PMC10174443_01
(A) Color ultrasound (52 mm x 42 mm hypoecho was seen in the right lobe of the thyroid gland, occupying almost the whole right lobe, with clear boundary and blood flow signals visible inside). (B) CT (irregular low-density mass, about 61 mm x 40 mm in size, unclear boundary, moderately uneven enhancement on enhanced scan). (C) Postoperative cervical CT. (D) Before radiotherapy. (E) 1 month after radiotherapy. (F) Lymph node shrinkage after local radiotherapy was observed by lymph node color ultrasonography 6 months after radiotherapy.
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F1
Case 1: A 53-year-old female patient was presented to our department due to "progressive enlargement of the anterior cervical mass for 8 months." Color ultrasound indicated the following: hypoechoic right lobe of thyroid, Ti-RADS 4A; no abnormal swollen lymph nodes were found in bilateral neck (Figure 1A). III and IV and the anterior superior mediastinum (Figure 1B). Inspection result was calcitonin (CT): 0.88 pg/ml and carcinoembryonic antigen (CEA): 7.49 ng/ml. Reexamination results at 1 month after operation: (1) Bilateral cervical lymphadenopathy. (2) Thyroid surgery: no obvious spheroid occupying was found in the thyroid area (Figure 1C). The portal structure was unclear, and blood flow signals could be seen inside (Figure 1F).
Pathology of case 1: (A,B) Routine postoperative pathology, inclined to myeloid carcinoma. (C,D) Lymph node puncture pathology, indicating small cell undifferentiated carcinoma. (E,F): Immunohistochemistry: CD117 (+) and CD5 (+).
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F2
The peripheral thyroid showed chronic lymphocytic thyroiditis. (2) (Left neck node) no metastasis was observed (0/2). (3) (Right neck lymphatic node) no metastasis was observed (0/6). (4) (Anterior laryngeal lymph node) no metastasis was observed (0/1) (Figures 2A,B). Further biopsy indicated the smear (left neck lateral lymph node biopsy): combined with clinical and cellular morphology, it was consistent with small cell thyroid undifferentiated carcinoma metastasis (Figures 2C,D). Immunohistochemistry: CT (-), Tg (-), CEA (-), CgA (-), Syn (-), TTF-1 (-), CK (+), CK5/6 (+), P53 (+), Ki-67 (45%+), GATA-3 (-), GCDFP-15 (-), CD56 (-), PAX-8 (-), HBME-1 (-), galectin-3 (+), ER (-), PR (-), P40 (+), P63 (+), CD117 (+), and CD5 (+) (Figures 2E,F).
(A) Color ultrasound showed hypoecho in the right lobe of the thyroid gland, about 44 mm x 40 mm x 49 mm in size, with unclear boundary. (B) Contrast-enhanced CT of the neck showed a mass in the right lobe of the thyroid, with infiltration of the surrounding internal jugular vein, common carotid artery, trachea, and esophagus.
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F3
Case 2: An elderly male patient was admitted to the hospital due to "hoarseness for half a month." Color ultrasound showed hypoecho in the right lobe of the thyroid, about 44 mm x 40 mm x 49 mm in size, with unclear boundary (Figure 3A). Follow-up was recommended to exclude metastasis. (2) The right lobe of thyroid was occupied; contrast-enhanced CT of the neck showed a mass in the right lobe of the thyroid, with infiltration of the surrounding internal jugular vein, common carotid artery, trachea, and esophagus (Figure 3B). combined ultrasound or CT enhancement examination showed thyrotropin (chemiluminescence) 9.5 muIU/ml and carcinoembryonic antigen (chemiluminescence) 7.1 ng/ml.
Pathology of case 2: (A) The follicular epithelial cells of obvious heterotopy were observed, and it has a papillary structure:fine needle aspiration. (B,C) A malignant tumor is suggested:coarse needle puncture. (D,E) Thymoid-differentiated carcinoma is suggested.
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F4
Under the guidance of color ultrasound, fine needle aspiration biopsy showed obvious abnormal follicular epithelial cells with papillary structure, which was consistent with malignancy (Figure 4A). Color ultrasound-guided coarse needle biopsy: (right lobe of thyroid puncture) malignant tumor, to be examined by immunohistochemistry to assist in the diagnosis (Figures 4B,C). P40 (+), CK (+), NapsinA (-), CK5/6 (+), P63 (+), Vim (-), CD5 (+), CD117 (+), CgA (-), Syn (-), CD56 (-), and Ki67 (about 50%+) (Figures 4E,F). HE morphology and immunohistochemistry were consistent with thymoid-differentiated carcinoma. PET-CT results showed that the right lobe of thyroid was obviously enlarged and PDG metabolism was increased, which was considered to be malignant tumor (thyroid cancer).