Digital Pathology Cases

Venous extension of a thyroid follicular carcinoma

2013-07-08T06:19:51Z

TNM staging

Discussion

Thyroid carcinoma usually presents as an asymptomatic thyroid nodule.

Thyroid cancer may show microscopic vascular invasion; however, internal jugular vein tumor thrombus is a rare complication of thyroid cancer.

Thyroid carcinomas with massive intralumen invasion of the great veins are extremely rare and reported to have poor prognosis.

Thyroid carcinoma causing tumor thrombus in the great veins is a rare situation and has been reported to have poor prognosis.

It can cause sudden death due to pulmonary embolism, and the management requires exclusive care.

Solitary internal jugular vein invasion of thyroid cancer has been occasionally reported, but tumor thrombi extending to the mediastinum great veins is extremely rare.

In the past, cases receiving palliative management have been reported due to the difficulty of surgical approach resulting in poor outcome.

In general, patients can eventually come down with symptoms of SVC syndrome, which would be critical.

Surgical treatment is necessary in collaboration with head and neck surgeons and cardiothoracic surgeons.

Thompson et al. reported the first case of follicular thyroid carcinoma with extended tumor thrombus in the mediastinum great veins that was operated successfully.

Thrombectomy is the most effective surgical treatment if possible.

In the English language literature, 11 cases of differentiated thyroid cancer invasion in the mediastinum great veins have been reported that were treated by thrombectomy.

Most of the previously reported cases revealed angio-invasion into a single vein.

Reconstruction of the vessels is necessary for cases with massive invasion and adhesion to the great veins.

Cases utilizing expanded polytetrafluoroethylene grafts or autologous tissue6 for reconstruction of mediastinum great veins are reported.

Appropriate preoperative vascular imaging is important whenever angio-invasion is suspected.

Enhanced CT and ultrasonography is reported to be useful for detecting tumor thrombi of thyroid malignancies.

Taib and Hisham described the importance of the positive ring sign, which is a rim of contrast around the tumor thrombus on enhanced CT examination.

This sign indicates the possibility of removing the thrombus by thrombectomy (without reconstruction) and is useful in deciding the surgical strategy.

Multimodality treatment is recommended including surgery, external beam radiotherapy (EBRT), and RI therapy for aggressive thyroid cancer with great vein involvement.

Links

Venous obstruction of thyroid malignancy origin: the Antoine Lacassagne Institute experience. Marcy PY et al. http://www.wjso.com/content/7/1/40

References

Follicular carcinoma of the thyroid with massive invasion into the cervical and mediastinum great veins: our own experience and literature review. Nakashima T, Nakashima A, Murakami D, Toh S, Shiratsuchi H, Yasumatsu R, Tominaga R, Komune S. Laryngoscope. 2012 Dec;122(12):2855-7. doi:10.1002/lary.23690 . PMID: #22951943#

Mishra A, Agarwal A, Agarwal G, Mishra SK. Internal jugular vein invasion by thyroid carcinoma. Eur J Surg 2001; 167: 64–67.

Lalak NJ, Campbell PR. Infiltrating papillary carcinoma of the thyroid with macroscopic extension into the internal jugular vein. Otolaryngol Head Neck Surg 1997; 117: S228–S230.

Wiseman O, Preston PG, Clarke JM. Presentation of thyroid carcinoma as a thrombosed external jugular vein, with intraluminal tumour thrombus in the great veins. Eur J Surg Oncol 2000; 26: 816–817.

Kim RH, Mautner L, Henning J, Volpe R. An unusual case of thyroid carcinoma with direct extension to great veins, right heart, and pulmonary arteries. Can Med Assoc J 1966; 94: 238–243.

Thompson NW, Brown J, Orringer M, Sisson J, Nishiyama R. Follicular carcinoma of the thyroid with massive angioinvasion: extension of tumor thrombus to the heart. Surgery 1978; 83: 451–457.

Wada N, Masudo K, Hirakawa S, et al. Superior vena cava (SVC) reconstruction using autologous tissue in two cases of differentiated thyroid carcinoma presenting with SVC syndrome. World J Surg Oncol 2009; 7: 75.

Motohashi S, Sekine Y, Iizasa T, Nakano K, Numata T, Fujisawa T. Thyroid cancer with massive invasion into the neck and mediastinal great veins. Jpn J Thorac Cardiovasc Surg 2005; 53: 55–57.

Taib NA, Hisham AN. Follicular thyroid carcinoma with direct tumour extension into the great cervical veins and right atrium: is transcervical thrombectomy a safe option? Asian J Surg 2007; 30: 216–219.

Kobayashi K, Hirokawa M, Yabuta T, et al. Tumor thrombus of thyroid malignancies in veins: importance of detection by ultrasonography. Thyroid 2011; 21: 527–531.

Hyer SL, Dandekar P, Newbold K, et al. Thyroid cancer causing obstruction of the great veins in the neck. World J Surg Oncol 2008; 6: 36.

