PMC8413079_01
Ultrasound image demonstrating a diffuse mildly heterogeneous enlargement of the right thyroid lobe (a). The associated increased flow within the right thyroid lobe on the color Doppler image (b). A soft tissue mass also seen in the region of palpable concern in the right supraclavicular area, measuring 5.77 cm (c). The associated internal flow in the mass on the color Doppler image (d).
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A subsequent soft tissue neck ultrasound confirmed a 5.4 x 3.6 cm mass extending from the thyroid with features of increased vascularity and calcification extending from the thyroid (Figure 1).
Axial CT image of the soft tissues of the neck (left image) demonstrating a heterogeneous mass within the right clavicular head, which is expansile with associated bony destruction (thin white arrow). There is also mass-like enlargement of the right thyroid lobe (short thick arrow). A coronal CT image of the soft tissues of the neck (middle image) also shows the destructive mass in the right clavicular head with soft tissue component (thin white arrow). A coronal CT image of the neck soft tissues more posterior in position (right image) demonstrates the mass-like enlargement of the right thyroid lobe (short thick arrow).
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CT of the neck showed extension of the mass into the adjacent sternoclavicular junction with osteolysis of the middle third of the clavicle and the superior aspect of the sternum body (Figure 2).
FNA of right neck mass shows cohesive nests of neoplastic thyroid tissue with overlapping nuclei and nuclear pleomorphism. The absence of colloid and macrophages is noted, and a subset of the cells shows nuclear pseudonuclear inclusions (arrow) supporting the diagnosis of papillary thyroid carcinoma (PAP stain, 200x).
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TTF-1, PAX8, CK7, and thyroglobulin, and they were negative for CK20, calcitonin, synaptophysin, or chromogranin (Figure 3).
(a), (b) Retracted and removed gross pathology of the PTC mass. (c) Gross pathology of the resected neck mass.
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The right sternocleidomastoid and strap muscles were sacrificed due to tumor involvement, but all other structures were dissected and preserved, including bilateral recurrent laryngeal nerves and the brachial plexus (Figure 4).
Papillary thyroid carcinoma. (a) Fine-needle aspirate of the right side neck mass showing abundant clusters of neoplastic thyroid tissue, and nuclear grooves (arrow) are present (Diff Quick stain, 200x). (b) Cluster of neoplastic thyroid tissue from the neck mass with focal pseudoinclusions (arrow) in nuclei (PAP stain, 200x). (c) Histologic sections of the right side neck mass showing thyroid carcinoma with papillary nuclear features (nuclear overlap, nuclear grooves, and nuclear clearing), consistent with papillary thyroid carcinoma (H&E stain, 200x). (d) Histologic sections of the thyroid mass in the right lobe showing papillary thyroid carcinoma (H&E stain, 100x). (e) Immunohistochemistry for beta-catenin staining showing no evidence of nuclear staining corresponding to the section of the thyroid mass in D (immunohistochemical stain, 100x). (f) Papillary thyroid carcinoma (follicular variant) involving clavicle (H&E stain, 100x).
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Pathological examination of the right thyroid and clavicle showed PTC with extrathyroidal extension and clavicle involvement (staged pT4a pN0) with margins and lymph nodes negative for carcinoma (Figure 5).