PMC10235689_01
Preoperative SPECT/CT showed bone destruction in the corresponding part of the left iliac crest and soft tissue mass in the left iliac crest lesion, which was considered as bone metastasis.
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SPECT/CT imaging of the whole body ( Figure 1 ) suggested: 1) abnormal concentration of imaging agent was distributed in the left iliac bone and the left part of T12 vertebrae, and bone destruction was observed in the corresponding parts; 2) abnormal concentration of imaging agent was observed in the left iliac crest near the symphysis pubis, lateral to the 8th spine of the right posterior rib, and in the lower segment of the right humerus; there is possibility of bone metastasis tumor, which need further diagnosis.
(A) Microscopically, thyroid follicles of different sizes were observed, and the cells were well differentiated. No ground-hyaline nuclei, nuclear furrows, sand bodies, or papilla were observed. The appearance of follicular tumor was consistent with bone metastasis of thyroid follicular carcinoma. (original magnification, x 400; hematoxylin-eosin [H-E] stain). (B) The tumor cells were dense and crowded, similar to fetal thyroid tissue, with a small number of follicles, nuclear atypia, and rare pathological mitosis.(original magnification, x 600; hematoxylin-eosin [H-E] stain).
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Under microscope, thyroid follicles of different sizes were observed, with mild atypia and mild morphology ( Figure 2A ); dense and crowded glands with active hyperplasia and mild atypia were observed, with a few ground-glass nuclei seen and no nuclear sulcus, no sand bodies, and no papilla observed ( Figure 2B ).
There was a solid lobe nodule on the right side of the thyroid gland, about 30mm x 28mm in size, with clear boundary, mainly solid in the thyroid gland, with irregular and non-echogenic inclusions. A short strip of strong echo could be seen around the nodule, and rich blood flow signals could be seen in and around the nodule.
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He underwent thyroid doppler ultrasound examination ( Figure 3 ), which showed: There was a solid nodule in the right lobe of the thyroid gland, about 30mmx28mm in size, with clear boundary, solid interior and irregular anechoic area; short strip-shaped strong echo could be seen around the nodules, and abundant blood flow signals could be seen in and around the nodules.
(1)There is a follicular tumor, fibrous capsule was seen around the tumor,the tumor invaded the capsule and vasculature,extrapulocapsular and intravascular tumor thrombus can be seen.(original magnification, x 20; hematoxylin-eosin [H-E] stain). (2) An enlargement of the previous picture,the tumor invaded the vasculature and capsule,there was a vascular tumor thrombus.tumor cells had eosinophilic cytoplasm,the cells showed mild atypia,(original magnification, x 100; hematoxylin-eosin [H-E] stain). (3) The tumor invaded the vasculars and tumor thrombus,(original magnification, x 400; hematoxylin-eosin [H-E] stain). (4) High magnification of tumor invasion capsule,the tumor cells were dense and crowded, the nuclei were hyperchromatic, there was no ground hyaline nucleus, no nuclear furrow, no nuclear overlap, and no sand body (original magnification, x 600; hematoxylin-eosin [H-E] stain). (5) Some cells of MC were positive by immunohistochemistry EliVision method magnification at medium power. (6) Immunohistochemistry: Tumor cells were negative for CK19 EliVision method magnification at medium power. (7) Immunohistochemistry showed that the tumor cells were negative for Galectin-3 EliVision method magnification at medium power. (8) Immunohistochemistry showed that a small number of tumor cells were positive for CyclinD1 EliVision method magnification at medium power. (9) BRAF V600E gene mutation was not detected by RTPCR.
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To further confirm the diagnosis, the original pathology of the patient's right thyroid in 2014 was reviewed ( Figure 4 ).
Embolization of the left pelvic tumor artery. (A): before tumor artery embolization; (B):after tumor artery embolization.
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In July 2020, left pelvic tumor artery embolization was perfomed on the patient in the interventional radiology department of our hospital ( Figure 5 ), with left and right internal iliac arteries embolized by gelatin sponge microstrips via catheterization, costing about 120ml of iodoxanol.
Residual tumor was inactivated by ultrasound-guided fractionated radiofrequency ablation. The ablation range was preliminarily estimated to reach 90%, achieving the expected therapeutic goal.
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Ultrasound-guided fractional radiofrequency ablation ( Figure 6 ) was then performed under intravenous basic anesthesia.
The hip tumor lesion was reduced compared with that before surgery, with a range of about 83mm x 54mm. No blood flow signal was observed in most areas, and the strip artery blood flow signal was observed in the medial margin, indicating no obvious activity in the lesion.
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In December 2021, contrast-enhanced ultrasound ( Figure 7 ) was re-examined: The tumor lesion on the left pelvis was smaller than before surgery, with a range of 83mmx54mm, and no blood flow signal was observed in most areas, indicating no significant activity of the lesion.
The treatment of large pelvic metastases which was successfully controlled by multiple methods.
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The follow-up showed stable condition, with no tumor progression found ( Figure 8 ).