Néphroblastome - EHB

2013-05-24T09:18:41Z

- Renal diseases

Hematopathology | Digital slides

2012-12-12T08:19:03Z

Lymphomas and lymphoid lesions

HPC:272 : Hyperplasia of the erythroid lineage. Reactional aspect.
HPC:276 : Bone marrow localization of a prostate adenocarcinoma. Metastasis.
HPC:277 : Acute leukemia after essential thrombocytosis;
HPC:278 : CD5+ small cell lymphoma in bone marrow.
HPC:279 : Lymphoplasmocytic lymphoma in bone marrow.
HPC:280 : Follicular lymphoma in bone marrow.
HPC:281 : Hairy cell leukemia.
HPC:282 : Atypical myeloma cells in bone marrow.
HPC:283 : Primary myelofibrosis.
HPC:284 : T-cell rich B-cell lymphoma in bone marrow.
HPC:285 : Dysmegacaryopoiesis without myelofibrosis.
HPC:286 : Mantle cell lymphoma.
HPC:287 : Chronic lymphocytic leukemia.
HPC:288 : Follicular lymphoma (lymph node).
HPC:289 : Rosaï-Dorfman disease. Sinusal histiocytosis with massive lymphadenopathy.
HPC:290 : Rosaï-Dorfman disease. Sinusal histiocytosis with massive lymphadenopathy.
HPC:291 : Lymph node in rheumatoid polyarthritis.
HPC:292 : Mixed cellularity, classic Hodgkin lymphoma.
HPC:293 : Nodal cat scratch disease.
HPC:294 : Small B cell lymphoma. Non otherwise specified - NOS.
HPC:295 : Nodal toxoplasmosis.
HPC:296 : Colonic MALT lymphoma.
HPC:297 : Gastric diffuse large B-cell lymphoma (Gastric DLBCL).
HPC:298 : Residual disease of digestive MALT lymphoma after treatment.
HPC:299 : Marginal zone B-cell lymphoma of the spleen.
HPC:300 : Normal spleen (Idiopathic thrombopenic purpura).
HPC:301 : Mantle cell lymphoma of the ocular conjunctiva.
HPC:302 : Mediastinal-pulmonary diffuse large B-cell lymphoma (DLBCL), EBV-associated.
HPC:303 : Pulmonary plasmocytic MALT lymphoma.
HPC:304 : Gastric MALT lymphoma (Gastric marginal zone lymphoma).
HPC:305 : Diffuse large B-cell lymphoma of the tonsil (DLBCL of the tonsil).
HPC:306 : Thyroid MALT lymphoma with lymphocytic thyroiditis.
HPC:307 : Parotidal diffuse large B cell lymphoma and MALT lymphoma.
HPC:308 : EBV-associated infectious mononucleosis.
HPC:309 : Accessory salivary gland in Sjögren syndrome.
HPC:310 : Thyroid follicular lymphoma.
HPC:311 : Follicular gastritis and active chronic gastritis, non-atrophical, Helicobacter pylori-associated.
HPC:312 : Nodal localization of a MALT lymphoma.
HPC:313 : Minimal residual disease after treated gastric MALT lymphoma.
HPC:314 : Mammary diffuse large B cell lymphoma (Mammary DLBCL).
HPC:315 : Mammary MALT lymphoma.
HPC:316 : EBV-associated nasal T/NK lymphoma.
HPC:317 : Pulmonary MALT lymphoma.
HPC:318 : Lymphocytic interstitial pneumonia (LIP).
HPC:319 : Gastric MALT lymphoma (Fundus).
HPC:320 : Undifferentiated carcinoma of the nasopharynx (Epstein-Barr virus associated).
HPC:321 : Diffuse large B-cell lymphoma of the tonsil (DLBCL of the tonsil).
HPC:322 : Parotidal follicular lymphoma.
HPC:323 : Diffuse large B-cell lymphoma (DLBCL) of the thyroid gland.
HPC:324 : Accessory salivary gland in Sjögren syndrome.
HPC:325 : Intestinal T-cell lymphoma.
HPC:326 : Intra-epithelial T-cell lymphoma.
HPC:327 : Lymphocytic colitis.
HPC:328 : Lymphocytic gastritis.
HPC:329 : Diffuse large B cell lymphoma (DLBCL) of duodenal mucosa.
HPC:330 : Rectal marginal zone B-cell lymphoma - Rectal MALT lymphoma.
HPC:331 : Follicular lymphoma grade 1 in lymph node.
HPC:332 : HIV-associated nodal follicular hyperplasia.
HPC:333 : Nodal EBV-associated infectious mononucleosis.
HPC:334 : Nodal plasmocytoma.
HPC:335 : Plasmocytic Castleman disease (associated to Kaposi sarcoma).
HPC:336 : ALK- anaplastic large cell lymphoma.
HPC:337 : Classic Hodgkin lymphoma, mixed cellularity.
HPC:338 : Nodal Langerhans histiocytosis with tuberculoid granulomatous pattern.
HPC:339 : Kikuchi necrotizing adenitis.
HPC:340 : T-cell rich diffuse large B cell lymphoma (T-cell rich DLBCL).
HPC:341 : ALK+ Large cell anaplastic lymphoma of the lymph node.
HPC:342 : Burkitt lymphoma.
HPC:343 : Richter syndrome. Activation of a chronic lymphocytic leukemia.
HPC:344 : T-cell lymphoblastic lymphoma.
HPC:345 : Mantle cell lymphoma.
HPC:346 : Chronic lymphocytic leukemia.
HPC:347 : Pseudonodular lymphocytic lymphoma (chronic lymphocytic leukemia).
HPC:347 : Chronic lymphocytic leukemia in bone marrow.
HPC:349 : Sclerosing diffuse large B cell lymphoma of the mediastinum.
HPC:350 : Progressive transformation of germinal centers.
HPC:351 : Classical Hodgkin lymphoma, scleronodular type.
HPC:352 : Nodular lymphocyte predominant Hodgkin lymphoma.
HPC:353 : Nodal mantle cell B-cell lymphoma.
HPC:354 : Chronic lymphocytic lymphoma-like follicular lymphoma.
HPC:355 : Systemic non-Langerhans cell histiocytosis.