PMC6868756_01
Pre-sternal swelling of 15 cm x 8 cm- anterior view & lateral view
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Fig1
A 15 cm x 8 cm vertically aligned, non-tender, well defined swelling was present on the pre-sternal region, with consistency ranging from soft to firm (Fig. 1).
CT scan showing soft tissue mass anterior to sternum
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Fig2
Computed tomography findings revealed a large 15 x 6.6 x 7 cm lobulated, pre-sternal, soft tissue lesion with solid & cystic components (Fig. 2).
MRI coronal view showing large pre-sternal mass
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Fig3
In view of invasion, Magnetic resonance imaging was also done, which revealed a large 14 x 6.5 x 7 cm well defined, multicystic lesion with solid components in the anterior aspect of lower neck extending inferiorly in the pre-sternal region (Figs. 3 and 4).
MRI sagittal view- multicystic lesion
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Fig4
In view of invasion, Magnetic resonance imaging was also done, which revealed a large 14 x 6.5 x 7 cm well defined, multicystic lesion with solid components in the anterior aspect of lower neck extending inferiorly in the pre-sternal region (Figs. 3 and 4).
PET CT showing FDG uptake in the mass and neck node
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Fig5
Henceforth a PET scan was done that showed increased FDG uptake by the lesion and the level IV lymph node (Fig. 5).
Pre-operative and intra-operative picture of the mass
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Fig6
The mass was removed with both sternal head of sternocleido-mastoid, the strap muscles and the surrounding fascia (Figs. 6 and 7).   
Resected specimen
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Fig7
The mass was removed with both sternal head of sternocleido-mastoid, the strap muscles and the surrounding fascia (Figs. 6 and 7).   
Specimen showing multiple cystic and solid areas
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Fig8
The gross specimen revealed solid components with multiple cystic areas (Fig. 8).
HPE consistent with papillary thyroid carcinoma. H & E stain
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Fig9
Focal area of necrosis and hemosiderin laden macrophages were also present (Fig. 9).