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

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.

A rare case of minimally invasive follicular thyroid cancer with intraluminal superior vena cava and right atrium metastases

Follicular thyroid cancers are known to spread hematogenously to the bones and lungs and rarely presenting with massive angioinvasion. We report a case of a middle-aged female who had undergone total thyroidectomy for minimally invasive follicular thyroid cancer with angioinvasion in 2014. She was noted to have a large tumor thrombus extending from the superior vena cava to the right atrium on whole body scan post-Iodine-131 (¹³¹I) remnant ablation therapy. We discuss the various imaging modalities, treatment options, and difficulties in managing such massive angioinvasion in patients with well-differentiated thyroid cancers.

Thrombosis in Thyroid Cancer

BACKGROUND

The number of studies on venous thromboembolism (VTE) and thyroid cancer is very scarce and existing data are contradictory. This paper reviews VTE in thyroid cancer.

METHODS

The following words were used for a comprehensive literature review using MEDLINE database: Blood coagulation factors; thyroid hormones; blood coagulation tests; venous thromboembolism; receptors thyroid hormone; hemostasis; fibrinolysis; bleeding; blood coagulation disorders; thyroid neoplasms; Thyroid cancer, papillary; Thyroid cancer, follicular; Thyroid carcinoma, anaplastic; Thyroid cancer, Hurthle cell; Familial medullary thyroid carcinoma; venous thrombosis; Pulmonary embolism; Blood coagulation factors. The studies, which include any changes in hemostasis and thyroid cancer were included and reviewed.

RESULTS

Although few studies have shown a possible increase in VTE occurrence in thyroid cancer in patients ≥ 60 years old and in proximity to cancer diagnosis, other studies could not find any difference compared to general population. New thyroid cancer classification excluding common subtype(s) with benign nature, may affect the results of the future studies on association of VTE and thyroid cancer.

CONCLUSIONS

Prospective studies on the occurrence of VTE in various types and severities of thyroid cancer and in different age groups are warranted, as the results would affect clinical practice on the necessity of usage of anticoagulants in some thyroid cancer groups.

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.