Images of Malignancy: Case 2 Papillary Carcinoma of the Thyroid

A 40-year-old man was concerned about an enlarging painless mass on the right side of his neck that had been present for 6 months (A). The patient reported no other health problems; his medical history was unremarkable, and he was taking no medications. There was no family or personal history of thyroid disease or of exposure to radiation. Thyroid function test results were within normal limits. A chest film revealed no pathology. Radical right neck surgery and total thyroidectomy were performed. Care was taken during surgery to protect the parathyroid and the recurrent laryngeal nerves. Pathologic examination revealed metastatic papillary carcinoma. The right lobe of the thyroid gland was the primary site; metastatic lesions had spread to the right neck. There were no distant metastases. After the operation (B), the patient was given levothyroxine, 1 mg/d. Papillary carcinoma of the thyroid gland is slowgrowing and most commonly occurs in persons younger than 40 years. Virtually all papillary tumors of the thyroid are malignant. Tumor spread most frequently occurs via the lymphatic system to the cervical lymph nodes; these metastases often are not noticed until the patient has become disfigured. Because the lung is a common site of thyroid papillary carcinoma metastasis, a postoperative chest film was obtained; it revealed no disease. This cancer also often metastasizes to bone. The patient was tumor-free for 5 years after surgery and was lost to follow-up thereafter. Generally, outcome is good for thyroid cancer patients who have papillary carcinoma; the prognosis is less favorable for those with follicular tumors and poorest for patients with undifferentiated carcinoma.