PMC9052974_01
(a) Contrast-enhanced computed tomography at the time of diagnosis showing embolism in the subsegmental branch of pulmonary artery. (b) Postmortem pathological examination shows pulmonary edema and pulmonary alveolar hemorrhage in bilateral lungs and intimal thickening and recanalization with tumor cell embolization in both pulmonary arteries. (c) Pulmonary artery intimal thickening and thrombus recanalization. (d) Tumor cells exhibiting the characteristics of those in the pulmonary artery observed in the parenchyma and vasculature of the thyroid gland. Left: low-magnification (x20) image showing tumors in the vasculature and parenchyma. Right: high-magnification (x200) image showing characteristics of papillary carcinoma including nuclear grooves, frosted nuclei, and intranuclear cytoplasmic inclusions. (e) Tumor cells are positive for thyroglobulin and cytokeratin 7 and negative for cytokeratin 20 and thyroid transcription factor-1.
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Pathological diagnosis was PTTM due to diffuse sclerosing variant of thyroid papillary adenocarcinoma (DSVTPC) with thromboembolism in pulmonary artery resembling CTEPH (Figure 1).