PMC7604291_01
A 76-year-old female with primary squamous cell carcinoma of the thyroid (PSCCT) in the left neck. (A) Low signal of grayscale ultrasound shows heterogeneously hypoechoic solid mass sized about 5 x 4 x 3 cm in her left thyroid gland accompanied with a 1.5 x 1.2-cm-size, well-defined, round-like microcalcification located in the central portion. (B) Preoperative fine-needle aspiration cytology of the mass shows no definite signs of malignancy. (C-E) CT scans show an annular calcification accompanied with a peripheral cystic degeneration portion in her left thyroid gland accompanied with the right deviation of trachea (axial, sagittal, and coronal planes). (F) Contrast-enhanced CT shows obvious heterogeneous enhancement with the central non-enhancing necrotic portion, and the thyroid capsule is intact. Chest CT suggested small nodules in the lower lobe of left lung (G) pulmonary window and (H) mediastinal window.
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F1
TIRADS (Thyroid Imaging Reporting and Data System) as 3-4a. The ultrasound also showed the absence of enlarged lymph nodes in her neck (Figure 1A). Fine-needle aspiration (FNA) cytology showed no definite signs of malignancy (mention Bethesda category) (Figure 1B), and an X-ray showed that the patient's cervical trachea shifted toward the right side. CT showed a hypodense mass occupying her left thyroid gland and across the isthmus to the whole thyroid lobe, accompanied by a ring calcification feature on her left lobe (Figures 1C-E). Contrast-enhanced CT showed a hypodense shadow with an annular calcification in her left lobar thyroid, and the capsule appeared to be intact (Figure 1F). CT scan and gastroscopy showed no positive findings, and laryngoscopy showed no positive findings. Chest CT alone suggested small nodules in the lower lobes of both lungs (Figures 1G,H).
Intraoperative findings and the gross specimens. (A) Endoscopic thyroidectomy shows the trachea deviated to the right and the recurrent laryngeal nerve was involved. (B) The gross specimen of the left thyroid mass is well-defined, with an approximate size of 5 x 3 x 2.5 cm and a 3 x 2 x 2 cm yellowish necrotic portion accompanied with calcification in the central portion.
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F2
During the course of the operation, there was a 5 x 3 x 2.5 cm mass with extensive adhesion of the topical surface, esophagus, and anterior cervical muscle in her left lobar thyroid (Figure 2A). The gross specimen showed a well-defined mass in the left thyroid gland, which consisted of large and extensive necrosis with an internal gray-yellow and hard texture nodule (Figure 2B).
Histopathological findings. (A) Microscopy observed that nesting pattern with cornified pearl, keratin, and intercellular bridge (H&E, x20). (B,C) Immunochemistry shows primary squamous cell carcinoma of the thyroid (PSCCT) cells positive for p63 and p40 (p63 and p40 immunostaining, x20).
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F3
The histopathological manifestations of the carcinomas were a prominent nesting pattern, with intercellular bridges and keratinization with a cancer pearl (Figure 3A). During the immunohistochemistry staining of the thyroid mass (Figures 3B,C), her positive stains were keratin (100%), especially AE1/AE3 and CK7, Ki-67 (30%), GAL-3, P63, and P40, while her negative stains were CK20 and calcitonin, CD56 and CD5, thyroglobulin, and thyroid peroxidase.