PMC5094151_01
Computed tomographic image showing a 50-mm mass in the left lobe of the thyroid gland and thrombus in the left internal jugular vein (A) and venous thrombus extending to the innominate vein and superior vena cava (B, C).
gr1.jpg
PMC5094151_01_gr1.jpg
fig0005
Computed tomography (CT) revealed left internal jugular vein thrombus extending to the innominate vein and SVC (Fig. 1).
Operative findings: The innominate vein (arrow) and left internal jugular vein (arrowhead) are hardly palpable (A). The innominate and left subclavian veins are transected (arrow), and the tumor thrombus is resected (B). Total thyroidectomy and prophylactic lymph node dissection of the central compartment are performed, and the left internal jugular vein (arrow) is transected near the processus styloideus (C).
gr2.jpg
PMC5094151_01_gr2.jpg
fig0010
We recognized that they were hardly pervasive and adhered to the surrounding tissue (Fig. 2A). The left subclavian and innominate veins were subsequently transected and extraction of the tumor thrombus was completed (Fig. 2B). The left internal jugular vein was transected near the processus styloideus (Fig. 2C).
Macroscopic view of the resected thyroid tumor and tumor thrombus (A), and the cross-section (B). Microscopic examination result showing that the tumor consisted of atypical follicular cells in a sheet- or nest-like pattern (C).
gr3.jpg
PMC5094151_01_gr3.jpg
fig0015
On macroscopic examination, the thyroid tumor occupied the left lobe and was connected to the left internal jugular vein, with direct infiltration of the innominate and left internal jugular veins (Fig. 3A). Intravenous tumor invasion was found in the sectioned surface (Fig. 3B). On microscopic examination, the tumor consisted of atypical follicular cells with round to oval, enlarged, hyperchromatic nuclei and notable nucleoli proliferation in a sheet- or nest-like pattern (Fig. 3C).
Postoperative contrast-enhanced computed tomographic image showing tumor thrombus in the left and right inferior pulmonary arteries, 12 days after surgery (A). Pulmonary arteriographic image showing the contrasting defect of the right inferior pulmonary artery from that of the left inferior pulmonary artery. After percutaneous venous interventions, the lower left pulmonary artery could be contrasted clearly on pulmonary arteriography (B).
gr4.jpg
PMC5094151_01_gr4.jpg
fig0020
Postoperative enhanced CT revealed a tumor thrombus in the right and left inferior pulmonary arteries (Fig. 4A). Pulmonary arteriography revealed a contrasting defect of the right inferior pulmonary artery from that of the left inferior pulmonary artery (Fig. 4B). After the percutaneous venous interventions, the left lower pulmonary artery could be contrasted clearly on pulmonary arteriography (Fig. 4C).
Postoperative contrast-enhanced computed tomographic image obtained 6 months after surgery showing that the tumor thrombus in the left pulmonary artery had decreased in size.
gr5.jpg
PMC5094151_01_gr5.jpg
fig0025
The tumor thrombus in the left pulmonary artery decreased in size on follow-up CT 6 months after the surgery (Fig. 5).