Follicular Variant of Papillary Carcinoma Thyroid with Massive Angioinvasion of the Internal Jugular Vein: Our Approach
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Follicular variant of papillary carcinoma thyroid is an aggressive variant of papillary carcinoma thyroid. It is morecommonly associated with extrathyroidal extension and regional lymphadenopathy. It can rarely be associated withmicroscopic vascular invasion but tumor thrombus into great veins is a rare phenomenon. We present a caseof 60-year-old male with follicular variant of papillary carcinoma thyroid with tumor thrombosis in superior thyroidvein and internal jugular vein (IJV). We report a case of a 60-year-old male who presented with a large swellingin the lower part of left side of neck for 4 months. Clinical examination revealed a hard swelling of 12x8 cmin left side of neck. Ultrasonography showed a solitary thyroid mass of the left lobe and a dilated left superiorthyroid vein and ipsilateral IJV. Fine-needle aspiration cytology revealed follicular variant of PTC cells. Totalthyroidectomy was done. A tumor thrombus was discovered in the superior thyroid vein and left IJV was foundto be dilated. The left IJV with superior thyroid vein was ligated and excised. The patient recovered well afterthe operation with no local or distant metastasis detected. Follicular variant of PTC commonly spreads to the lymphnodes. Vascular spread via direct intravascular extension through superior thyroid vein is extremely rare. Onpalpation cord like IJV is felt on the involved side. Neck ultrasound play important role in the diagnosis. Aggressivesurgical treatment with IJV ligation above and below the tumor thrombus is recommended to minimize the riskof potentially fatal complications of the intraluminal masses. Intravascular tumor extension into IJV of neck infollicular variant of PTC is rare and can be associated with serious consequences. Total thyroidectomy withthrombectomy with ligation of IJV must be done.
Abstract
Follicular variant of papillary carcinoma thyroid is an aggressive variant of papillary carcinoma thyroid. It is morecommonly associated with extrathyroidal extension and regional lymphadenopathy. It can rarely be associated withmicroscopic vascular invasion but tumor thrombus into great veins is a rare phenomenon. We present a caseof 60-year-old male with follicular variant of papillary carcinoma thyroid with tumor thrombosis in superior thyroidvein and internal jugular vein (IJV). We report a case of a 60-year-old male who presented with a large swellingin the lower part of left side of neck for 4 months. Clinical examination revealed a hard swelling of 12x8 cmin left side of neck. Ultrasonography showed a solitary thyroid mass of the left lobe and a dilated left superiorthyroid vein and ipsilateral IJV. Fine-needle aspiration cytology revealed follicular variant of PTC cells. Totalthyroidectomy was done. A tumor thrombus was discovered in the superior thyroid vein and left IJV was foundto be dilated. The left IJV with superior thyroid vein was ligated and excised. The patient recovered well afterthe operation with no local or distant metastasis detected. Follicular variant of PTC commonly spreads to the lymphnodes. Vascular spread via direct intravascular extension through superior thyroid vein is extremely rare. Onpalpation cord like IJV is felt on the involved side. Neck ultrasound play important role in the diagnosis. Aggressivesurgical treatment with IJV ligation above and below the tumor thrombus is recommended to minimize the riskof potentially fatal complications of the intraluminal masses. Intravascular tumor extension into IJV of neck infollicular variant of PTC is rare and can be associated with serious consequences. Total thyroidectomy withthrombectomy with ligation of IJV must be done.
참고문헌 (13)
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