Venous extension of a thyroid follicular carcinoma
Monday 8 July 2013
Thyroid carcinoma usually presents as an asymptomatic thyroid nodule.
Thyroid cancer may show microscopic vascular invasion; however, internal jugular vein tumor thrombus is a rare complication of thyroid cancer.
Thyroid carcinomas with massive intralumen invasion of the great veins are extremely rare and reported to have poor prognosis.
Thyroid carcinoma causing tumor thrombus in the great veins is a rare situation and has been reported to have poor prognosis.
It can cause sudden death due to pulmonary embolism, and the management requires exclusive care.
Solitary internal jugular vein invasion of thyroid cancer has been occasionally reported, but tumor thrombi extending to the mediastinum great veins is extremely rare.
In the past, cases receiving palliative management have been reported due to the difficulty of surgical approach resulting in poor outcome.
In general, patients can eventually come down with symptoms of SVC syndrome, which would be critical.
Surgical treatment is necessary in collaboration with head and neck surgeons and cardiothoracic surgeons.
Thompson et al. reported the first case of follicular thyroid carcinoma with extended tumor thrombus in the mediastinum great veins that was operated successfully.
Thrombectomy is the most effective surgical treatment if possible.
In the English language literature, 11 cases of differentiated thyroid cancer invasion in the mediastinum great veins have been reported that were treated by thrombectomy.
Most of the previously reported cases revealed angio-invasion into a single vein.
Reconstruction of the vessels is necessary for cases with massive invasion and adhesion to the great veins.
Cases utilizing expanded polytetrafluoroethylene grafts or autologous tissue6 for reconstruction of mediastinum great veins are reported.
Appropriate preoperative vascular imaging is important whenever angio-invasion is suspected.
Enhanced CT and ultrasonography is reported to be useful for detecting tumor thrombi of thyroid malignancies.
Taib and Hisham described the importance of the positive ring sign, which is a rim of contrast around the tumor thrombus on enhanced CT examination.
This sign indicates the possibility of removing the thrombus by thrombectomy (without reconstruction) and is useful in deciding the surgical strategy.
Multimodality treatment is recommended including surgery, external beam radiotherapy (EBRT), and RI therapy for aggressive thyroid cancer with great vein involvement.
Venous obstruction of thyroid malignancy origin: the Antoine Lacassagne Institute experience. Marcy PY et al. http://www.wjso.com/content/7/1/40
Follicular carcinoma of the thyroid with massive invasion into the cervical and mediastinum great veins: our own experience and literature review. Nakashima T, Nakashima A, Murakami D, Toh S, Shiratsuchi H, Yasumatsu R, Tominaga R, Komune S. Laryngoscope. 2012 Dec;122(12):2855-7. doi:10.1002/lary.23690 . PMID: #22951943#
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