Head Neck Surg. 2014; 22(2):121–6.

2. Hod R, Bachar G, Sternov Y, Shvero J. Insular thyroid carcinoma: a retrospective clinicopathologic study. Am J Otolaryngol. 2013; 34(4):292–5.

3. Bongiovanni M, Sadow PM, Faquin WC. Poorly differentiated thyroid carcinoma: a cytologic-histologic review. Adv Anat Pathol. 2009; 16(5):283–9.

4. Sanders EM Jr, LiVolsi VA, Brierley J, Shin J, Randolph GW. An evidence-based review of poorly differentiated thyroid cancer. World J Surg. 2007; 31(5):934–45.

5. Chao TC, Lin JD, Chen MF. Insular carcinoma: infrequent subtype of thyroid cancer with aggressive clinical course. World J Surg. 2004; 28(4):393–6.

6. Patel KN, Shaha AR. Poorly differentiated and anaplastic thyroid cancer. Cancer Control. 2006; 13(2):119–28.

7. Ibrahimpasic T, Ghossein R, Carlson DL, Nixon I, Palmer FL, Shaha AR. et al. Outcomes in patients with poorly differentiated thyroid carcinoma. J Clin Endocrinol Metab. 2014; 99(4):1245–52.

8. Are C, Shaha AR. Anaplastic thyroid carcinoma: biology, pathogenesis, prognostic factors, and treatment approaches. Ann Surg Oncol. 2006; 13(4):453–64.

9. Wreesmann VB, Ghossein RA, Patel SG, Harris CP, Schnaser EA, Shaha AR. et al. Genome-wide appraisal of thyroid cancer progression. Am J Pathol. 2002; 161(5):1549–56.

10. Onaran Y, Terzioglu T, Oguz H, Kapran Y, Tezelman S. Great cervical vein invasion of thyroid carcinoma. Thyroid. 1998; 8(1):59–61.

11. Lalak NJ, Campbell PR. Infiltrating papillary carcinoma of the thyroid with macroscopic extension into the internal jugular vein. Otolaryngol Head Neck Surg. 1997; 117(6):S228–30.

12. Roh JL. Papillary thyroid carcinoma presenting a great vein invasion in the neck and upper chest. Otolaryngol Head Neck Surg. 2006; 135(5):818–20.

13. Thomas S, Sawhney S, Kapur BM. Case report: bilateral massive internal jugular vein thrombosis in carcinoma of the thyroid: CT evaluation. Clin Radiol. 1991; 43(6):433–4.

14. Kobayashi K, Hirokawa M, Yabuta T, Fukushima M, Kihara M, Higashiyama T. et al. Tumor thrombus of thyroid malignancies in veins: importance of detection by ultrasonography. Thyroid. 2011; 21(5):527–31.

15. Leong JL, Yuen HW, LiVolsi VA, Loevner L, Narula N, Baloch Z. et al. Insular carcinoma of the thyroid with jugular vein invasion. Head Neck. 2004; 26(7):642–6.

16. Donnellan KA, Carron JD, Bigler SA, Wein RO. Metastatic insular thyroid carcinoma in the pediatric patient. Am J Otolaryngol. 2009; 30(1):61–4.