Thyroid carcinoma with extensive tumor thrombus in the atrium

Internal jugular vein tumor thrombus in papillary thyroid cancer: our institution's experience and a systematic review of the literature

Papillary thyroid tumor thrombosis of the internal jugular vein (IJV) is a rarely observed phenomenon with fewer than 30 cases reported to date. The clinical features and underlying pathogenesis of tumor thrombosis are not well-elucidated. A PRISMA-compliant systematic review was conducted, yielding 20 studies eligible for analysis. Additionally, we describe a case of papillary thyroid cancer (PTC) tumor thrombus involving the IJV with solitary metastasis to the ipsilateral kidney. The majority of patients in the cohort presented in an asymptomatic state (n = 14) with variable timepoints in diagnosis: preoperative (n = 9), intraoperatively (n = 1), and postoperative period (n =11), up to 30 years post-thyroidectomy. Primary tumor sizes ranged widely, with a mean of 4.22 cm ± 2.64cm. Most patients (85.7%) presented with nodal involvement and a few (n =4) had distant metastases with pulmonary involvement most commonly reported. Open tumor thrombectomy was performed in 10 (52.6%) cases and extensive vascular reconstruction was required in 8 (42%). Adjuvant treatment including radioactive iodine ablation (36.8%) and external beam radiation (21.1%) was also employed. Patient clinical factors, presentation, diagnosis, and management of PTC vascular tumor thrombus are heterogeneous. Tumor thrombus occurred in patients with solitary, small primary tumors and patients with heavy locoregional disease burden and presents as isolated and extensive thrombotic burden, the latter requiring complex open cardiovascular reconstruction in some patients. The rarity of the disease and diverse clinical presentation reporting remains a challenge in the understanding of pathogenesis, optimal management, and outcomes in PTC-related thrombosis.

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.

A Rare and Intriguing Case of Papillary Thyroid Carcinoma with Tumor Thrombus Extending into the Right Ventricle: Documentation with 131 I-NaI-SPECT/CT, MRI, and 18 F-FDG-PET/CT

A unique case of papillary carcinoma of the thyroid with an extensive tumor thrombus extending into the right ventricle is presented. The patient was a known case of solid variant of papillary carcinoma of thyroid, post three cycles of radioiodine therapy, had reported for a diagnostic 131 I-NaI scintigraphy as a part of the workup for planning the next 131 I therapy. Clinically, the patient was asymptomatic. 131 I-NaI scintigraphy showed an arcuate pattern concentration of tracer in the upper mediastinum, which descended up to the lower mediastinum. A 131 I-NaI single photon emission computed tomography/computed tomography (SPECT/CT) showed a tracer avid tumor with an extensive tumor thrombus extending from the left brachiocephalic vein to the right ventricle. 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG-PET/CT) and magnetic resonance imaging (MRI) demonstrated similar findings. The patient was decided to be managed with tyrosine kinase inhibitors as surgical intervention was not deemed possible due to the involvement of major vessels and the high risk of bleeding.

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.

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.

Tumor thrombus: incidence, imaging, prognosis and treatment

Intravascular tumor extension, also known as tumor thrombus, can occur in many different types of cancer. Those with the highest proclivity include Wilm's tumor, renal cell carcinoma (RCC), adrenal cortical carcinoma (ACC) and hepatocellular carcinoma (HCC). The presence of tumor thrombus markedly worsens prognosis and impacts treatment approach. Imaging plays a key role in its diagnosis. Endovascular methods also play a large role in treatment.

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

•

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

•

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

•

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.

Primary rhabdomyosarcoma of the thyroid in an adult with auricular thrombosis

INTRODUCTION

Rhabdomyoscarcoma (RMS) is the most common soft-part tumour in children, however, it is infrequent in adults. Thyroid involvement is exceptional and only four cases have been reported: two primary RMS in children and another two cases in young adults with RMS metastasis to the thyroid. We report the first case in the literature of a primary adult RMS with thyroid involvement and superior vena cava syndrome.

CASE PRESENTATION

A 67-year-old male was admitted for an oedema of the arm extending to the laterocervical region. Computed tomography showed a 6cm mass in the hemithyroid with venous thrombosis to the auricle. Fine-needle aspiration was compatible with Bethesda category III. Surgery revealed a stone-hard consistency thyroid. An intraoperative biopsy showed an undifferentiated neoplasia, and no additional surgical intervention was undertaken. The patient died 48hours later. Definitive histology showed a RMS.

DISCUSSION

Venous thrombosis due to a thyroid tumour is infrequent. The scarce information in the literature recommends that thyroid carcinomas with auricular thrombosis be resected as soon as they are diagnosed. However, in cases of anaplastic or poorly differentiated carcinomas is controversial. Had there been a preoperative diagnosis in the histology in our case, surgery would not have been indicated.

