Follicular carcinoma of the thyroid with massive invasion into the cervical and mediastinum great veins: our own experience and literature review

Metastatic papillary thyroid carcinoma with internal jugular vein tumor thrombus - A case report and review of the literature

Papillary thyroid carcinoma (PTC) is the most common malignancy of the thyroid gland, typically associated with an indolent course and favourable prognosis. However, although rare, PTC can demonstrate aggressive behaviour, including vascular invasion with extension into major vessels. Intraluminal tumor thrombus involving the great veins, such as the internal jugular vein (IJV), is an uncommon but significant complication. We present the case of a 56-year-old male who was referred to our clinic for evaluation of a right-sided anterior neck mass. Neck ultrasonography revealed a 5.5 x 6.5 cm heterogeneous mass within the right thyroid lobe and a suspected intraluminal thrombus in the right internal jugular vein. Fine-needle aspiration biopsy under ultrasound guidance confirmed the diagnosis of papillary thyroid carcinoma. Subsequent preoperative contrast-enhanced computed tomography (CT) of the neck confirmed the presence of an intraluminal tumours thrombus extending into the right IJV. The patient underwent total thyroidectomy, right modified radical neck dissection, and resection of the involved segment of the IJV. Postoperatively, the patient received radioactive iodine (I-131) ablation therapy. At the one-year follow-up, imaging studies indicated a recurrence of the disease. A review of the literature focusing on vascular involvement in PTC and diagnostic methods for tumours thrombus reveals that, while rare, intraluminal tumor thrombus should be considered in patients with PTC, especially when there is evidence of vascular invasion. Early and accurate preoperative diagnosis using Doppler ultrasonography and/or contrast-enhanced CT is critical for optimal surgical planning and improved prognosis. Given the potential for recurrence, vigilant long-term follow-up is recommended.

Breaking down tumor thrombus: Current strategies for medical management

Tumor thrombus, the intravascular extension of tumor into adjacent blood vessels, is frequently encountered in patients with renal cell carcinoma and hepatocellular carcinoma, and often involves the abdominal vasculature including the renal vein, portal vein, and the inferior vena cava. While a bland thrombus is composed of platelets and fibrin, in contrast, a tumor thrombus refers to an organized collection of tumor cells. Though oftentimes detected incidentally on imaging, tumor thrombus may have significant clinical implications and can be challenging to differentiate from bland thrombus. Additionally, the optimal management of tumor thrombus, including the use of anticoagulation, remains poorly described. This review summarizes common causes of tumor thrombus, as well as its impact on staging, prognosis, and treatment.

Middle thyroid vein tumor thrombus in metastatic papillary thyroid microcarcinoma: A case report and review of literature

BACKGROUND

Although papillary thyroid microcarcinoma (PTMC) is not considered a threatening tumor, in some cases, it can be aggressive. Metastatic thrombosis of papillary thyroid carcinoma, follicular thyroid carcinoma, Hürthle cell carcinoma, poorly differentiated thyroid carcinoma and anaplastic thyroid carcinoma have been reported in the literature, but there have been no reports about PTMC.

CASE SUMMARY

A 45-year-old woman presented with a thyroid mass and thrombosis in a middle thyroid vein during a physical examination. She had no symptoms, and the physical examination showed no positive signs. Subsequent ultrasonography-guided fine-needle aspiration biopsy results indicated an atypical lesion of ambiguous significance, with some actively growing cells (TBSRTC III) and the BRAF^V600E mutation not present. This patient underwent left thyroidectomy, isthmus lobectomy, prophylactic central lymph node dissection and thromboembolectomy. Postoperative pathology showed papillary microcarcinoma of the left thyroid, and the thrombus in the middle thyroid vein was a tumor thrombus.

CONCLUSION

Middle thyroid vein tumor thrombus is an extremely rare condition in PTMC, but it does exist. Lobectomy and thromboembolectomy may be an option for patients with thrombi in the middle vein of the thyroid, and we strongly suggest close follow-up of these patients.

Occlusion of the internal jugular vein in differentiated thyroid carcinoma: Causes and diagnosis

Occlusion of the internal jugular vein (IJV) can be observed in thyroid cancer either on preoperative imaging with ultrasound or cross-sectional imaging, particularly contrast-enhanced CT-scan, and can be detected during follow-up when using these same imaging modalities. For thyroid cancer, four different causes of occlusion of the IJV can be identified: venous thrombosis associated with a hypercoagulable state, tumor thrombus in the vein, compression or invasion of the IJV by thyroid disease or lymph node metastases, and fibrotic collapse of the IJV following lateral neck dissection. Clinicians managing patients with thyroid cancer need to be aware of and able to diagnose each of these conditions. The overall patient impact and appropriate management of each will be discussed.

