PMC7674202_01
Pre-operative physical examination and ultrasound examination. (A) Three subcutaneous palpable nodules at the right anterior neck and the right supraclavicular. The neck ultrasound showed two hypoechoic nodules with a size of about 9*7*9 mm (F) and 5*3*7 mm (G) subcutaneously at the right anterior neck. A hypoechoic nodule with a size of about 8*4*6 mm (H) was observed at the right supraclavicular. Three nodules are annotated with black, red, and blue arrows, respectively, and corresponding the nodules indicated by the arrow in (A).
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F1
Physical examination revealed several palpable nodules with a maximal size of about 1*1 cm located within the scar site of the previous surgery (Figure 1A). Neck ultrasonography revealed the presence of three hypoechoic nodules with a maximum size of 9*7*9 mm subcutaneously, at the right anterior neck and the right supraclavicular, characterized by irregular edges, irregular internal echoes, and intramodular blood flow (Figures 1B-D).
Pre-operative computed tomography findings. The neck enhanced computed tomography scans were observed (A) a general image of the neck, and (B-D) features of three nodules. The three nodules are annotated with black, red, and blue arrows, respectively, and corresponding nodules indicated by the arrow in Figure 1A.
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F2
A preoperative enhanced computed tomography scan showed increased subcutaneous soft tissue mass in the right neck and multiple enlarged lymph nodes on both sides of the neck (Figures 2A-D).
During surgery and post-operative image features. (A) The thyroid was incised, and the cervical fascia exposed intraoperatively. (B) The specimen was resected during surgery, and the arrows indicate the three palpable nodes. (C) Three removed nodules were presented individually, with a maximum size of 8*8 mm. Three nodules are annotated with black, red, and blue arrows, respectively, and corresponding nodules indicated by the arrow in Figure 1A. (D,E) Postoperative histopathology revealed subcutaneous nodules of the neck as metastatic carcinoma of follicular variant of papillary thyroid carcinoma. OM, omohyoid muscles; STM, sternothyroid muscle; SHM, sternohyoid muscle.
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F3
During the operation, we completely removed the superficial layer and nodules of the subcutaneous cervical fascia, the thyroid cartilage, the superior margin of the clavicle, the bilateral layer of the sternocleidomastoid muscle, and the anterior cervical fascia (Figures 3A,B). Three nodules with a maximum size of 8*8 mm were visible in the right subcutaneous and subclavian epithelium of the anterior neck, with a relatively hard texture (Figure 3C). Microscopic examination revealed atypical irregular follicular cells with ovoid nuclei, nuclear overlap, and nuclear grooves without papillary structures, as well as surrounding fibrous tissue reaction (Figures 3D,E).