PMC4147657_01
(a and b) Computed tomography (CT) images of the neck. The yellow arrow in the left image (a) points towards a large nodule with areas of cystic degeneration and calcification occupying the right lobe of the thyroid gland. The yellow arrow in the right image (b) denotes a well-defined mass at the right anterior jugular digastric region with multiple areas of necrosis. (For interpretation of the references to color in figure legend, the reader is referred to the web version of the article.)
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Computed tomography (CT) imaging showed a large hypo dense nodule with areas of cystic degeneration and calcification occupying the right lobe of the thyroid gland and invading the left lobe (Fig. 1a) and a large, well defined, heterogeneously enhancing mass in the right anterior jugulo-digastric region representing a pathological lymph node partially compressing the right IJV (Fig. 1b).
Intra operative photograph showing a tumour thrombus easily removed from the right IJV (arrow) via a longitudinal venetomy incision.
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Longitudinal venotomy revealed a tumour thrombus with no endothelial adhesion and was easily removed (Fig. 2).
(a-c) Photomicrographs of the histological analysis of surgical resections. (a (left)) shows the right thyroid lobe with anaplastic carcinoma. Immunohistochemistry analysis expressed positive cytokeratin 7, positive thyroid transcription factor-1, positive vimentin, negative thyroglobulin and cytokeratin 20. (b (middle)) also shows anaplastic carcinoma pattern taken from shaved surface of the trachea. (c (right)) shows differentiated thyroid cancer of papillary type in the sample taken from the right IJV tumour thrombus.
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Histopathology and immunohistochemistry analysis of the right thyroid lobe mass and the tissue shavings of the trachea revealed stage (PT4bN1Mx) undifferentiated anaplastic carcinoma (Fig. 3a and b respectively). Histology of the right IJV intraluminal mass revealed a papillary thyroid carcinoma (Fig. 3c).