PMC9874187_01
Pre-operative imaging findings of papillary thyroid cancer. (A) Ultrasonography revealed a hypoechoic 28-mm mass with internal calcification was found in the right lobe of the thyroid gland. (B) Contrast-enhanced CT revealed a 37 mmx 25 mm tumor in the right lobe of the thyroid gland without surrounding invasion and no lymph node metastasis or distant metastasis. *: tumor, CA: carotid artery, IJV: internal jugular vein, T: trachea, E: esophagus.
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PTC (pT3bN1aM0 pStage II; Fig. 1). Pre-operative blood examination showed a thyroglobulin (Tg) level of 351 ng/mL (normal value of Tg, <=33.7 ng/mL).
Change in the thyroglobulin level. X: date of initial surgery. (a) Total thyroidectomy and central neck dissection. (b) Total hysterectomy and bilateral adnexal resection. (c) Right neck dissection and left III lymph node resection.
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After surgery, her Tg level remained around 100 ng/mL (Fig. 2). The patient's post-operative Tg level decreased to 143 ng/mL (Fig. 2).
CT findings of left III lymph node metastasis. (A) 4 years after initial surgery, size: 9 mm x 7 mm. (B) 5 years after initial surgery, size: 14 mm x 10 mm. (C) 7 years after initial surgery, size: 32 mm x 27 mm. *: left III lymph node, T: trachea, E: esophagus.
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However, 5 years after initial surgery, her Tg level increased to 366 ng/mL, with subsequent computed tomography (CT) revealing metastasis to the left III (Fig. 3) and right Vb and VI lymph nodes.
Imaging of OG. (A) Transvaginal ultrasonography showed numerous separate structures and substantial nodules. (B) CT showed a 10.5-cm multifocal cystic tumor on the right side of the uterus. (C) Magnetic resonance imaging (T2-weighted image) revealed a tumor with numerous separate structures and substantial nodules, which led to speculations that the cystic area was serous. Right ovarian cancer was suspected. (D) Gross examination also showed numerous separate structures and substantial nodules.
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CT also incidentally observed a right ovarian tumor, for which transvaginal ultrasonography and magnetic resonance imaging (MRI) were performed given suspicions of malignancy (Fig. 4).
Pathological diagnosis of OG was established (HE, x100). Histologically, the right ovarian tumor showed large and small thyroid follicles with colloid, no papillary thyroid carcinoma nuclei and no malignant findings.
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A pathological diagnosis of OG with no malignancy was then established (Fig. 5).