PMC5547242_01
Abdominal/pelvic CT obtained when the patient presented to the ER with right hip pain.
gr1.jpg
PMC5547242_01_gr1.jpg
fig0005
Abdominal and pelvic CT revealed a 13 cm hypervascular mass arising from the right iliac bone with extensive bone destruction and involvement of the right psoas, iliopsoas, and gluteal muscles (Fig. 1).
Core biopsy of right iliac lesion. (A) Follicular cells with ovoid nuclei, chromatin pallor, and mild nuclear contour irregularity (hematoxylin & eosin, 400x magnification). Tumor cells are positive for thyroglobulin (B) and TTF-1 (C) by immunohistochemistry (400x magnification).
gr2.jpg
PMC5547242_01_gr2.jpg
fig0010
A subsequent core biopsy of the mass showed evidence of metastatic thyroid cancer with histopathology revealing follicular architecture and some nuclear features consistent with PTC (Fig. 2).
Thyroid ultrasound demonstrating a 1.4 x 1.5 x 2 cm heterogenous nodule with internal calcifications in the right thyroid lobe.
gr3.jpg
PMC5547242_01_gr3.jpg
fig0015
A thyroid ultrasound showed a 2 cm nodule with internal calcifications in the right thyroid lobe (Fig. 3).
Total thyroidectomy. (A) Thyroid tumor partially surrounded by fibrous capsule (dotted line), with infiltrative growth into the surrounding thyroid parenchyma (20x magnification). (B) Tumor cells show follicular architecture and nuclear atypia characteristic of papillary thyroid carcinoma, including nuclear crowding, mild nuclear contour irregularity, nuclear grooves (arrows), and chromatin pallor (400x magnification). (C) Tumor shows vascular invasion (arrow; 100x magnification). Hematoxylin & eosin.
gr4.jpg
PMC5547242_01_gr4.jpg
fig0020
Histopathological examination of the thyroid gland showed a 1.6 cm infiltrative FVPTC with focal extrathyroidal extension and vascular invasion (Fig. 4).