Poorly Differentiated Thyroid Carcinoma with Gross Internal Jugular Vein Invasion and Multiple Lung Metastases

Abstract

A rare case of poorly differentiated thyroid carcinoma (PDTC) with gross intraluminal invasion to the internal jugular vein whose clinical manifestation was multiple lung metastases is described. A 66-year-old man was referred to the outpatient clinic of the Department of Internal Medicine, hemato-oncology subdivision for multiple lung nodules found by his regular health check-up. These lung nodules showed variable sizes with irregular shapes, and typical distributions throughout the parenchyma, which were consistent with metastatic nodules. Ultrasonography revealed a 4.5 cm sized hypoechoic mass with irregular shape in his left thyroid lobe and a huge thrombus in the left internal jugular vein. PDTCs associated with gross intraluminal invasion to the great cervical vein and multiple lung nodules as their first clinical manifestation are extremely rare. We would emphasize the importance of preoperative detailed evaluation of the disseminated disease by ultrasonography in suspected patients.

Intraluminal extension of papillary thyroid carcinoma into the Internal Jugular Vein; a case report

“…The papillary thyroid carcinoma, being the most common subtype of thyroid cancer, is generally a slow-growing tumor and is usually confined to the thyroid gland for a long time [ 6 ]. Yet it spreads to the cervical lymph nodes in approximately 50% of the patients and distance metastasis to the lung and/or bone is relatively frequent at the time of diagnosis [ 5 ]. Extensive lymph-vascular invasion could be a warning sign of distance metastasis or early relapse.…”

“…Indeed, ultrasound neck assessment using Valsalva maneuver is advocated as the first investigation to be done when a vein invasion is suspected [ 6 ]. Color Doppler or contrast enhanced CT are reliable and accurate to diagnose great cervical vein invasion and plan surgical resection of the tumor [ 5 ]. In addition to imaging FNAC is mandatory to rule out poorly differentiated subtypes such as anaplastic carcinoma or a more prevalent entity, metastatic tumors where the prognosis is dismal [ 6 ].…”

“…Extrathyroid extension into the soft tissues of the neck is found in about one-fourth of cases and adversely affects the prognosis in a very significant fashion [ 3 ]. Although involvement of cervical lymph nodes is very common [ 4 ], vascular invasion and distant metastasis are not characteristics of PTCs and cases associated with direct spread of the primary tumor or the regional lymph node recurrence to great veins are extremely rare, in particular [ 5 ]. We present a case of 40-year-old lady with intraluminal invasion and propagation of Internal Jugular Vein (IJV) with lymph node recurrence of PTC.…”