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Laurin BJ, Ballard R, Malik I, Mitchell J. Internal jugular vein tumor thrombus in papillary thyroid cancer: our institution's experience and a systematic review of the literature. Front Endocrinol (Lausanne) 2025; 16:1514455. [PMID: 40070593 PMCID: PMC11893390 DOI: 10.3389/fendo.2025.1514455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2024] [Accepted: 01/27/2025] [Indexed: 03/14/2025] Open
Abstract
Papillary thyroid tumor thrombosis of the internal jugular vein (IJV) is a rarely observed phenomenon with fewer than 30 cases reported to date. The clinical features and underlying pathogenesis of tumor thrombosis are not well-elucidated. A PRISMA-compliant systematic review was conducted, yielding 20 studies eligible for analysis. Additionally, we describe a case of papillary thyroid cancer (PTC) tumor thrombus involving the IJV with solitary metastasis to the ipsilateral kidney. The majority of patients in the cohort presented in an asymptomatic state (n = 14) with variable timepoints in diagnosis: preoperative (n = 9), intraoperatively (n = 1), and postoperative period (n =11), up to 30 years post-thyroidectomy. Primary tumor sizes ranged widely, with a mean of 4.22 cm ± 2.64cm. Most patients (85.7%) presented with nodal involvement and a few (n =4) had distant metastases with pulmonary involvement most commonly reported. Open tumor thrombectomy was performed in 10 (52.6%) cases and extensive vascular reconstruction was required in 8 (42%). Adjuvant treatment including radioactive iodine ablation (36.8%) and external beam radiation (21.1%) was also employed. Patient clinical factors, presentation, diagnosis, and management of PTC vascular tumor thrombus are heterogeneous. Tumor thrombus occurred in patients with solitary, small primary tumors and patients with heavy locoregional disease burden and presents as isolated and extensive thrombotic burden, the latter requiring complex open cardiovascular reconstruction in some patients. The rarity of the disease and diverse clinical presentation reporting remains a challenge in the understanding of pathogenesis, optimal management, and outcomes in PTC-related thrombosis.
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Affiliation(s)
- Bryce J. Laurin
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Robert Ballard
- Department of Vascular Surgery, Fox Valley Surgical Specialists, Appleton, WI, United States
| | - Ifthikar Malik
- Division of Endocrinology, Fox Valley Surgical Specialists, Appleton, WI, United States
| | - Janeil Mitchell
- Division of Endocrine Surgery, Department of General Surgery, Fox Valley Surgical Specialists, Appleton, WI, United States
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Adnan Z, Sabo E, Kassem S. Metastatic papillary thyroid carcinoma with internal jugular vein tumor thrombus - A case report and review of the literature. Front Endocrinol (Lausanne) 2025; 16:1505800. [PMID: 39944204 PMCID: PMC11813748 DOI: 10.3389/fendo.2025.1505800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Accepted: 01/07/2025] [Indexed: 05/09/2025] Open
Abstract
Papillary thyroid carcinoma (PTC) is the most common malignancy of the thyroid gland, typically associated with an indolent course and favourable prognosis. However, although rare, PTC can demonstrate aggressive behaviour, including vascular invasion with extension into major vessels. Intraluminal tumor thrombus involving the great veins, such as the internal jugular vein (IJV), is an uncommon but significant complication. We present the case of a 56-year-old male who was referred to our clinic for evaluation of a right-sided anterior neck mass. Neck ultrasonography revealed a 5.5 x 6.5 cm heterogeneous mass within the right thyroid lobe and a suspected intraluminal thrombus in the right internal jugular vein. Fine-needle aspiration biopsy under ultrasound guidance confirmed the diagnosis of papillary thyroid carcinoma. Subsequent preoperative contrast-enhanced computed tomography (CT) of the neck confirmed the presence of an intraluminal tumours thrombus extending into the right IJV. The patient underwent total thyroidectomy, right modified radical neck dissection, and resection of the involved segment of the IJV. Postoperatively, the patient received radioactive iodine (I-131) ablation therapy. At the one-year follow-up, imaging studies indicated a recurrence of the disease. A review of the literature focusing on vascular involvement in PTC and diagnostic methods for tumours thrombus reveals that, while rare, intraluminal tumor thrombus should be considered in patients with PTC, especially when there is evidence of vascular invasion. Early and accurate preoperative diagnosis using Doppler ultrasonography and/or contrast-enhanced CT is critical for optimal surgical planning and improved prognosis. Given the potential for recurrence, vigilant long-term follow-up is recommended.
