PMC4560134_01
Computed tomography. Thyroid tumor with a diagnosis as a well- differentiated papillary carcinoma, invaded the cervical esophagus and right jugular vein with lymph node metastasis in July 2004
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Fig1
A 60-year-old man underwent total thyroidectomy with bilateral neck dissection in July 2004 for the treatment of well-differentiated papillary thyroid carcinoma (PTC) (Fig. 1).
Computed tomography. Abdominal computed tomography showing an intra-abdominal abscess adjacent to the small intestine
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Fig2
At the time of admission to our hospital, an emergent CT scan revealed an intra-abdominal mass that partially involved the adjacent small bowel (Fig. 2) and the abdominal symptoms worsened; therefore, we decided to perform emergent exploratory laparotomy.
Macroscopic findings of the resected small intestine indicated a type 2 tumor, which perforated and developed a mesenteric abscess
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Fig3
Macroscopically, the tumor was mainly composed of infectious tissue and an abscess caused by perforation of a small intestinal tumor, which extended through the muscularis propria of the small intestine and connected to the abscess cavity (Fig. 3).
PET/CT depicting increased of FDG uptake at the paratracheal site. a PET/CT in 2006. b PET/CT in 2012
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Fig4
Maximum standardized uptake value (SUVmax) of fluorodeoxyglucose-positron emission tomography (FDG-PET) at the paratracheal lesion increased from 6.0 in 2006 to 28.8 in 2012 (Fig. 4).
PET/CT depicting increased of FDG uptake at the intrathoracic esophagus site. a PET/CT in 2006 showed no accumulation of FDG around the middle mediastinum. b PET/CT in 2012 indicated FDG uptake on the thoracic esophagus and adjacent lymph node
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Fig5
Simultaneously, FDG uptake of the thoracic esophagus at the middle mediastinum was observed positively, comparing with the find at the prior PET scan in 2006 that showed no accumulation of FDG around the thoracic esophagus (Fig. 5).
Endoscopic findings of esophageal stenosis showing a circular occlusion caused by the esophageal tumor
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Fig6
Endoscopic examination revealed a circular occlusion caused by an esophageal tumor (Fig. 6) at the middle part of the esophagus and a biopsy confirmed the suspicion of undifferentiated carcinoma.
Computed tomography scan of thoracic esophageal tumor growing in the middle portion of the mediastinum at the time when the patient suffered from severe dysphagia
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Fig7
A CT scan at this time clearly indicated the esophageal tumor expanding around the middle portion of the mediastinum (Fig. 7).
Histological findings of the tumor in the small intestine. a Tumor cells proliferating in the submucosal area of the small intestine (HE, x100). b Anaplastic polygonal tumor cells with a prominent neutrophilic infiltrate (HE, x400)
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Fig8
Histological scrutiny of both specimens from the small intestine (Fig. 8) and esophagus (Fig. 9) revealed that the tumors were similarly composed of large anaplastic polygonal cells that were discohesive and tended to dissociate from each other with a prominent neutrophilic infiltrate.