Images of Malignancy: Case 2 Papillary Carcinoma of the Thyroid

January 2, 2004
Roy T. Rapp, MD
Roy T. Rapp, MD

A 40-year-old man was concerned about an enlarging painlessmass on the right side of his neck that had been presentfor 6 months (A). The patient reported no other healthproblems; his medical history was unremarkable, and hewas taking no medications.There was no family or personal history of thyroiddisease or of exposure to radiation. Thyroid function testresults were within normal limits. A chest film revealed nopathology.

A 40-year-old man was concerned about an enlarging painlessmass on the right side of his neck that had been presentfor 6 months (A). The patient reported no other healthproblems; his medical history was unremarkable, and hewas taking no medications.There was no family or personal history of thyroiddisease or of exposure to radiation. Thyroid function testresults were within normal limits. A chest film revealed nopathology.Radical right neck surgery and total thyroidectomywere performed. Care was taken during surgery to protectthe parathyroid and the recurrent laryngeal nerves.Pathologic examination revealed metastatic papillary carcinoma.The right lobe of the thyroid gland was the primarysite; 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 slowgrowingand most commonly occurs in persons youngerthan 40 years. Virtually all papillary tumors of the thyroidare malignant. Tumor spread most frequently occurs viathe lymphatic system to the cervical lymph nodes; thesemetastases often are not noticed until the patient has becomedisfigured.Because the lung is a common site of thyroid papillarycarcinoma metastasis, a postoperative chest film wasobtained; it revealed no disease. This cancer also oftenmetastasizes to bone.The patient was tumor-free for 5 years after surgeryand was lost to follow-up thereafter. Generally, outcome isgood for thyroid cancer patients who have papillary carcinoma;the prognosis is less favorable for those with folliculartumors and poorest for patients with undifferentiatedcarcinoma.