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Weekly Chest CasesArchive of Old Cases

Case No : 1059 Date 2018-02-12

  • Courtesy of Kyung Eun Shin, MD, PhD. / Soonchunhyang University Bucheon Hospital
  • Age/Sex 87 / F
  • Chief ComplaintDyspnea
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Papillary thyroid cancer with tracheal invasion
Radiologic Findings
Fig 1. Chest PA image shows a lobulated contoured endotracheal mass in the upper trachea.
Fig 2-5. Enhanced chest CT scan show a heterogeneously enhancing lobulated mass in the anterior wall of the upper trachea connecting to a thyroid gland mass. The thyroid gland mass also shows heterogenous enhancement with focal calcification.
Brief Review
1~8% of PTC patients experience tumor invasion to the aerodigestive tract including the trachea, larynx, esophagus and the hypopharynx. Among them, the trachea is the most common site, with an incidence of 35~60% among PTC patients with tumor invasion, followed by the larynx and the esophagus.
Extrathyroidal extension in thyroid cancer represents a gradual mechanism of infiltration from the outer to the inner wall layers of the trachea. When pathologically reviewed, tumor infiltration can be noted to occur in the cartilaginous spaces rather than the cartilaginous ring. The PTC cells invade the laryngotracheal system by bluntly dissecting along blood vessels and collagen fibers oriented perpendicularly to the tracheal lumen in between cartilaginous rings.
With advancement in surgical techniques, radical surgery with extended tracheal resection and tracheal reconstruction can be the choice of treatment for advanced thyroid cancer.
References
1. Thyroid cancer with tracheal invasion: a pathologic estimation. Vincenzo P et al. Gand Surg 2016;5(5): 541-545
Keywords
Trachea, Thyroid, Neoplasm_Malignant,

No. of Applicants : 97

▶ Correct Answer : 50/97,  51.5%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan TOMOAKI OTANI
  • - Showa university Northern Yokohama Hospital , Japan KOTA WATANABE
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - , Korea (South) HANKYUL KIM
  • - McGill University Health Center , Canada Alexandre Semionov
  • - The University of Tokyo Hospital , Japan Yusuke Watanabe
  • - Kyeongpook National University Hospital , Korea (South) CHUNGEUN LIM
  • - Chonnam National University Hospital , Korea (South) MOON GYEONG IL
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - , India SANTOSH KUMAR PADHY
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - 罹…stanbul , Turkey AYHAN YILMAZ
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Qatif Central Hospital , Saudi Arabia Hani Makky Al Salam
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Ajou University Hospital , Korea (South) Taeyang Ha
  • - Yonsei University, Wonju Severance Christian Hospital , Korea (South) JUYEON LEE
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Gifu University Hospital , Japan Yo Kaneko
  • - VDC, HYDERABAD , India KARTHIK RAYASAM
  • - Okayama Red Cross Hospital , Japan KAZUAKI MUNETOMO
  • - Kurashiki Central Hospital , Japan TORU KONISHI
  • - , United Kingdom KRISHNA PRASAD PREMNATH BELLAM
  • - NTUH , Taiwan KUEI-PIN CHUNG
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - National Taiwan University Hospital Hsin-Chu Branch , Taiwan LI-TA KENG
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Other , Korea (South) HAYEON LEE
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - University of Florence , Italy MARIAELENA OCCHIPINTI
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Multimagem Diagn泥˜sticos , Brazil PEDRO PAULO TEIXEIRA E SILVA TORRES
  • - , India DHRUV UMESH SHARMA
  • - Sarawak General Hospital , Malaysia POHSEN TAY
  • - christian medical college , India Prateek Malik
  • - University of New South Wales , Australia RASHID HASHMI
  • - Escola Paulista de Medicina , Brazil RENATO MASSON DE ALMEIDA PRADO
  • - MBAL BURGAS , Bulgaria VLADISLAV BOYANOV RUSINOV
  • - , India SAHITHI REDDY IRALA
  • - Residente , Chile SEBASTIAN ANDRES VILLARREAL
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Private sector , Greece VASILIOS TZILAS
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 21/97,  21.6%
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - MD , India DEEPANDER SINGH RATHORE
  • - Asan Medical Center , Korea (South) HYUN JUNG KOO
  • - Freelance resident in Reunion Island , Reunion Fabien HO
  • - The Jikei university , Japan TAKU GOMI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - HHS , Canada S LEE
  • - Intermed Hospital , Mongolia KHULAN KHURELSUKH
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - , Korea (South) JANG SEONG WON
  • - The University of Tokyo Hospital , Japan TAKU TAJIMA
  • - Holy Family Hopsital , India RAJESH GOTHI
  • - District TB centre, kasaragod,India , India rikhy krishnan
  • - Universit , Italy ROBERTO CASTELLANA
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - Kaohsiung Veterans General Hospital , Taiwan MING-TING WU
  • - University of Utah , United States AKIHIKO SAKATA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
▶ Semi-Correct Answer : 5/97,  5.2%
  • - Azienda Ospedaliera Universitaria Integrata di Verona , Italy GIAN ALBERTO SOARDI
  • - Other , Korea (South) JIN YOUNG KIM
  • - CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
  • - Gachon University Gil Hospital , Korea (South) KIHYUN LEE
  • - , Korea (South) TAE SUN KANG
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