Fig. 1(A) A palpable mass and protruding scar with discharge were observed on a patient's neck at admission. (B) Neck sonography revealed a metastatic lymph node (LN) and tumor thrombus in the right internal jugular vein; however, a recurred mass was not seen at the thyroid bed. (C) Chest computed tomography (CT) showed a large lung mass and fat infiltration around the mass. The superior vena cava was compressed by the mass. Hematogenous metastatic lung nodules in the right lung were also detected. (D) Follow-up chest CT showed noticeably increased lung mass. (E) Biopsy findings from the right supraclavicular lymph node (LN) were compatible with metastatic papillary thyroid carcinoma (H&E stain, ×100). (F) A metastatic brain lesion was detected incidentally on neck CT.
Fig. 2(A) Chest computed tomography revealed two pulmonary nodules (arrows). The nodule located at the RLL was a ground glass opacity (GGO) pattern and the nodule at the LLL was a solid and GGO pattern. These were thought to be benign nodules by the radiologist. (B) H&E staining of metastatic papillary thyroid carcinoma within the bronchioloalveolar carcinoma (BAC). (Ba) The BAC contained a microscopic lesion showing papillary structures (arrows) (H&E stain, ×10). (Bb) The greater part of the nodule showed histological features typical of BAC (H&E stain, ×100). (Bc) At higher magnification of the papillary area, papillary structures lined by cells showed nuclear features of PTC (H&E stain, ×200).
Fig. 3(A) Follow-up neck sonography showed small nodules which were thought to be metastatic papillary thyroid carcinoma. (B) Follow-up chest computed tomography (CT) showed mediastinal lymph node enlargement and tracheal obstruction with pleural effusion that were not detected by previous chest CT. And also abdominal CT showed the adrenal metastatic mass (white arrow).
Fig. 4(A) Neck sonography showed metastatic lymph nodes in the right lower jugular chain (left figure) and in the left supraclavicular area (right). (B) Follow-up chest computed tomography (CT) showed an enlarged nodule at the right minor fissure and a new small nodule at the RLL. (C) Follow-up chest CT after 6 months showed multiple metastatic lymphadenopathies, right pleural effusion with metastatic pleural mass, and hematogenous lung metastasis in the right lower lobe and middle lobe. (D) Cytologic finding of pleural fluid was compatible with metastatic papillary thyroid carcinoma (Pap stain, ×400).