PMC5672604_01
(a) EUS examination of the thyroid revealed a hypoechoic, round, and well-demarcated mass that measured 26.9 mm x 21.9 mm in the right lobe. (b) Under echoendosonographic guidance, FNA with a 25-gauge needle (Expect EUS-FNA 25 G needle; Boston Scientific, Menomonie, WI, USA) was performed successfully.
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Upon withdrawing the EUS scope, examination of the thyroid revealed hypoechoic, round, and well-demarcated mass that measured 26.9 mm x 21.9 mm in the right lobe (Figure 1(a)). US with a linear-array echoendoscope revealed no vascular flow within or vascular invasion by the nodule. Under echoendosonographic guidance, 2 passes of FNA with a 25-gauge needle (Expect EUS-FNA 25 G needle; Boston Scientific, Menomonie, WI, USA) were performed successfully close to the upper esophageal sphincter on the right side without adverse events (Figure 1(b)).
(a) Cell block of thyroid nodule FNA is displaying multiple nests of clear cells, which have clear to eosinophilic cytoplasm. These nests are separated by delicate vascular network and surrounded by lymphocytic infiltrate (hematoxylin-eosin stain, original magnification x400). (b) Staining of cell block with PAX-8 shows strong nuclear positivity (PAX-8 immunohistochemistry stain, original magnification x200). (c) Staining the cell block with thyroid transcription factor-1 (TTF-1) shows negative staining (TTF-1 immunohistochemistry stain, original magnification x200). (d) Kidney section is showing multiple nests of clear cells, which have clear to eosinophilic cytoplasm. These nests are separated by delicate vascular network (hematoxylin-eosin stain, original magnification x400).
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The thyroid FNA results showed renal cell carcinoma with positive immunohistochemical stains for PAX8 and CAIX and negative for thyroid transcription factor-1 (TTF-1), thyroglobulin, and chromogranin (Figures 2(a)-2(c)). The patient had a history of right renal cell carcinoma (RCC) status after right nephrectomy 11 years ago (Figure 2(d)).
PET scan image that was done one month after the diagnosis of thyroid RCC and esophageal adenocarcinoma. Increased PET activity is appreciated within the lower esophagus. There was a lesion in the left adrenal gland which is PET avid that could represent adrenal metastasis (arrow). (b) A stent is present in the lower esophagus (arrow) crossing the GE junction into the stomach. Increased PET activity is appreciated within the lower esophagus, surrounding the esophageal stent. (c) Enlarging lesion in the right lobe of the thyroid (arrow) with increased PET activity compared to the remainder of the gland.
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Subsequent positron emission tomography (PET) scan is shown in Figure 3.