Case No: 1

60 yrs old lady

presented to us with:
Gradually increasing
6x4 cm swelling
involving left thyroid
lobe x 1yrs lobe x 1yrs
No compressive
features, no recent
change in voice
No rapid increase in size
No h/o thyroid swelling
in family
No palpable Cervical
lymphadenopathy
No RSE
9/2/2014 Endocrine Imaging 1
Investigations
HR-USG neck:
7X3 cm NODULE in Left lobe of thyroid extending to
isthmus with heterogeneous calcification with mild to
significant vascularity. No significant LAP
FNAC Left lobe thyroid and Isthmus: FNAC Left lobe thyroid and Isthmus: c/w PTC
IDL:
Left VC in para-median position, Rt. VC compensatory
movements
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TT with CCLND + Left MRND
(12
th
may 2009)
Per-op Findings:
Hard and calcified nodule
of size 4x3 cm in Left
thyroid lobe infiltrating
overlying deep strap
muscles and with tracheal
invasion (Shin 1) over 2cm
muscles and with tracheal
invasion (Shin 1) over 2cm
area
Rt. Lobe unremarkable
Large (upto 2cm) cystic
LNs in left Level 2,3,4, and
5
Multiple small sub-
centimetric level 6 LNs
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Histopathology
5x4x4 cm size single left lobe nodule: PTC with
strap muscles infiltration
5/10 Level 6 LNs: Metastatic PTC 5/10 Level 6 LNs: Metastatic PTC
2/7 Left MRND LNs:Metastatic PTC
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FU: Scan negative with rising S.Tg
On TSH suppressive LT4 therapy
20
th
March 2010:
WBRAI Scan: negative,
S.Tg-55.7 ng/mL
17.2
55.7
181
50
100
150
200
S.Tg
S
.
T
g
n
g
/
m
L
S.Tg-55.7 ng/mL
23
rd
Oct.2010:
WBRAI Scan: negative,
S.Tg-181 ng/mL
USG Neck: Small LN(1cm) left lower deep cervical
region
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17.2
0
50
17.08.09 20.3.10 23.10.10
Radioiodine Remnant ablation
(17
th
Aug 2009)
WBRAI Scan with 5 mCi 131-I (3 months post-
op): Increase tracer uptake in thyroid bed
High dose 40 mCi 131-I: Remnant ablation
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18-FDG PET/CT Whole Body Scan
Hypermetabolic LNs noted:
Left level 4 cervical
Pretracheal
Right Tracheobroncheal
Left level 2 Axillary regions
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CECT Neck and Chest
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Surgical Details (25
th
jan. 2011)
Selective LN excision form Right Tracheobroncheal
and Rt. Pulmonary artery region (via open Anterolateral
Thoracotomy), Left level 4 LNs in neck (via Lower lateral
incision) and Left level 2 Axillary LN (via Axillary crease
incision) incision)
Per-op findings:
3 black colored LNs each at right lower thymic horn, adjacent to
pulmonary vein and along Rt. Pulmonary artery and Rt .main
bronchus found (largest 2x1 cm)
2 LNs in left level 4 region of 2 and 1cm size
Single 2 cm LN in left level 2 Axillary region
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Histopathology
Cervical LN: Metastatic PTC
Left Axillary LN: Free of tumor
Mediastinum LNs: Free of tumor with
numerous charcoal laden foamy histiocytes numerous charcoal laden foamy histiocytes
On TSH suppression and calcium/ vit.D
replacement
follow Tg normalised
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