Treatment Approach to Follicular Thyroid Carcinoma Tumor Thrombus in the Internal Jugular Vein and Brachiocephalic Vein

Thyroid gland carcinoma causing tumor thrombus in the great veins of the neck and mediastinum is a rare condition with poor prognosis. Invasion of the internal jugular vein by thyroid gland carcinoma has been occasionally reported, but tumor thrombi extending to the great veins of the mediastinum are reported extremely rarely. We present a treatment approach in a case of follicular thyroid carcinoma intravascular tumor thrombus in the left internal jugular and left brachiocephalic vein.

Staged surgical management of follicular thyroid carcinoma with extensive thrombus reaching up to right atrium - A case report

INTRODUCTION

Differentiated thyroid carcinoma with an extensive intravenous tumor thrombus which is extending into internal jugular vein (IJV), superior vena cava (SVC) and right atrium (RA) is a rare clinical finding. We report a multimodal staged surgical approach for this life threatening complicated case.

PRESENTATION OF CASE

A 52 year old female, presented with diffuse thyroid swelling, FNAC revealed it as follicular thyroid neoplasm. Computed tomography (CT) scan showed tumor thrombus extending into IJV, SVC and right atrium (RA). We planned complete resection of tumor in two stage operation. Initially in first stage, cardio-thoracic surgery was done to remove SVC and RA thrombus to eliminate the immediate risk of pulmonary embolism. In the second stage, neck surgery was performed to resect thyroid tumor and to perform extensive thrombectomy in the cervical veins. This patient has been followed for one year after successful surgery without recurrence.

DISCUSSION

Venous involvement by follicular thyroid carcinoma reaching to RA is a rare life threatening condition. Though there is no standard guidelines available, treatment strategies should be discussed and planned among multidisciplinary team. Intraluminal extension is not a contraindication for aggressive surgical management. It will avoid fatal pulmonary embolism, as well as improve overall survival of the patient.

CONCLUSION

Invasion of the great vessels by thyroid carcinoma is usually associated with early relapse and poor prognosis, but if tumor in the blood vessel is resected completely, a better prognosis is possible. Two staged surgical approach is safe and gives a predictable outcome.

Great veins invasion in follicular thyroid cancer: single-centre study assessing prevalence and clinical outcome

PURPOSE

Great veins invasion is considered as a rare and prognostically unfavourable event in thyroid cancer. However, current knowledge about this issue is mainly based on single case reports. Follicular thyroid cancer (FTC) represents the histotype with the most pronounced angioinvasive feature. This study is aimed at assessing the actual prevalence of great veins invasion in FTC and providing information about prognosis and the proper clinical management of these patients.

METHODS

Clinico-pathological and radiological data of patients with thyroid cancer undergoing thyroidectomy in our institution were retrospectively retrieved. Inclusion criteria were as follows: (a) histological diagnosis of FTC; (b) instrumental and histological evidence of great veins invasion and (c) documented follow-up entirely performed at our institution. Pre-surgical assessment of great veins status was performed in all patients by means of Doppler ultrasonography.

RESULTS

Out of 637 patients operated from 2003 to 2013, four subjects, all affected with FTC, showed great veins involvement (0.62% of the overall cohort and 7.85% of the FTC group). One of them was lost at follow-up. All three patients with available follow-up were subjected to aggressive surgery obtaining a complete eradication of neck disease. All of them achieved the 5-year survival target (60, 63 and 96 months of survival for patients 1, 2 and 3, respectively).

CONCLUSIONS

Great veins invasion may not be uncommon in FTC and preoperative detection and characterisation of such condition may optimise surgical approach and improve survival.

Massive internal jugular vein tumor thrombus derived from squamous cell carcinoma of the head and neck: two case reports

PURPOSE

Tumor thrombosis of the internal jugular vein (IJV) is an extremely rare disease, and the reported cases have been exclusively associated with differentiated thyroid cancer. In the present study, we describe two cases of IJV tumor thrombosis originated from squamous cell carcinoma (SCC), which is the first case report.

METHODS

Case 1 was a 67-year-old man diagnosed with advanced supraglottic SCC with a massive tumor thrombus in the IJV. He was treated with bio-radiotherapy followed by radical surgery. Case 2 was a 65-year-old woman who underwent radical surgery for SCC of thyroid with tumor thrombosis in the IJV.

RESULTS

These cases rapidly developed local recurrences and distant metastases and died within 10 months after surgery.

CONCLUSIONS

IJV tumor thrombosis originated from SCC apparently reflects extremely aggressive state of the tumor. Recognition and precaution to this condition is essential for the development of a clinically effective treatment strategy.

Thyroid carcinoma with extensive tumor thrombus in the superior vena cava: A case report

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This is an uncommon surgical case report of thyroid carcinoma with extensive tumor thrombus in the superior vena cava.

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Management criteria for thyroid carcinoma with venous tumor thrombus is considered for safe and effective operation.

