Endocrine Abstracts

Introduction: Papillary microcarcinoma is a malignant disease of the thyroid measuring less than 1 centimeter at its highest dimension. It has a good prognosis with a small rate of metastasis and giant adenopathies with rapid growth are a rare find.

Case report: We present the case of a 75-year-old male patient, who recently underwent surgery for massive laterocervical adenopathy, measuring 50/38.5/48.5 mm in diameters, with rapid growth (in approximately three months), well defined, in close contact with right internal jugular vein. Histological exam revealed cystic metastasis of thyroid papillary carcinoma and immunohistochemical stains were positive for paired-box gene 8 (PAX8), cytokeratin 19 (CK 19), thyroid transcription factor 1 (TTF 1), Thyroglobulin (Tg), p40 with Ki67 proliferation index of 15%. Preoperative full body CT scan did not find other distant tumors, so no associated distant metastasis. He was admitted in our department in good physical condition and thyroid ultrasound disclosed three heterogenous microfoci in the right thyroid lobe, of 0.1 mm in the largest dimension. Biochemical exams showed normal thyroid function and negative calcitonin. Total thyroidectomy was performed and histological exam confirmed the presence of a 0.25/0.1 cm, non-encapsulated, lymphovascular and perivascular invasive papillary thyroid microcarcinoma. Post surgery, ultrasound found paratracheal thyroid tissue, confirmed by the 131I Thyroid scintigraphy. Therapy with 100 micrograms of Levothyroxine was initiated with good adaptation to therapy. Postoperative follow-up included non-stimulated thyroglobulin of 0.04uUi/ml, stimulated thyroglobulin of 3.14 uUi/ml, antithyroglobulin antibodies in the normal range. The next step was to administer 50mCi radioiodine. Unfortunately, the patient was lost to follow up.

Conclusions: One should consider papillary microcarcinoma when it comes to giant lymph nodes with rapid growth.