PMC4812356_01
Positron Emission Tomography, Computed Tomography Scan. Fusion PET/CT demonstrating diffuse right cervical and left axillary lymphadenopathy.
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Due to the potential association with NLPHL, PET/CT was performed, and increased uptake was noted in the right parotid, bilateral jugulodigastric chains, right supraclavicular region, right axilla, peripancreatic region, and bilateral inguinal regions (Figure 1).
PTGC microscopic examination. (a) PTGC, markedly enlarged lymphoid follicle infiltrated by small mature mantle zone lymphocytes with gradual replacement of germinal center (H&E, 4x). (b) Background of florid follicular lymphoid hyperplasia (H&E, 2x). (c) PTGC, germinal center replaced by small mature mantle zone lymphocytes (H&E, 20x). (d) Reactive germinal center with numerous tingle body macrophages (H&E, 20x).
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Additional excisional biopsy of a particularly high FDG uptake supraclavicular lymph node revealed PTGC without any evidence of malignancy (Figure 2).
Papillary thyroid cancer microscopic examination. (a) Papillary thyroid carcinoma. Circumscribed nodule with papillary and follicular architecture and background fibrous bands (H&E, 2x). (b) Nuclear crowding, oval to elongated nuclei with fine open chromatin, nuclear membrane irregularity, and nuclear grooves (H&E, 40x). (c) Lymph node showing metastatic papillary thyroid cancer (H&E, 4x). (d) Metastatic papillary thyroid cancer nuclear features (nuclear crowding, fine open chromatin pattern, nuclear grooves, and nuclear membrane irregularity) (H&E, 40x).
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Pathology confirmed papillary thyroid carcinoma (Figure 3), and two of four lymph nodes demonstrated metastatic disease without extranodal invasion.