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Affiliation(s)
- Zaina Adnan
- Department of Endocrinology and Metabolism, Clalit Medical Health Care Services, Haifa and Western Galilee District, Bar-Ilan Faculty of Medicine, Safed, Israel
| | - Edmond Sabo
- The Institute of Pathology, Carmel Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
| | - Sameer Kassem
- Department of Internal Medicine, Carmel Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
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Gui Y, Wang JY, Wei XD. Middle thyroid vein tumor thrombus in metastatic papillary thyroid microcarcinoma: A case report and review of literature. World J Clin Cases 2022; 10:3213-3221. [PMID: 35647132 PMCID: PMC9082703 DOI: 10.12998/wjcc.v10.i10.3213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/07/2022] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although papillary thyroid microcarcinoma (PTMC) is not considered a threatening tumor, in some cases, it can be aggressive. Metastatic thrombosis of papillary thyroid carcinoma, follicular thyroid carcinoma, Hürthle cell carcinoma, poorly differentiated thyroid carcinoma and anaplastic thyroid carcinoma have been reported in the literature, but there have been no reports about PTMC.
CASE SUMMARY A 45-year-old woman presented with a thyroid mass and thrombosis in a middle thyroid vein during a physical examination. She had no symptoms, and the physical examination showed no positive signs. Subsequent ultrasonography-guided fine-needle aspiration biopsy results indicated an atypical lesion of ambiguous significance, with some actively growing cells (TBSRTC III) and the BRAFV600E mutation not present. This patient underwent left thyroidectomy, isthmus lobectomy, prophylactic central lymph node dissection and thromboembolectomy. Postoperative pathology showed papillary microcarcinoma of the left thyroid, and the thrombus in the middle thyroid vein was a tumor thrombus.
CONCLUSION Middle thyroid vein tumor thrombus is an extremely rare condition in PTMC, but it does exist. Lobectomy and thromboembolectomy may be an option for patients with thrombi in the middle vein of the thyroid, and we strongly suggest close follow-up of these patients.
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Affiliation(s)
- Yan Gui
- Department of Otorhinolaryngology Head and Neck Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Jun-Yi Wang
- Department of Thyroid and Neck Tumor, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xu-Dong Wei
- Department of Otorhinolaryngology Head and Neck Surgery, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
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Clinical analysis of 48 cases of malignant superior vena cava syndrome. World J Surg Oncol 2021; 19:185. [PMID: 34162380 PMCID: PMC8223363 DOI: 10.1186/s12957-021-02300-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/12/2021] [Indexed: 11/25/2022] Open
Abstract
Background The aim of our study was to observe and compare the curative effect of radiotherapy, chemotherapy, and combined radiotherapy and chemotherapy, as well as comprehensive treatment on superior vena cava syndrome (SVCS) caused by malignant etiology. Methods A total of 48 patients with malignant SVCS admitted to our hospital from 2015 to 2020 were selected in this study. According to the different treatment methods, they were divided into radiotherapy group (group 1, 10 cases), chemotherapy group (group 2, 8 cases), combined radiotherapy and chemotherapy group (group 3, 22 cases), and comprehensive treatment group (group 4, 8 cases). Results There were no significant differences in efficacy and side effects among the four groups (all P > 0.05). Group 4 (median survival time of 36 months) could provide longer survival time than groups 1, 2, and 3 (median survival time of 10 months, 13.5 months, and 12 months, respectively). Conclusions For patients with severe symptoms or good prognosis, comprehensive treatment could be selected to improve the quality of life and prolong the survival period; for patients with mild symptoms, radiotherapy, chemotherapy, or combined radiotherapy and chemotherapy could also reduce the symptoms of SVCS and treat tumor lesions.
