PMC10356124_01
Pituitary magnetic resonance images. (A) precontrast; (B) Postcontrast sagittal T1WI magnetic resonance imaging; (C) Postcontrast; (D) Precontrast coronal T1WI magnetic resonance imaging showing pituitary mass with suprasellar extension (thick white arrows), invasion of the right cavernous sinus (curved white arrow), and optic chiasm compression (short white arrows)
2317-6385-eins-21-eRC0229-gf01.jpg
PMC10356124_01_2317-6385-eins-21-eRC0229-gf01.jpg
f01
Pituitary magnetic resonance imaging (MRI) revealed a pituitary mass with suprasellar extension, invasion of the right cavernous sinus, and compression of the optic chiasm (Figure 1).
Patient's coronal (A), axial (B), and sagittal (C) neck computed tomography images with contrast. Deviated trachea, obliterated internal jugulary vein and substernal extention of the thyroid can be observed
2317-6385-eins-21-eRC0229-gf02.jpg
PMC10356124_01_2317-6385-eins-21-eRC0229-gf02.jpg
f02
During the preoperative evaluation, thoracic and neck computed tomography (CT) was performed for the substernal goiter (Figure 2).
Positron emission tomographic images of the patient. Increased fluoro-deoxyglucose uptake in the thyroid gland with substernal extension (A); left 9th rib (B) and one of the pulmonary metastatic nodules (C) are seen
2317-6385-eins-21-eRC0229-gf03.jpg
PMC10356124_01_2317-6385-eins-21-eRC0229-gf03.jpg
f03
Positron emission tomography-computed tomography (PET/CT) revealed an increased fluoro-deoxyglucose (FDG) uptake in the thyroid gland (SUVmax: 9.56), pituitary gland (SUVmax: 8.28), pulmonary nodules (SUVmax: 9.50), left 9th rib (SUVmax:7.05), right-sided area adjacent to the thyroid gland, retrosternal and retroclavicular lymph nodes, and right femur (Figure 3).
Figure showing the patient's total thyroidectomy with central and right lateral neck lymph node dissection. The thyroid capsule was not observed over the right thyroid lobe; the tumor was extrathyroidal, and the right internal jugular vein was obliterated
2317-6385-eins-21-eRC0229-gf04.jpg
PMC10356124_01_2317-6385-eins-21-eRC0229-gf04.jpg
f04
A total thyroidectomy with central and right lateral neck lymph node dissection was performed (Figure 4).
A) Histological sample of the papillary thyroid carcinoma in a multinodular developmental pattern (HEx40); B) Nuclear features of papillary carcinoma characterized by nuclear enlargement, nuclear membrane irregularity, and chromatin opening in thyrocytes with follicular array (H&Ex400); C) Jugular vein obliterated by the papillary thyroid tumor (HEx200); D) CD31 (marker of endothelial differentiation) immunolabeling image of venous invasion; E) HBME-1stained papillary thyroid cancer (HBME-1x200); F) Histological sample of the pituitary tissue metastasis of the papillary thyroid cancer (Thyroglobulin x40)
2317-6385-eins-21-eRC0229-gf05.jpg
PMC10356124_01_2317-6385-eins-21-eRC0229-gf05.jpg
f05
Histopathological examination revealed diffuse FVPTC (10 x 8 x 5cm in diameter, tumor invading the adjacent tissue) in the right lobe, six foci of papillary microcarcinoma in the left lobe, tumor thrombosis in the right internal jugular vein, and no lymph node metastasis on the right side of the neck (Figure 5). The histopathological and immunohistochemical results of both total thyroidectomy and PM are shown in figure 5.
Graph depicting the serum thyroglobulin variation following the initiation of radioiodine and sorafenib treatments after the surgery
2317-6385-eins-21-eRC0229-gf06.jpg
PMC10356124_01_2317-6385-eins-21-eRC0229-gf06.jpg
f06
Serum thyroglobulin variations after treatment initiation are shown in figure 6.