To present a case of late recurrent papillary thyroid cancer.
Clinical and paraclinical data of the patient are presented.
This is a 75 year old male with history of papillary thyroid cancer, being followed in thyroid cancer survival clinic. He was diagnosed with thyroid cancer in 1993 after being found to have a right neck lesion on exam. This lesion was a lymph node positive for metastatic papillary thyroid cancer. He underwent total thyroidectomy and pathology was consistent with right sided sclerosing variant papillary thyroid cancer, measuring 0.5 cm, involving 4/5 lymph nodes. He received radioactive iodine treatment with 164 mCi. One year later, a whole-body scan showed right-sided thyroid bed uptake and he was retreated with 120 mCi radioactive iodine. In 1995, thyroid ultrasound showed persistent residual tissue in the right thyroid bed but thyroglobulin was undetectable. He underwent repeat whole-body scan in 1996 showing small focus of uptake in the right thyroid bed, total uptake 0.21%. In October 1999, a Thyrogen stimulated scan showed a small focus of uptake in the right thyroid bed, uptake 0.11%. Stimulated thyroglobulin was <0.5 ng/mL. Close follow up was recommended as he continued to have a thyroglobulin of <0.1 ng/mL. Follow up whole body scans and thyroid ultrasounds (2000-2014) failed to show any thyroid bed lesions or lymphadenopathy. He returned to our clinic in June 2018. Thyroid ultrasound identified an enlarged right supraclavicular lymph node and biopsy was positive for metastatic papillary thyroid cancer. Thyroglobulin was <0.1 ng/mL, thyroglobulin antibodies <1.8 IU/mL, TSH 1.92 mIU/mL and free T4 1.7 ng/dL. He underwent right selective neck dissection in August 2018. Pathology was positive for metastatic papillary thyroid carcinoma in 2/16 lymph nodes in the right supraclavicular region, with largest measuring 2.2 cm. Thyroid ultrasound done 2 months post surgery identifies no abnormalities.
Papillary thyroid cancer (PTC) makes up to 85% of all thyroid cancers. The numerous histopathologic variants of PTC include the conventional, follicular, tall cell, oncocytic, diffuse sclerosing variant, etc. Diffuse sclerosing variant is a rare and aggressive subtype of PTC with a prevalence of 0.7-6.6%. The recurrence rate is high within the first 5 years and is similar to the high risk PTC.
Our patient had recurrent thyroid cancer in the neck after 25 years from initial diagnosis. Recurrent thyroid cancer happens mostly within the first 5 years from diagnosis. As in this case, lifelong periodic follow up is warranted for patients with papillary thyroid cancer, especially the ones with more aggressive variants.
Majlinda Xhikola– Endocrinology Fellow, Mayo Clinic Florida, Jacksonville, Florida
Robert Smallridge– Deputy Director, Mayo Clinic Cancer Center, Mayo Clinic, Jacksonville, Florida
Majlinda Xhikola– Deputy Director, Mayo Clinic Cancer Center, Mayo Clinic, Jacksonville, Florida
Mayo Clinic Florida
My name is Majlinda Xhikola and I am the second year endocrinology fellow at Mayo Clinic Florida.
Deputy Director, Mayo Clinic Cancer Center
Military career(1973-1996): COLONEL (Ret.) US Army Medical Corps; Director, Walter Reed Army Institute of Research; Chair, Endocrine Division, Uniformed Services University of the Health Sciences; Consultant in Endocrinology to US Congress Mayo Clinic (1996-preaent)--Chair, Division of Endocrinology; Professor of Medicine; President, American Thyroid Association (2015)