Nakashima, Torahiko1 ; Yasumatsu, Ryuji2; Uryu, Hideoki1; Nakagawa, Takashi2
1 Department of Otorhinolaryngology, Clinical Research Institute, National Kyushu Medical Center
2 Department of Otorhinolaryngology, Graduate School for Medical Sciences, Kyushu University
Background: Vascular invasion is a histological characteristic of follicular carcinoma of the thyroid that can cause lung or bone metastasis. Massive angio-invasion causing tumor thrombus is rare, however, it can cause sudden death due to pulmonary embolism and the management requires exclusive care.
Objectives: To report our experience in the preoperative diagnosis and management of thyroid cancer accompanied with tumor thrombosis.
Methods: The clinical features of two thyroid cancer cases with major tumor thrombosis are presented. Preoperative evaluation and management are reviewed.
Results: Case 1: A case of a poorly differentiated follicular carcinoma of the thyroid with extensive invasion into the bilateral internal jugular veins, brachiocephalic vein and superior vena cava. Case 2: A case of a tall cell variant papillary carcinoma of the thyroid with invasion into the jugular vein and subclavian vein.
In both cases, preoperative enhanced CT and ultrasonography were useful for detecting tumor thrombi. Preparation had been made to place the patient on venous reconstruction using an autologous graft if necessary. The patients were successfully treated by surgical resection including removal of the tumor thrombus with venous repair without reconstruction.
Conclusion: Appropriate preoperative vascular imaging is important whenever angio-invasion is suspected. Enhanced CT and ultrasonography are useful. Literature review is also presented.