Subcutaneous Recurrences of Thyroid Cancer After Conventional Transcervical Thyroidectomy: A Case Report

Abstract

Metastatic subcutaneous implantation of the follicular variant of papillary thyroid cancer is very rare. We present a 62-year-old woman with a history of follicular variant of papillary thyroid cancer, who developed multiple asymptomatic subcutaneous nodules, after 5 years of initial thyroidectomy. Eventually, the subcutaneous nodules were diagnosed as tumor recurrence and completely excised. She has reportedly lived for more than 1 year, without signs of disease progression or recurrence. This case emphasizes the need for surgeons to take into account the tumor-free concept during the operation, and to a great extent prevent the occurrence of implantation recurrence.

Keywords: computed tomography; follicular variant of papillary thyroid cancer; imaging features; subcutaneous implantation metastasis; thyroid cancer; ultrasound.

Figure 1

Pre-operative physical examination and ultrasound examination. (A) Three subcutaneous palpable nodules at the right anterior neck and the right supraclavicular. The neck ultrasound showed two hypoechoic nodules with a size of about 9^*7^*9 mm (F) and 5^*3^*7 mm (G) subcutaneously at the right anterior neck. A hypoechoic nodule with a size of about 8^*4^*6 mm (H) was observed at the right supraclavicular. Three nodules are annotated with black, red, and blue arrows, respectively, and corresponding the nodules indicated by the arrow in (A).

Figure 2

Pre-operative computed tomography findings. The neck enhanced computed tomography scans were observed (A) a general image of the neck, and (B–D) features of three nodules. The three nodules are annotated with black, red, and blue arrows, respectively, and corresponding nodules indicated by the arrow in Figure 1A.

Figure 3

During surgery and post-operative image features. (A) The thyroid was incised, and the cervical fascia exposed intraoperatively. (B) The specimen was resected during surgery, and the arrows indicate the three palpable nodes. (C) Three removed nodules were presented individually, with a maximum size of 8^*8 mm. Three nodules are annotated with black, red, and blue arrows, respectively, and corresponding nodules indicated by the arrow in Figure 1A. (D,E) Postoperative histopathology revealed subcutaneous nodules of the neck as metastatic carcinoma of follicular variant of papillary thyroid carcinoma. OM, omohyoid muscles; STM, sternothyroid muscle; SHM, sternohyoid muscle.