PMC4245677_01
Preoperative contrast enhanced computed tomographic scan of the chest showing a mass in the sternal manubrium that measured 8.7 x 5.4 cm at the level of the left brachiocephalic vein that also appeared to involve the left clavicular head.
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A contrasted CT scan of the chest showed that the mass in the manubrium measured 8.7 x 5.4 cm and also involved the left clavicular head and superior mediastinal tissues (Fig. 1).
Preoperative PET-CT scan showing a large, heterogeneous mass arising primarily from the right thyroid lobe that measures approximately 5.6 x 6.8 cm in greatest axial dimensions. Calcifications are present within this mass. Heterogeneous radiopharmaceutical uptake compatible with areas of necrosis is identified with an average SUV equal to 24.84. A mass was identified in the manubrium in direct contact with the thyroid tumor. Complete destruction of the manubrium down to the level of the sternomanubrial junction is identified.. (CT = computed tomography; PET = positron emission tomography; SUV = standardized uptake value).
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Invasion by direct extension into the manubrium was identified, with complete destruction of the bone to the level of the sternomanubrial junction (Fig. 2).
Microscopic pathologic examination of the thyroid tumor with hematoxylin and eosin staining demonstrating a poorly differentiated thyroid carcinoma with varied morphology, consisting of large areas of solid nests (insular carcinoma), areas with trabeculated architecture and foci with follicles containing intraluminal colloid (x100).
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Microscopic examination of the thyroid mass showed poorly differentiated thyroid carcinoma with varied morphology and large areas of solid nests (insular carcinoma) with lymphovascular invasion, areas of coagulative necrosis, and foci with well-defined follicles (Fig. 3).
Five-year postoperative PET-CT scan showing patchy FDG activity along the left posterior aspect of the innominate vein. Anterior to the trachea, soft tissue with minimal FDG activity is noted, likely reflective of prior radiation therapy.. (CT = computed tomography; FDG = fluoro-deoxy-glucose; PET = positron emission tomography).
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The PET-CT scan showed residual patchy FDG activity anterior to the trachea with minimal FDG activity, likely reflective of prior radiation therapy, although recurrent tumor could not be excluded (Fig. 4).