This case report describes a 65-year-old man with papillary carcinoma of the thyroid that had spread widely to distant sites via the bloodstream. He presented with a neck swelling and swelling on his left cheek. Imaging showed metastases in the lungs, bones, and brain. He underwent a total thyroidectomy to debulk the thyroid tumor. Histopathology confirmed papillary carcinoma. Despite hematogenous metastases being rare for this cancer type, this case illustrates that papillary carcinoma can uncommonly spread to distant soft tissues and bones through the bloodstream. The patient received radioactive iodine therapy and radiation to treat the widespread metastases.

1. A CASE OF PAPILLARY CARCINOMA
THYROID WITH HEMATOGENOUS SPREAD
AND RARE SOFT TISSUE METASTASES
Prof Dr.S.Saradha M.S.,
Dr.R.Radhika M.S.,
Dr.P.Murugadasan M.S.,
Dr.Sujith M.Jose M.S Post Graduate
Coimbatore Medical College

2. Introduction
• Papillary Carcinoma is the
most common thyroid
malignancy.
• Metastases typically
disseminate via lymphatic
spread to regional lymph
nodes.
• Distant metastases are
present at diagnosis in
3-5% of cases.

3. Case Report
65 year old male
admitted with neck
swelling of 5 years
duration and swelling
over Left cheek of 3
months duration.

4. • He had history of
fracture distal
femur after a trivial
trauma 6 months
back

5. X Ray shows pathological fracture Femur Distal
end with callus formation

6. • Cough of 1 month
duration
• Hemoptysis of 1
week duration
History of loss of
weight and
appetite of 6
months duration

7. On Examination
• Patient was moderately built and nourished.
• Patient was anemic.
• No palpable cervical lymphnodes
• A swelling of size 8*6*4 cm was present in front of neck
which moves up with deglutition.
– Surface bossalated
– Dilated veins over the swelling
– Firm to hard in consistency
– Lower border palpable
– Carotid pulsations present on either sides

8. • Another swelling of
size 4*3*3cm was
present over the left
cheek.
• Mobility of the swelling
got restricted on
clenching teeth

9. Investigations
• Basic blood investigations done
• Thyroid profile done – Euthyroid state
• USG Neck –
• Diffuse swelling of Thyroid gland
• Right lobe- 7*6*4.5cm
• Left lobe- 8*6.6*5cm
• Areas of calcification ++

10. • FNAC from the
Thyroid swelling
showed thyroid
follicular cells
arranged in syncytial
clusters and
microfollicles, features
suggestive of follicular
neoplasm

11. • FNAC from the Left
maxillary swelling showed
small round cells arranged
in microfollicles, features
suggestive of metastatic
carcinomatous deposits
from follicular carcinoma of
thyroid.

12. • CT showed features of malignant mass from
thyroid with multiple pulmonary, skeletal and
brain metastases.
• Tumor partly encasing the common carotid
artery
• The soft tissue mass on the left side of cheek,
infilterating the masseteric muscle

13. Course and Treatment
• After adequate preoperative preparation,we
proceeded with total thyroidectomy as a debulking
procedure.
• Gland was deeply adherent to the trachea,and
tracheostomy was done during the procedure
• Specimen was send for Histopathological
Examination

14. • Retrospectively, histopathology report of
the thyroid specimen came to be
PAPILLARY CARCINOMA THYROID
(Papillary Carcinoma with focal Cribriform Morular Pattern
and Squamous morules without keratinisation)

15. • Post operatively, patient was on
ventilatory support.
• Patient was weaned from ventilator and is
in followup with Radioactive Iodine
Ablation Therapy and
• External Beam Radiotherapy for
Brain and Femur Metastasis

16. Discussion
• Papillary Carcinoma is the most common
thyroid malignancy (80% of Thyroid
malignancy)
• Lymph node metastases are common
• Distant metastases are uncommon,
develop in upto 20% patients
• Most common sites are
Lungs > Bones > Liver > Brain

17. • The most important risk factor for papillary
cancer is childhood radiation exposure
• Other important risk factors:
– history of thyroid cancer in a first-degree
relative
– presence of a familial syndrome that includes
thyroid cancer, such as Werner syndrome,
Carney complex, and familial polyposis.

18. • Thyroid neoplasm may form well-defined
follicles, with only minimal papillary
architecture. They are classified as the
follicular variant of papillary carcinoma and
constitutes about 10% of papillary
cancers.

19. • Histologically Pure follicular variant and
Mixed pattern of follicular and papillary
structures are classified as papillary
carcinoma because they behave
pathologically as papillary carcinoma
thyroid

20. The case reported herein is interesting
because,
Extrathyroidal extension into the soft
tissue can occur, but distant soft tissue
and skeletal muscle metastases are rarely
reported in literature
Thyroid malignancy with hematogenous
spread need not always be follicular
carcinoma

21. thank you