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Chen W, Lei J, Wang Y, Tang X, Liu B, Li Z, Zhou Q. Case Report: Superior Vena Cava Resection and Reconstruction for Invasive Thyroid Cancer: Report of Three Cases and Literature Review. Front Surg 2021; 8:644605. [PMID: 34141718 PMCID: PMC8204692 DOI: 10.3389/fsurg.2021.644605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 05/07/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Thyroid cancer with massive invasion into the cervical and mediastinal great veins is extremely rare, and the surgical treatment is controversial, thus posing a great challenge for head and neck surgeons. Here, we report our successful experiences in reconstructing the superior vena cava (SVC) system to treat thyroid cancer with an extensive tumor thrombus growing intraluminally into the SVC. Case Presentation: From September 2019 to September 2020, three patients with superior vena cava syndrome(SVCS) caused by tumor thrombus invasion from thyroid cancer were continuously included in this series. After preoperative evaluation, radical resection and reconstruction of the SVC system with expanded polytetrafluoroethylene (EPTFE) grafts were performed. In addition, bypass support from the right internal jugular vein to the right femoral vein was routinely prepared intraoperatively to prevent a rise in central venous pressure (CVP). Postoperatively, SVC-related syndrome improved immediately after the operation. Imaging examination showed good function of the reconstructed venous system. The patients recovered well with no surgical complications and remain under continuous follow-up. Conclusions: Tumor growth into the SVC does not seem to be an absolute contraindication for surgery for thyroid carcinoma. Comprehensive treatment, including reconstruction of the SVC, is effective for relieving symptoms and preventing disease progression and is thus worth advocating. In addition, bypass support from the internal jugular vein to the femoral vein is easy to implement and can improve the safety of the operation.
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Affiliation(s)
- Wenjie Chen
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Jianyong Lei
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Yichao Wang
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaojun Tang
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Bin Liu
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Zhihui Li
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Qinghua Zhou
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
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Carrillo JF, Flores JM, Espinoza G, Vázquez-Romo R, Ramírez-Ortega MC, Carrillo LC, Cortés-García BY, Ochoa-Carrillo FJ, Oñate-Ocaña LF. Treatment of Unresectable Differentiated Thyroid Carcinoma With Upfront External Radiotherapy and Salvage Surgery: A STROBE-Compliant Retrospective Cohort Study. Front Oncol 2021; 10:572958. [PMID: 33542898 PMCID: PMC7851046 DOI: 10.3389/fonc.2020.572958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/30/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION In patients with unresectable Differentiated thyroid cancer (DTC), the use of external beam radiation therapy (EBRT), leads mostly to palliation. Our aim is to define the role of upfront EBRT, followed or not by salvage surgery, on Progression-free survival (PFS) or Overall survival (OS) in patients with DTC. METHODS This is a cohort study of patients with initially unresectable DTC who received EBRT. Cohort A received EBRT followed by rescue surgery and cohort B, EBRT only. The Kaplan-Meier method and Cox model were employed for survival analysis. RESULTS Thirty-three patients were included; 69.6% females and 30.3% males. Mean age was 60.6 and mean tumor diameter was 10.4 cm; 17 and 16 patients were included in cohorts A and B, respectively. Belonging to cohort A (Hazard ratio [HR] 0.177, 95% CI 0.05-0.7) and use of intensity modulated radiotherapy (HR 0.177, 95% CI 0.03-1.08) were associated to better PFS, while high-risk histopathology (HR 6.6, 95% CI 0.9-50) and EBRT dose (HR 1.05, 95% CI 1.01-1.08) were independently associated with lower PFS. Patients from cohort A (HR 0.061, 95% CI 0.01-0.3) had improved OS, while high-risk histopathology (HR 5.7, 95% CI 1.1-28.6) and EBRT dose (HR 1.05, 95% CI 1.01-1.09) were independently associated to worse OS. CONCLUSION EBRT, and when feasible, salvage surgery, should be an integral part of the therapeutic strategy in initially unresectable DTC.
