PMC4334885_01
Positron emission tomography (PET) scan demonstrates an isolated focus of FDG uptake in the liver indicating an isolated metastatic focus of tumor.
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Consultations with medical oncology, radiation oncology, interventional radiology and surgery obtained with the resultant consensus that the best option was surgical resection Fig. 1.
Intraoperative ultrasonography was used to assess the liver mass.
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Intraoperative ultrasonography was used to assess the liver mass (Fig. 2).
(a-d) Describes the pathological findings of the metastasis.. The gross appearance of the hepatic metastasis seen intraopratively is shown in Fig. 3a.. The hepatic resection specimen (Fig. 3b) showed a bulging ovoid subserosal nodule, with in the liver, measuring 4.3 cm in greatest dimension.. Microscopic evaluation of routine hematoxylin and eosin-stained sections showed a neoplasm with a follicular architecture (Fig. 3c). The cells were cuboidal with pleomorphic nuclei which frequently showed deep indentations or grooves. Nuclear chromatin was fine and nucleoli were inconspicuous. Intranuclear pseudoinclusions were not seen. Within the follicles was homogeneous eosinophilic material. The morphologic features were highly suggestive of metastatic papillary thyroid carcinoma (follicular variant). This impression was confirmed by immunohistochemical stains showing nuclear staining for TTF-1 (Fig. 3d) and cytoplasmic positivity for thyroglobulin (not shown).
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Fig. 3(a-d) describes the pathological findings of the metastasis. The gross hepatic metastasis seen intraopratively is shown in Fig 3a. The hepatic resection specimen (Fig. 3b) showed a bulging ovoid subserosal nodule measuring 4.3 cm in greatest dimension. Microscopic evaluation of routine hematoxylin and eosin-stained sections showed a neoplasm with a follicular architecture consistent with metastatic thyroid carcinoma (Fig 3c). Immunohistochemical stains showed expression of TTF-1 (Fig. 3d) and thyroglobulin (not shown), supporting the diagnosis of metastatic thyroid carcinoma.