Papillary thyroid carcinoma with tracheal invasion: A case report

Abstract

Rationale: Compared with most malignant tumors, papillary thyroid carcinoma (PTC) is usually associated with favorable survival and low recurrence rate. The prognostic factors of PTC include age, sex, tumor size, enlarged lymph nodes, and extrathyroidal extension. Among the extrathyroidal extension, upper aerodigestive tract (ADT) invasion by PTC is a marker of more aggressive tumor behavior, defining a subpopulation of patients at a greater risk of recurrence and death.

Patient concerns: A 61-year-old woman had a cervical mass that was slowly growing for three years. Additionally, she had haemoptysis of 1-year duration. During the month prior to her visit, she had difficulty breathing.

Diagnosis: Neck ultrasonography (US) and thyroid computed tomography (CT) images both showed a well-defined calcified mass on the left lobe of the thyroid gland. Additionally, the thyroid CT revealed that part of the mass protruded into the lumen which resulted in the thickening on the left side of the trachea. Accordingly, her diagnoses were as follows: firstly, a solid mass on the left lobe of the thyroid gland with tracheal compression; and finally, the space-occupying airway lesion.

Interventions: She underwent a bronchoscopic examination, which revealed a mass blocking most of the upper endoluminal trachea. Thus, the mass was resected at the upper tracheal segment, followed by electrotome and argon plasma coagulation treatment. She was then transferred to the Thyroid Surgery Department. Thyroid surgeons took the surgical type of bilateral subtotal thyroidectomy + exploration of bilateral recurrent laryngeal nerve + dissection of the lymph node in neck central area + circumferential sleeve resection + end-to-end anastomosis + tracheotomy in the patient.

Outcomes: After surgery, she recovered well without any local recurrence or distant metastasis.

Lessons: When patients with PTC have haemoptysis, hoarseness, dyspnea, or any other symptoms, and the imaging examinations reveal a space-occupying lesion in the thyroid and airway, clinicians should focus on PTC with tracheal invasion, a bronchoscopic examination must be immediately performed because the subsequent surgical management depends on the degree of tracheal invasion.

Figure 1

Neck ultrasonogram. (A) The cross-section showed that part of the trachea was surrounded by a solid mass; (B) the longitudinal section showed a solid mass with calcifications on the middle and lower part of the left lobe of the thyroid gland; (C) the longitudinal section showed that the mass had a second-degree blood supply.

Figure 2

Thyroid computed tomography scan. (A) The axial image showed a well-defined calcified mass on the left lobe of the thyroid gland; (B) the sagittal image showed that the mass blocked most of the upper endoluminal trachea; (C) the coronal image showed a thickened area on the left side of the trachea and part of the mass protruding into the lumen.

Figure 3

Bronchoscopic appearance. A neoplasm blocked most of the upper endoluminal trachea.

Figure 4

Microscopic appearance. Pathological features revealed a papillary infiltrating growth of the lamina propria of the cricotracheal mucosa. H&E = high-power field.

Figure 5

Positron emission tomography–computed tomography scan. (A) The axial image showed a soft-tissue mass with intense radioactivity on the left lobe of the thyroid gland; (B) the sagittal image showed an intensely radioactive soft-tissue mass blocking most of the upper endoluminal trachea; (C) the coronal image showed that the trachea was compressed to the right side, and part of the mass protruded into the lumen, which can result in the stenosis observed in that area of the trachea.