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Affiliation(s)
- José F. Carrillo
- Departamento de Cabeza y Cuello, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Jesús Manuel Flores
- Departamento de Radioterapia, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Gilberto Espinoza
- Subdirección de Cirugía, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Rafael Vázquez-Romo
- Subdirección de Cirugía, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Liliana C. Carrillo
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | | | - Luis F. Oñate-Ocaña
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
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7
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Xu MS, Li J, Wiseman SM. Major vessel invasion by thyroid cancer: a comprehensive review. Expert Rev Anticancer Ther 2018; 19:191-203. [DOI: 10.1080/14737140.2019.1559059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Michael S. Xu
- Department of Surgery, St. Paul’s Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer Li
- Department of Surgery, St. Paul’s Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Sam M. Wiseman
- Department of Surgery, St. Paul’s Hospital & University of British Columbia, Vancouver, British Columbia, Canada
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8
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Retrosternal Metastatic Papillary Thyroid Cancer Causing Superior Vena Cava Syndrome: A Very Rare Presentation. Ann Vasc Surg 2017; 46:368.e9-368.e12. [PMID: 28890067 DOI: 10.1016/j.avsg.2017.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/30/2017] [Accepted: 08/02/2017] [Indexed: 11/22/2022]
Abstract
Thyroid cancer causing superior vena cava (SVC) syndrome is a very rare clinical entity with only 26 cases reported worldwide. Metastatic thyroid cancer causing SVC syndrome several years following resection of the primary tumor is extremely rare with only 2 cases reported; one of them was of the papillary variety. We report the second case worldwide of metastatic papillary thyroid cancer causing SVC syndrome 2 years after total thyroidectomy of the original tumor in a 62-year-old Indian female pilgrim. Unfortunately, the patient died on the third day of intensive care unit admission. The severity of the clinical condition in addition to the late presentation resulted in a catastrophic outcome, which made all the possible resuscitative efforts very difficult.
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9
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Massive internal jugular vein tumor thrombus derived from squamous cell carcinoma of the head and neck: two case reports. Oral Maxillofac Surg 2016; 21:69-74. [PMID: 27885568 DOI: 10.1007/s10006-016-0600-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 11/18/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE Tumor thrombosis of the internal jugular vein (IJV) is an extremely rare disease, and the reported cases have been exclusively associated with differentiated thyroid cancer. In the present study, we describe two cases of IJV tumor thrombosis originated from squamous cell carcinoma (SCC), which is the first case report. METHODS Case 1 was a 67-year-old man diagnosed with advanced supraglottic SCC with a massive tumor thrombus in the IJV. He was treated with bio-radiotherapy followed by radical surgery. Case 2 was a 65-year-old woman who underwent radical surgery for SCC of thyroid with tumor thrombosis in the IJV. RESULTS These cases rapidly developed local recurrences and distant metastases and died within 10 months after surgery. CONCLUSIONS IJV tumor thrombosis originated from SCC apparently reflects extremely aggressive state of the tumor. Recognition and precaution to this condition is essential for the development of a clinically effective treatment strategy.
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10
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Diamantini G, Levi Sandri GB, Procacciante F. Unexpected cause of superior vena cava syndrome. Gland Surg 2015; 4:359-360. [PMID: 26312222 PMCID: PMC4523624 DOI: 10.3978/j.issn.2227-684x.2015.01.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 01/20/2015] [Indexed: 11/14/2022]
Affiliation(s)
- Giulia Diamantini
- Department of General and Endocrine Surgery, Umberto I Policlinic of Rome, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Giovanni Battista Levi Sandri
- Department of General and Endocrine Surgery, Umberto I Policlinic of Rome, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Fabio Procacciante
- Department of General and Endocrine Surgery, Umberto I Policlinic of Rome, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
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11
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Shindo ML, Caruana SM, Kandil E, McCaffrey JC, Orloff LA, Porterfield JR, Shaha A, Shin J, Terris D, Randolph G. Management of invasive well-differentiated thyroid cancer: an American Head and Neck Society consensus statement. AHNS consensus statement. Head Neck 2014; 36:1379-90. [PMID: 24470171 DOI: 10.1002/hed.23619] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 01/24/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Invasive differentiated thyroid cancer (DTC) is relatively frequent, yet there is a paucity of specific guidelines devoted to its management. The Endocrine Committee of the American Head and Neck Society (AHNS) convened a panel to provide clinical consensus statements based on review of the literature, synthesized with the expert opinion of the group. METHODS An expert panel, selected from membership of the AHNS, constructed the manuscript and recommendations for management of DTC with invasion of recurrent laryngeal nerve, trachea, esophagus, larynx, and major vessels based on current best evidence. A Modified Delphi survey was then constructed by another expert panelist utilizing 9 anchor points, 1 = strongly disagree to 9 = strongly agree. Results of the survey were utilized to determine which statements achieved consensus, near-consensus, or non-consensus. RESULTS After endorsement by the AHNS Endocrine Committee and Quality of Care Committee, it received final approval from the AHNS Council.
