PMC5952856_01
Ultrasonography on day X reveals a hypoechoic lesion with ill-defined margins and irregular form, appearing avascular and heterogeneous (a). Computed tomography of the neck on admission (day X + 5) also reveals a low-density lesion in the right thyroid gland, 37 x 37 x 42 mm in size with enhancement in the marginal area (b)
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Fig1
Neck ultrasonography showed a 47-mm nodule, with ill-defined margins, irregular form, and a hypoechoic, heterogeneous appearance, in the area of the right thyroid, suggesting thyroid malignancy (Fig. 1a). The thyroid mass resulted in displacement of the trachea toward the left and showed enhancement in the peripheral area of the nodule (Fig. 1b).
Cytology from FNA shows scant nuclear atypia (a), with numerous neutrophils in the background (b). Four months later, cytology reveals overlapping cell clusters, high nuclear density, nuclear groove ( ), and intranuclear cytoplasmic inclusion bodies ( ), leading to a diagnosis of papillary thyroid carcinoma (c)
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Fig2
Findings on cytological examination were suggestive of AST, because little nuclear atypia was evident, and numerous number of neutrophils were seen in the background (Fig. 2). FNA was repeated, and cytological examination revealed overlapping cell clusters, high nuclear density, nuclear grooves, and intranuclear cytoplasmic inclusion bodies, leading to a diagnosis of PTC (Fig. 2c).
Summary of the clinical course
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Fig3
The clinical course is shown in Fig. 3.
Barium swallow study (frontal view) does not show any fistula from the apex of the pyriform recess
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Fig4
A barium swallow study was performed after CRP turned negative, but no fistula of the pyriform sinus was detected (Fig. 4).
Gross (a and b) and microscopic (c and d) appearance of papillary carcinoma of the thyroid
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Fig5
PTC in the right lobe with invasion to the sternothyroid muscle, and a 16-mm PTC in the left lobe (Fig. 5). PTC in the left lobe was not found by ultrasonography before surgery.