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

Yong-Moon Lee; Jae Hyun Park; Junjeong Choi; Keum-Seok Bae; Seong Joon Kang

doi:10.11106/cet.2015.8.1.103

Journal List > J Korean Thyroid Assoc > v.8(1) > 1056578

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Lee, Park, Choi, Bae, and Kang: Poorly Differentiated Thyroid Carcinoma with Gross Internal Jugular Vein Invasion and Multiple Lung Metastases

Original Article

Clin Exp Thyroidol 2015;8(1):103-107.

Published online: 4 May 2015

DOI: https://doi.org/10.11106/cet.2015.8.1.103

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

Yong-Moon Lee¹, Jae Hyun Park², Junjeong Choi³, Keum-Seok Bae², Seong Joon Kang²

Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea

Chungbuk National University College of Medicine, Cheongju, Departments of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea

Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea

Correspondence: Keum-Seok Bae, MD, PhD, Department of Surgery, Wonju Severance Christian Hospital, 20 Ilsan-ro, Wonju 220-701, Korea Tel: 82-33-741-1303, Fax: 82-33-742-1815, E-mail: bksgs@yonsei.ac.kr

Received 7 April 2014 Accepted 13 August 2014

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Poorly differentiated thyroid carcinoma, Internal jugular vein, Lung, Invasion, Metastasis

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Fig. 1.

Radiologic evaluations. Multiple small nodules (arrows) were found in lung parenchyma, which showed irregular shape, but well-defined border on simple chest X-ray (A) and chest CT scan (B). (C) Ultrasonography of transverse section of the left internal jugular vein. A solid tumor thrombus (arrow) in the lumen are shown. (D) With color Doppler ultrasonography of a transverse section applied, Doppler signal of moving blood flow can be observed around the tumor thrombus (arrow) in the lumen of the left internal jugular vein.

Fig. 2.

Intraoperative and microscopic features. (A) A gross intraluminal tumor thrombus (arrow) are shown with hard and whitish tumor mass in the left thyroid lobe. (B) After dissection, tumor thrombus (arrow) are clearly found in the lumen of left internal jugular vein. (C) The tumor has an insular pattern of growth with absence of conventional nuclear features of papillary carcinoma. Atypical mitoses (up to 4/10 HPF, arrow) and (D) microscopic vascular invasion are detected (x400).

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