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Affiliation(s)
- Maisie L Shindo
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
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12
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Tumor thromboembolization into the internal jugular vein through its draining vein: A preoperative radiologic feature of high-risk thyroid cancer. Surgery 2014; 155:196-7. [DOI: 10.1016/j.surg.2012.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 08/03/2012] [Indexed: 11/17/2022]
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13
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Franco IF, Gurrado A, Lissidini G, Di Meo G, Pasculli A, Testini M. Floating left innominate vein neoplastic thrombus: a rare case of mediastinal extension of follicular thyroid carcinoma. Phlebology 2013; 30:140-4. [PMID: 24335091 DOI: 10.1177/0268355513515209] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We report a case of advanced follicular thyroid cancer with innominate vein involvement. To our knowledge, this seems to be the first case treated in emergency surgery, reported in literature. METHOD A 59-year-old woman with a five-year history of a large and mainly right-sided cervical mass presented with dyspnea, unilateral arm swelling, facial flushing, and venous congestion. An emergency computed tomography scan revealed a thyroid mass extending into the upper mediastinum with displacement and compression of the right jugular vein and carotid artery and apparent adherence to the superior vena cava and left innominate vein. RESULTS An emergency total thyroidectomy was performed by means of a sternotomy. The lower portion of the retrosternal goiter projected directly into the left innominate vein, with tumor floating in its lumen. Removal of the neoplastic thrombus was performed, through an incision in the vein, en bloc with the thyroid mass. Both goiter and thrombus were completely replaced by follicular carcinoma. CONCLUSIONS Accurate preoperative assessment through contrast-enhanced computed tomography is strongly suggested in the presence of enlarged thyroid gland extending into the mediastinum whenever angioinvasion is suspected. This could prevent blinded maneuvers such as digital externalization of the thoracic component of the gland, which can be fatal in cases of cervico-mediastinal goiter extending into great cervical or mediastinal veins.
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Affiliation(s)
- I F Franco
- Department of Biomedical Sciences and Human Oncology, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy
| | - A Gurrado
- Department of Biomedical Sciences and Human Oncology, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy
| | - G Lissidini
- Department of Biomedical Sciences and Human Oncology, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy
| | - G Di Meo
- Department of Biomedical Sciences and Human Oncology, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy
| | - A Pasculli
- Department of Biomedical Sciences and Human Oncology, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy
| | - M Testini
- Department of Biomedical Sciences and Human Oncology, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy
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14
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Yu HM, Lee JM, Park KS, Park TS, Jin HY. Papillary Thyroid Carcinoma: Four Cases Required Caution during Long-Term Follow-Up. Endocrinol Metab (Seoul) 2013; 28:335-40. [PMID: 24396700 PMCID: PMC3871035 DOI: 10.3803/enm.2013.28.4.335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 01/04/2013] [Indexed: 11/11/2022] Open
Abstract
Due to the increased prevalence of papillary thyroid carcinoma (PTC), difficult cases and unexpected events have become more common during long-term follow-up. Herein we reported four cases that exhibited poor progress during long-term follow-up. All the cases were diagnosed with PTC and treated with total thyroidectomy before several years, and the patients had been newly diagnosed with recurrent and metastatic PTC. These four cases included recurred PTC with invasion of large blood vessels, a concomitant second malignancy, malignant transformation, and refractoriness to treatment. Physicians should closely monitor patients to promptly address unforeseen circumstances during PTC follow-up, including PTC recurrence and metastasis. Furthermore, we suggest that the development of a management protocol for refractory or terminal PTC is also warranted.
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Affiliation(s)
- Hea Min Yu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Jae Min Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Kang Seo Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Tae Sun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Heung Young Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
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15
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Nakashima T, Nakashima A, Murakami D, Toh S, Shiratsuchi H, Yasumatsu R, Tominaga R, Komune S. Follicular carcinoma of the thyroid with massive invasion into the cervical and mediastinum great veins: our own experience and literature review. Laryngoscope 2012; 122:2855-7. [PMID: 22951943 DOI: 10.1002/lary.23690] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 07/09/2012] [Accepted: 08/01/2012] [Indexed: 12/20/2022]
Abstract
Thyroid carcinomas with massive intralumen invasion of the great veins are extremely rare and reported to have poor prognosis. We report a case of a poorly differentiated follicular carcinoma of the thyroid with extensive invasion into the bilateral internal jugular veins, brachiocephalic vein, and superior vena cava. All of the seven major drainage veins from the thyroid were involved by tumor thrombus. The patient was successfully treated by surgical resection including removal of the tumor thrombus and repair of the great veins. The importance of preoperative radiological findings, treatment, and outcome are discussed along with a literature review.
