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First case of huge classic papillary thyroid cancer rupturing spontaneously leading to ischemic necrosis, perforation and inflammation of overlying skin: Case report and review of the literature
Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar ; College of Medicine, Qatar University, Doha, Qatar. (Medborgarcentrerad hälsa MeCH, Research on Citizen Centered Health, University of Skövde (Reacch US))ORCID iD: 0000-0003-0961-1302
Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
Department of Laboratory Medicine & Pathology, Hamad Medical Corporation, Doha, Qatar.
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2021 (English)In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 85, article id 106136Article in journal (Refereed) Published
Abstract [en]

Introduction: Papillary thyroid cancer (PTC) is the commonest form of well-differentiated endocrine carcinoma. It is categorized into indolent and aggressive, where the indolent subtypes (classic, follicular) rarely demonstrate aggressive behavior. We present a classic PTC presenting with a rapidly growing huge anterior neck mass that subsequently spontaneously ruptured subcutaneously resulting in ischemia, necrosis, and perforation of overlying skin leading to inflammation. Presentation of case: A 37-year-old female with no comorbidities presented to our emergency department with a neck swelling of 2 years duration that rapidly enlarged one week prior to presentation. Though the mass initially appeared of inflammatory nature, the tumor was a PTC, and she underwent total thyroidectomy with selective right side neck dissection and debridement of necrotic skin. The gross specimen revealed a fragmented non-intact right thyroid lobe mass causing pressure ischemia, necrosis and perforation of the skin. Histopathology showed a 9 × 9 × 5 cm classic PTC staged as pT3b N1b. Postoperative course was uneventful, she was discharged by the eighth postoperative day, and then she received a high dose of radioactive iodine ablation (RAI). Discussion: Classic PTC is usually of a smaller size and a relatively benign course compared to other PTC subtypes and thyroid cancers. It is indolent with favorable prognosis. Although it is associated with increased risk of lymph node metastases at the time of diagnosis, it is slow growing with high survival rates approaching 95%. Conclusion: Despite that classic PTC progresses slowly, it should still be suspected in neck swellings presenting with rapid and aggressive behavior. Prompt and systematic assessment is required with surgical intervention and radioactive iodine ablation therapy. 

Place, publisher, year, edition, pages
Elsevier, 2021. Vol. 85, article id 106136
Keywords [en]
Case report, Ischemic necrosis, Lymphocytic thyroiditis, Papillary thyroid cancer, Thyroid cancer
National Category
Cancer and Oncology Surgery
Research subject
Research on Citizen Centered Health, University of Skövde (Reacch US)
Identifiers
URN: urn:nbn:se:his:diva-20257DOI: 10.1016/j.ijscr.2021.106136ISI: 000685298900002PubMedID: 34274758Scopus ID: 2-s2.0-85110055357OAI: oai:DiVA.org:his-20257DiVA, id: diva2:1582606
Note

CC BY 4.0

Corresponding author: E-mail address: welansari9@gmail.com (W. El Ansari).

Available from: 2021-08-02 Created: 2021-08-02 Last updated: 2024-01-17Bibliographically approved

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El Ansari, Walid

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