Brain Metastases of Papillary Thyroid Carcinoma with Horner's Syndrome

Papillary thyroid carcinoma (PTC) is the most common type of thyroid malignancy and has relatively favorable prognosis. Blood-borne metastases of PTC are very rare among the thyroid malignancies. Moreover a case of blood-borne central nervous system metastasized PTC with only unilateral Horner's syndrome, and without any abnormalities in laboratory or physical examinations has not been described before. A 53-year-old female patient had been managed in ophthalmologic clinic due to vague symptoms of right monocular blurred vision with eye dryness for 3 months, but showed no signs of improvement. So it was performed a magnetic resonance imaging and magnetic resonance angiography to evaluate the possibilities of cerebral lesion. And a left frontal mass was incidentally found, and the tumor turned out to be a PTC that had metastasized to brain, regional lymph node, cervical, thoracic spine, and lung. We describe a PTC with extraordinary initial symptoms that metastasized to an unusual site. We recommend that if a papillary thyroid tumor with unusual symptoms or at an advanced stage is found, further investigation should be performed for distant metastasis.

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.

Successful surgical treatment of advanced follicular thyroid carcinoma with tumor thrombus infiltrating the superior vena cava: report of a case

We report a case of advanced follicular thyroid carcinoma with massive involvement of the great veins of the cervix and mediastinum, and extensive tumor thrombus growing intraluminally into the superior vena cava. The patient, a 70-year-old Japanese woman, was treated successfully by a cooperative surgical team of endocrine and cardiovascular surgeons. Total thyroidectomy with thrombectomy was performed via a minimum phlebotomy in the right brachiocephalic vein, sacrificing only the right internal jugular vein, achieving complete primary tumor resection. She recovered quickly without any complications, and received (131)I radioisotope ablation for her multiple lung metastases. At the time of writing, more than 12 months after surgery, she was well. These treatments thus achieved progression-free survival without impairing her quality of life. Following the case report, we discuss the surgical indications for locally advanced thyroid carcinoma involving the great veins of the mediastinum by reviewing previous reports.

Cardiac metastasis from thyroid carcinoma

Cardiac metastasis from epithelial thyroid cancer is a very rare and potentially serious complication. We have identified only 54 reported cases over a 130-year period. Here we review this literature. Cardiac metastases are frequently asymptomatic, but when symptoms develop these tend to be severe and often fatal. The prognosis of cardiac metastases from thyroid cancer is unclear as survival data are often missing or absent in reported cases. However, as many patients died suddenly from cardiac complications, the prognosis seems poor. Of those patients who survived, all underwent surgical intervention. Trans-thoracic echocardiography is the diagnostic modality of choice as it allows dynamic evaluation of intracardiac masses. Metastatic involvement of the heart from thyroid cancer is uncommon. Left untreated this complication seems likely to be fatal. Therefore, in patients with established thyroid malignancy who develop cardiac arrhythmias, new murmurs, or signs of cardiac decompensation, we suggest that cardiac metastases be considered. Echocardiography should be performed in patients with advanced thyroid cancer and cardiac symptoms or signs. If a cardiac metastasis is present, we recommend surgical intervention if possible.

Study of papillary carcinoma of thyroid with uncommon sites of metastasis

Papillary carcinoma of thyroid (PCT) is the most common type of thyroid malignancy and metastasis to cervical lymph nodes is very common [1]. Blood borne metastases from PCT are less frequent than with the other thyroid carcinomas [2]. Uncommon sites include lungs, bone, atrium, cerebrum, kidney, skin [3].We report four cases of papillary carcinoma with uncommon sites of metastasis.One showed tumor emboli of 2.5 cm in internal jugular vein, one had tumor deposit in metacarpal bone and lung, one had a subcutaneous tumor deposit and one was a micropapillary carcinoma with metastasis axillary nodes. All these four cases were classical PCT.

Superior vena cava (SVC) reconstruction using autologous tissue in two cases of differentiated thyroid carcinoma presenting with SVC syndrome

Herein, we report two extremely rare cases of differentiated thyroid carcinoma (DTC) with extended tumor thrombus or mediastinum lymph node metastasis (LNM) involving the superior vena cava (SVC), causing SVC syndrome. Both of these patients were successfully treated with radical resection and reconstruction of the SVC using autologous tissue instead of an expanded polytetrafluoroethylene (ePTFE) graft. The left brachiocephalic vein was used to reconstruct the SVC in a papillary thyroid carcinoma patient with mediastinum LNM and a pericardial patch was used in a follicular thyroid carcinoma patient with tumor thrombus. Our search of the English-language literature found sporadic reports of SVC resection with reconstruction by vascular graft (ePTFE), interposed between the brachiocephalic vein and the right atrium. However, SVC reconstruction using autologous tissue in thyroid carcinoma has not been reported to date. To our knowledge, this is the first report describing such an unusual technique in DTC patients.