Intravascular extension of papillary thyroid carcinoma to the internal jugular vein: A case report

Abstract

INTRODUCTIONPapillary thyroid cancer (PTC) is the most common thyroid malignancy and usually spreads via lymphatic system. PTC can sometimes show microscopic vascular invasion, but rarely causes tumour thrombus in the internal jugular vein (IJV) or other great veins of the neck.PRESENTATION OF CASEWe report a case of a 62-year-old female presented with symptomatic central neck mass. Clinical examination revealed a hard solitary right-sided thyroid nodule with ipsilateral cervical lymphadenopathy. Ultrasonography (US) confirmed the clinical diagnosis and visualised a dilated ipsilateral IJV. Fine-needle aspiration cytology revealed PTC cells so total thyroidectomy with right neck dissection was done. A tumour thrombus was discovered in the distended right IJV and was cleared successfully. The patient recovered well after the operation with no local or distant metastasis detected.DISCUSSIONTumour vascular spread is observed in tumours with angio-invasive features including follicular carcinoma of the thyroid gland where great cervical veins can be affected. PTC commonly spreads to the lymph nodes and vascular spread via direct intravascular extension is extremely rare. Neck US has an important role in the diagnosis, and operators should attempt to detect signs of tumour thrombi in all patients with thyroid masses. Aggressive surgical treatment with vascular repair is recommended whenever possible to minimise the risk of potentially fatal complications of the intraluminal masses.CONCLUSIONIntravascular tumour extension of PTC is rare but with serious consequences. Diagnosis with neck US is possible but some cases are only discovered intraoperatively. Thrombectomy with vascular repair or reconstruction is usually possible.

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

“…In 1879, Kaufmann and Graham reported the first two cases of vascular tumor thrombus associated with thyroid cancer [4]. It has been generally accepted that patients with malignancies with vascular invasion have poor prognoses.…”

“…With regard to the management of venous tumor thrombus of thyroid cancer, no guidelines have been established yet (including Japanese thyroid tumor guidelines) [4]. Surgical resection or thrombectomy for tumor thrombi in the internal jugular vein has been reported.…”

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

“…Similar cases receiving only palliative treatment due to difficult surgical approach resulted in poor outcome [3,17]. There are no standard guidelines available in the literature to manage this condition [18], though there are anecdotal case reports of successful surgical treatment of this condition. Yamagami et al [8] reported a case of successful surgical resection of thyroid cancer with extensive tumor thrombus in the RA.…”

Follicular thyroid carcinoma with internal jugular vein tumour thrombus

“… 3 , 4 The first reported cases of thyroid cancer tumour thrombus was by Kaufmann and Graham in 1879. 5 Most often, tumour thrombus by thyroid carcinoma is asymptomatic, 6 and may not be detected by clinical examination, not being palpable. 1 Imaging plays a vital role in patient assessment and diagnosis.…”