PMC4756211_01
Preoperative neck CT images of the patient. The trachea is seen to be deviated to the left. Red arrow: thyroid gland featuring calcifications and extending into the retrosternal area, which cannot be clearly differentiated from the surrounding tissues. Yellow arrow: lymphadenopathies.
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An increase in soft tissue density narrowing in the right paralaryngeal area and depletion of the larynx to the left were observed (Fig. 1).
The image of the total thyroidectomy specimen of the patient.
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Once bleeding control was achieved, the surgery was completed (Fig. 2).
The venography image of the patient performed after the development of the third hematoma. The right IJV is observed to be obliterated in inferior parts (r: right; white arrow: the obliterated area of the IJV).
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Intraoperative angiography and venography were performed; no bleeding foci could be determined (Fig. 3).
Histopathological and immunohistochemical images of the patient: (a) vascular tumoral structures between thyroid follicles (H&E c40). (b) Vascular tumoral structures in the muscle tissues around the thyroid gland (H&E x40). (c) CD31 positivity (x40). (d) CD34 positivity (x40).
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Immunohistochemical studies revealed that the tumor cells were positively reacting with CD31, CD34, and vimentin, while they were negatively reacting with CK7, CK20, chromogranin, EMA, thyroglobulin, TTF-1, and calcitonin (Fig. 4, Fig. 5).