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Treatment and natural history for pulmonary infarction that occurred for drop off of the tumor thrombus are recognizable.

Introduction

Venous tumor thrombus of thyroid cancer that extend to the great vein is rare, and management criteria for venous thrombus have not been established yet. We report a surgical case of thyroid carcinoma with extensive tumor thrombus in the superior vena cava (SVC) and consider the appropriate treatment strategy for venous thrombus.

Presentation of case

A 75-year-old woman consulted our hospital because of thyroid carcinoma with an extensive tumor thrombus. Computed tomography (CT) revealed a solitary thyroid mass with extensive continuous tumor thrombus in the left internal jugular vein, innominate vein, and SVC. We planned complete tumor resection. During operation, the tumor thrombus in the SVC disappeared, suggesting that pulmonary embolism occurred. Therefore, she underwent total thyroidectomy with extensive phlebectomy (the innominate and internal jugular veins). Although she had some morbidities during her postoperative course, she was followed up for 6 months without progression of thyroid cancer.

Discussion and conclusion

Intravascular tumor extension of thyroid carcinoma is rare, but is a life-threatening complication. For patients with thyroid tumor with venous tumor thrombus, segmental resection and thrombectomy should be considered if radical operation is possible. Therefore, preoperative correct imaging evaluation and operative planning are necessary to perform safe and effective operations. We suggest a management criteria for patients with thyroid carcinoma with venous tumor thrombus.

Clinical, pathologic, and immunohistochemical prognostic factors in dogs with thyroid carcinoma

Background

Prognostic markers for dogs with thyroid tumors are limited.

Hypothesis/Objectives

To identify clinical, pathologic, and immunohistochemical prognostic factors for dogs with thyroid tumors.

Animals

Seventy dogs with thyroid neoplasia.

Methods

Retrospective study. Dogs with thyroid neoplasia were included when follow‐up information and formalin‐fixed paraffin‐embedded tumor samples were available. Immunohistochemistry (IHC) was performed for thyroglobulin, calcitonin, Ki‐67, and E‐cadherin. Correlation of tumor variables (diameter, volume, localization, scintigraphic uptake, thyroid function, IHC) with local invasiveness and metastatic disease was performed on all tumor samples. Forty‐four dogs treated by thyroidectomy were included in a survival analysis.

Results

Fifty dogs (71%) had differentiated follicular cell thyroid carcinoma (dFTC) and 20 (29%) had medullary thyroid carcinoma (MTC). At diagnosis, tumor diameter (P = .007; P = .038), tumor volume (P = .020), tumor fixation (P = .002), ectopic location (P = .002), follicular cell origin (P = .044), and Ki‐67 (P = .038) were positively associated with local invasiveness; tumor diameter (P = .002), tumor volume (P = .023), and bilateral location (P = .012) were positively associated with presence of distant metastases. Forty‐four dogs (28 dFTC, 16 MTC; stage I–III) underwent thyroidectomy. Outcome was comparable between dogs with dFTC and MTC. Macroscopic (P = .007) and histologic (P = .046) vascular invasion were independent negative predictors for disease‐free survival. Although time to presentation, histologic vascular invasion and Ki‐67 were negatively associated with time to metastases, and time to presentation was negatively associated with time to recurrence, no independent predictors were found. E‐cadherin expression was not associated with outcome.

Conclusions and Clinical Importance

Prognostic factors have been identified that provide relevant information for owners and clinicians.

Floating left innominate vein neoplastic thrombus: a rare case of mediastinal extension of follicular thyroid carcinoma

OBJECTIVE

We report a case of advanced follicular thyroid cancer with innominate vein involvement. To our knowledge, this seems to be the first case treated in emergency surgery, reported in literature.

METHOD

A 59-year-old woman with a five-year history of a large and mainly right-sided cervical mass presented with dyspnea, unilateral arm swelling, facial flushing, and venous congestion. An emergency computed tomography scan revealed a thyroid mass extending into the upper mediastinum with displacement and compression of the right jugular vein and carotid artery and apparent adherence to the superior vena cava and left innominate vein.

RESULTS

An emergency total thyroidectomy was performed by means of a sternotomy. The lower portion of the retrosternal goiter projected directly into the left innominate vein, with tumor floating in its lumen. Removal of the neoplastic thrombus was performed, through an incision in the vein, en bloc with the thyroid mass. Both goiter and thrombus were completely replaced by follicular carcinoma.

CONCLUSIONS

Accurate preoperative assessment through contrast-enhanced computed tomography is strongly suggested in the presence of enlarged thyroid gland extending into the mediastinum whenever angioinvasion is suspected. This could prevent blinded maneuvers such as digital externalization of the thoracic component of the gland, which can be fatal in cases of cervico-mediastinal goiter extending into great cervical or mediastinal veins.