PMC3934617_01
Monophasic SVS of the thyroid: pathological aspects. a Highly cellular proliferation of ovoid undifferentiated cells admixed with arborized vessels (original magnification x200). b CD34 IHC highlights the rich vascularization, but is negative on tumor cells (original magnification x100). c EMA IHC shows weak and focal positivity on tumor cells (original magnification x100).
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F1
Pathological examination (fig. 1) of multiple white-tan tumor fragments (between 2 and 3.5 cm each) revealed a dense cellular proliferation composed of ovoid-shaped to frankly spindle-shaped cells, without overt nuclear atypia, and disposed in a fascicular pattern.
Monophasic SVS of the thyroid: radiological aspects. a Before chemotherapy: enhanced cervical axial CT scan showing the mass (white star) with invasion of the thyroid cartilage and in contact with the frontal parts of the left primitive carotid artery and internal jugular vein. b After chemotherapy: enhanced axial cervical CT scan (left) showing an increase of the necrotic part (asterisk) in the tumor; sagittal cervical CT scan (right) showing persisting contact with the left jugular vein and no visible margin relative to the thyroid cartilage.
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F2
Cervical magnetic resonance imaging (MRI) confirmed a 4.2-cm mass in contact with large vessels and likely invasion of the paralaryngeal fat tissue above the thyroid cartilage (fig. 2a). CT scan showed small tumor reduction (4 x 2.5 x 4.5 vs. 4 x 3 x 5.5 cm) with further extension of tumor necrosis and improvement of tumor contact with the internal carotid artery and the internal jugular vein, without a resectability margin relative to the thyroid cartilage (fig. 2b). Chemotherapy was stopped and the patient was operated on.
Monophasic SVS of the thyroid: perioperative images. a Surgical photograph after tumor resection (left lateral view). A = Anterior; S = superior; 1 = cricoid cartilage; 2 = trachea; 3 = carotid artery; 4 = internal jugular vein; 5 = phrenic nerve; 6 = thyroid cartilage (after removal of the superior horn); 7 = hypoglossal nerve; 8 = superior laryngeal nerve; 9 = vagal nerve; 10 = sternocleidomastoid muscle. b Aspect of the tumor after removal. 1 = Tumor; 2 = thyroidectomy area with fat and lymph nodes of the upper mediastinum; 3 = cutaneous scar resection.
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F3
During the procedure, the left inferior laryngeal nerve was resected, but all other vascular and nervous elements could be preserved (fig. 3).