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Thursday, 9 November 2017

CASE 460: THYROID CALCIFIED TUMOR , Dr PHAN THANH HẢI, Dr LÊ THANH LIÊM, Dr DƯƠNG NGỌC THÀNH, MEDIC MEDICAL CENTER, HCMC, VIETNAM



Man 52 yo, voice tone changes for  2 months, and  ENT doctor said vocal paralysis by endoscopy.
Ultrasound of the neck    
US1  left thyroid lobe normal

US2  right  lobe   covered by a big mass  4 cm  with strong  posterior shadowing  cannot see structure inside.


US3  near R/ CCA  small nodes with calcification #1cm.


US4  with convex probe ultrasound cannot se intra tumor by very strong calcification.


MTSC  non CE   


CT1: cross- section of the neck = mass is  very high calcification 

CT2 : cross- section=  calcification some lymph nodes near R/  CCA.


CT3 : frontal view  with CE=HU of this mass is  1,319 UI



CT4:   lymph node also has HU  1326UI.


CT5:  sagittal view   this mass  is  covered near the righ lobe of thyroid gland.


Blood test   TSH  is  0,041  T4  1,2   TG  97,42 (  n 3, 5-77)

 Pre-op diagnosis is thyroid cancer  metastasis neck lymph nodes.
OPERATION REMOVED RIGHT THYROID GLAND AND LYMPHADENECTOMY.

SEE  SPECEMEN 
 FOTO1    FOTO2  THYROID TUMOR CALCIFICATION



 FOTO3  LYMPH NODE



 For this case  clinical  ultrasound and CT , blood tests suggested   thyroid carcinoma   but report  of FNA  cytology is negative.

CALCITONINE = 2PG/ML   (M <18.2PG/ML)..RULES OUT MTC ( MEDULLARY THYROID CARCINOMA)
MICROSCOPIC REPORT OF SURGICAL SPECIMEN IS PAPILLARY CARCINOMA ( PTC)  METASTASIS TO SOME LYMPH NODES.


SUMMARY = PTC  WITH  HUGE CALCIFICATION  UNKNOWN.

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