Detection of Metastases to Internal Jugular Vein and Superior Vena Cava on 131-I Scan

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.

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.

Follicular thyroid carcinoma metastasis to the internal jugular vein demonstrated by 131I SPECT/CT

Cervical uptake detected by 131I whole body scintigraphy (131I-WBS) may be due to thyroid remnants or loco-regional metastases. We describe a patient with follicular carcinoma submitted to total thyroidectomy. 131I-WBS showed left cervical linear uptake and focal areas of uptake in the abdomen and pelvis. SPECT/CT images demonstrated a potential thrombus in the left jugular vein (confirmed by doppler neck ultrasound and MRI) as well as bone metastases. The patient was submitted to thrombectomy and histopathology confirmed metastasis of follicular carcinoma.