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

Abstract

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.

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

“…Koike et al [9] reported that the various tumor pathologies may explain the different paths of tumor invasion to a great vein. Only a few reports have shown thyroid cancer patients with tumor thrombus that progress to the innominate vein, SVC, and intracranial sigmoid sinus beyond the internal jugular vein [1], [9], [10], [11]. Yamagami et al [12] reported a case of thyroid cancer with extensive tumor thrombus in the atrium.…”

“…However, patients with tumor thrombus in the SVC often show the SVC syndrome [1], [13]. Detection of tumor thrombus is important for the planning of operative procedures.…”

“…When the tumor thrombus progresses to the SVC and right atrium, phlebectomy of the innominate vein should be performed for complete resection. Onoda et al [1] summarized 19 reported surgical cases of thyroid cancer with tumor thrombus in SVC. In their report, thrombectomy was conducted for many cases.…”

“…Venous tumor thrombus of thyroid cancer is occasionally experienced, but tumor thrombus extending to the great vein such as the innominate vein and superior vena cava (SVC) is rare [1]. The treatment criteria for tumor thrombus in the great vein have not been established yet.…”

Thrombosis in Thyroid Cancer

“…Occasionally, both high-risk papillary and follicular thyroid cancer invade great vessels of neck and upper mediastinum ( 10 - 13 ), but in rare occasions tumor embolism can affect remote anatomical sites such as middle cerebral artery ( 50 ). Clinical presentation in great cervical veins can vary from asymptomatic presentation to florid superior vena cava syndrome ( 51 - 54 ). Nine out of 5,507 thyroidectomized thyroid malignancies had tumor thrombi ( 55 ).…”