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Affiliation(s)
- Torahiko Nakashima
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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16
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Radio-anatomy of the superior vena cava syndrome and therapeutic orientations. Diagn Interv Imaging 2012; 93:569-77. [DOI: 10.1016/j.diii.2012.03.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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17
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Successful surgical treatment of advanced follicular thyroid carcinoma with tumor thrombus infiltrating the superior vena cava: report of a case. Surg Today 2011; 42:185-90. [PMID: 22072150 DOI: 10.1007/s00595-011-0033-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Accepted: 01/31/2011] [Indexed: 12/12/2022]
Abstract
We report a case of advanced follicular thyroid carcinoma with massive involvement of the great veins of the cervix and mediastinum, and extensive tumor thrombus growing intraluminally into the superior vena cava. The patient, a 70-year-old Japanese woman, was treated successfully by a cooperative surgical team of endocrine and cardiovascular surgeons. Total thyroidectomy with thrombectomy was performed via a minimum phlebotomy in the right brachiocephalic vein, sacrificing only the right internal jugular vein, achieving complete primary tumor resection. She recovered quickly without any complications, and received (131)I radioisotope ablation for her multiple lung metastases. At the time of writing, more than 12 months after surgery, she was well. These treatments thus achieved progression-free survival without impairing her quality of life. Following the case report, we discuss the surgical indications for locally advanced thyroid carcinoma involving the great veins of the mediastinum by reviewing previous reports.
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Churilla TM, Stallman JS, Peters CA, Brereton HD. Superior vena cava syndrome arising from a solitary metastasis to an indwelling catheter. Clin Radiol 2011; 66:1110-3. [PMID: 21855861 DOI: 10.1016/j.crad.2011.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 06/07/2011] [Indexed: 10/17/2022]
Affiliation(s)
- T M Churilla
- The Commonwealth Medical College, Scranton, PA, USA.
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Kobayashi K, Hirokawa M, Yabuta T, Fukushima M, Kihara M, Higashiyama T, Tomoda C, Takamura Y, Ito Y, Miya A, Amino N, Miyauchi A. Tumor thrombus of thyroid malignancies in veins: importance of detection by ultrasonography. Thyroid 2011; 21:527-31. [PMID: 21476893 DOI: 10.1089/thy.2010.0099] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Tumor thrombus in the thyroid vein or the internal jugular vein may be caused by thyroid malignancies. Therefore, a tumor thrombus is very suspicious for malignancy. Total thyroidectomy should be performed in such patients if there is a primary thyroid tumor, and a high probability of pulmonary metastasis seems likely as there is direct exposure of malignant cells to the circulation. Our study was performed to determine whether ultrasonography is an effective preoperative modality to detect tumor thrombi of thyroid malignancies and whether tumor thrombi are associated with pulmonary metastases. METHODS Between 2004 and 2009, all thyroid surgery patients at Kuma Hospital had preoperative neck ultrasonography to look for tumor thrombi in the thyroid veins and the internal jugular veins as well as thyroid masses and abnormal lymph nodes. We looked for solid masses with an echogenic "tongue" in the internal jugular vein and masses with a projection from thyroid tumor to the thyroid vein on grayscale ultrasonography. We also used Doppler ultrasonography to look for the absence of blood flow. RESULTS Among 7754 patients who had thyroid surgery, there were 9 patients with tumor thrombi. In seven of the patients, tumor thrombi were detected by preoperative ultrasound, and in the remaining two patients, tumor thrombi were detected during surgery. Tumor thrombi were identified in the internal jugular vein in six patients and in the thyroid vein in three patients. Pulmonary metastases were present in three patients (50% of the patients with thyroid carcinoma). The patients with tumor thrombi were more likely (33.3%) to have pulmonary metastasis than those without (0.9%) tumor thrombi (p < 0.0001). In four patients with papillary carcinoma, projection-like lesions of irregularly shaped tumors were misdiagnosed to be tumor thrombi in the thyroid veins on preoperative ultrasound. These four patients did not have pulmonary metastases. CONCLUSIONS The preoperative detection of a tumor thrombus on ultrasonography has important clinical significance. Therefore, preoperative neck ultrasound in patients with thyroid masses should attempt to determine whether there are signs of tumor thrombi as well as to characterize the nature and location of abnormal thyroid and extrathyroid masses.
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