Chonnam Med J.  2012 Apr;48(1):60-64. 10.4068/cmj.2012.48.1.60.

A Case of Papillary Thyroid Cancer Recurring as an Esophageal Submucosal Tumor

• Seoung HG
• Kim JH
• Choi JC
• Kim SM
• Kim SS
• Kim BH
• Kim IJ
• Song GA
• Kim GH

• KMID: 2274884
• DOI: http://doi.org/10.4068/cmj.2012.48.1.60

Abstract

A 75-year-old woman who underwent a total thyroidectomy for papillary thyroid cancer 7 years previously presented with a palpable neck mass. Computed tomography (CT) showed two metastatic masses on the thyroid bed and another mass that looked benign originating from the esophageal wall. Endoscopic ultrasonography (EUS) showed a hypoechoic mass in the esophageal wall that looked similar to a gastrointestinal stromal tumor. The mass on the esophagus had intense fluorodeoxyglucose (FDG) uptake in positron emission tomography-computed tomography (PET-CT), which suggested the possibility of malignancy. Subsequently, after surgery, the mass in the esophagus was confirmed as a metastasis from the thyroid papillary carcinoma. Here we report this unusual case of papillary thyroid cancer that recurred as an esophageal submucosal tumor.

Keyword

Esophagus; Papillary thyroid cancer

MeSH Terms

Aged
Carcinoma, Papillary
Electrons
Endosonography
Esophagus
Female
Gastrointestinal Stromal Tumors
Humans
Neck
Neoplasm Metastasis
Thyroid Gland
Thyroid Neoplasms
Thyroidectomy

Figure

• 

  FIG. 1 Computed tomography findings. Two well-enhanced ill-defined masses (blue arrow head) are seen on the anterior aspect of the thyroid bed. An approximately 24-mm sized well-defined mass (red arrow) is located on the left side of the esophagus.

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  FIG. 2 Endosonography findings. (A) A round mass covered with normal overlying mucosa is seen in the upper esophagus 3 cm distal to the upper esophageal sphincter. (B, C) A relatively poorly demarcated, 2.7×2.4 cm sized hypoechoic nonhomogeneous mass originates from the third (submucosal) and fourth (muscularis propria) layer.

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  FIG. 3 Gross and microscopic findings. (A, B) Two metastatic masses on the thyroid beds. Two masses with fibrous capsule are seen. The cut surface is papillary with multiple foci of cystic change. Microscopically, the tumor cells exhibited predominantly papillary structures (H&E stain, ×40). Inset: Nuclei of tumor cells have typical intranuclear inclusions and groovings, which are the typical characteristics of papillary cancer cells (H&E stain, ×400). (C, D) The cut surface of the esophageal mass is light brown in color with focal fibrosis and hemorrhage. Microscopically, the tumor of the esophageal mass is located in the submucosal and muscularis propria layer. The tumor cells also showed a papillary pattern in appearance (H&E stain, ×40). Inset: Nuclei of tumor cells also have intranuclear inclusions and groovings, which are typical characteristics of papillary cancer cells (H&E stain, ×400).

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