Presentation
Thyroid carcinoma ? with local invasion. Hard anterior neck swelling, fixed to underlying tissues + dysphagia, dysphonia and approximately 720 kilograms weight loss.
Patient Data
The entire thyroid gland and the isthmus is replaced with an extensively large, lobulated and heterogenous solid nodule that shows retrosternal, lateral as well as subtle cranial extension. The thyroid capsular outline is overtly disrupted and there are visible intra-nodular punctuate and scattered micro-millimeter sized calcific foci bilaterally. The lesional borders is broadly spiculated with the left lobe nodule showing taller than wider phenomenon. The right and the left lobe nodules measures approximately 30 cc and 62 cc in volumes respectively.
Multiple round solid nodules exhibiting heterohypoechoic reflectivity with intrinsic calcification foci, are noted at the bilateral para-jugular regions. Posterior neck triangles shows bilaterally enlarged hypoechoic lymphnodes that minimally maintain their central echogenic stromal fats. The anterior major neck vasculature, musculature and the salivary glands are grossly preserved.
Surveyed abdomen however, reveals para-aortic lymphadenopathy and small multiple hyperechogenic materials of sub-centimeter diameters within the right liver lobe. Non-layering and peripherally irregularly outlined intraluminal gallbladder homogeneous, hypoechogenic material adherent at the supero-medial gallbladder wall is noted.
Case Discussion
Clinically confirmed thyroid carcinoma. Ultrasound features shows diffusely expansile, ill-defined, taller than wider, lobulated solid nodule with punctate and scattered micro-millimeter sized calcification foci. Multiple almost similar nodules (compared with the thyroid lesion) are noted within the paratracheal/para-jugular anterior neck regions which portends local invasion. There is attendant bilateral levels IIB infiltrated or reactive enlarged lymphnodes.
Non-layering sludge within the gallbladder lumen seen could be tumefactive. There are small multiple enlarged para-aortic lymphnodes. The right hepatic sub-centimeter hyperechogenic foci noted could be suspicious for early distant metastases deposition.
Unable to process the form. Check for errors and try again.