PMC9121794_01
Preoperative and postoperative imaging diagnosis. (A) preoperative thyroid sonography. (B) Subcutaneous nodules around the right areola of the breast. (C) separate nodules in the right chest wall. (D) Ultrasound assessment of thyroid and cervical lymph nodes after patient receiving ETC. Ultrasound of thyroid (E1, 2) and breast (E3, 4) at five years post-operation. (F1, 2) metastatic lymph nodes. (F3, 4) No abnormality was found at five years post-operation. (G) A predominantly cystic mass with solid portions. No abnormality was found on MRI (H) and 131I-whole-body scan (I) at five years post-operation. (J) NRAS, BRAF, and PIK3CA genes by quantitative real-time PCR. ETC, Endoscopic thyroidectomy; MRI, magnetic resonance imaging.
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The size was about 3.0 x 2.0 cm ( Figures 1A1, A2 ), and the primary diagnosis was left thyroid adenoma. Nevertheless, a postoperative pathological examination subsequently showed that she had left papillary carcinoma ( Figure 1D ) without any form of neck lymph node metastasis. Sonography revealed four separate nodules in the right chest wall of sizes of 2.5 x2.5 cm, 2.0 x1.6 cm, 3.0 x1.8 cm, and 2.5 x 2.0 cm, all located along the previously operated tunnels ( Figures 1C1-3 ). Therefore, to remove those nodules in the right chest wall, the woman underwent local-tumor excision ( Figure 1C4 ). Contrast-enhanced ultrasonography suggested that subcutaneous nodules around the right areola of the breast were metastatic tumors ( Figures 1B1, B2 ). A magnetic resonance imaging (MRI) examination revealed a metastatic tumor in the neck ( Figures 1F1, F2 ) and the upper inner quadrant of the right breast ( Figures 1G1-4 ). No mutations were detected in the NRAS, BRAF, and PIK3CA genes by quantitative real-time PCR ( Figure 1J ).
Histopathologic examination. Postoperative pathologic examination of nodules in the chest wall showed that all nodules contained PTC tissues (A-C). (D) Total thyroidectomy (in 2014) revealed PTC without reporting cell features. (E) lesion of right breast. Left lateral cervical (F) and left supraclavicular fossa (G) lymph node excision revealed metastatic PTC. Nodule of right chest wall (H) and Subcutaneous tissue of left neck (I) excision revealed metastatic PTC. (J) TG. (K) Ki67. (L) CK-19. (M) GATA-3. (N) TTF-1. (O) Pax8.
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The size was about 3.0 x 2.0 cm ( Figures 1A1, A2 ), and the primary diagnosis was left thyroid adenoma. Sonography revealed four separate nodules in the right chest wall of sizes of 2.5 x2.5 cm, 2.0 x1.6 cm, 3.0 x1.8 cm, and 2.5 x 2.0 cm, all located along the previously operated tunnels ( Figures 1C1-3 ). Contrast-enhanced ultrasonography suggested that subcutaneous nodules around the right areola of the breast were metastatic tumors ( Figures 1B1, B2 ). Sonography revealed lymph nodes metastatic in the neck ( Figure 2D ). A magnetic resonance imaging (MRI) examination revealed a metastatic tumor in the neck ( Figures 1F1, F2 ) and the upper inner quadrant of the right breast ( Figures 1G1-4 ). The final diagnosis of the right breast nodule was PDTC with breast metastasis by postoperative permanent pathological examination ( Figure 2E ). CK19, PCK, HBME-1, Pax8 expressions and negative ER, TPO, BRAF, calcitonin, Syn, CgA, and P63 expressions ( Figures 2J-O ). Combined with clinical characteristics and previous thyroid surgery history, the final diagnosis was PDTC with breast implantation.