EP13 – A case of papillary cancer presenting as a very large cystic mass

      Bellabarba, Diego1; Belzile, Mathieu2, Temmar Rabia3 1 Division of Endocrinology, Faculty of Medicine, University of Sherbrooke,Sherbrooke, QC, Canada 2 Department of Otolaryngology – Head and Neck Surgery, University of Sherbroke, Sherbrooke, QC, Canada 3 Department of Pathology, University of Sherbrooke, Sherbrooke, QC, Canada   Background: Cystic papillary thyroid carcinoma are rare and they have some particular cell features. Case description: A 74 year-old woman consulted  because of a very large cervical mass occupying all the right side of the neck. Ultrasound showed a cystic mass in the right thyroid lobe of 4.8 x 6.2 x 3.8cm containing solid portions with microcalcifications. FNA detected follicular tall cells with cytoplasmic vacuoles, nuclear anomalies such inclusions, overlapping, and psammoma bodies, typical of a papillary carcinoma. Total thyroidectomy was recommended, but the patient preferred to wait. A year later a ultrasound showed a solid growth  in the lover part of the mass, but the patient still hesitated.  4 years later,   she came because the  mass had become enormous,extending from the sternum to the jaw. It measured 20 x10 cm with a  large nodule at inferior pole. 130ml of fluid were aspirated and the the FNA results were similar to previous one. Thyroidectomy was performed in two times since the removal of the mass required 3 hours due to its extensions. The mass weighted 292gr, contained a cystic portion of 12.5cm and a solid portion of 8cm. Histology confirmed the diagnosis of papillary carcinoma with the same cell features. There was also vascular invasion and extrathyroidal extension. Treatment was completed with 150 mCi of 131Il. Discussion and conclusion: We have presented a case of a cystic papillary thyroid cancer with rapid and aggressive evolution, formed by tall follicular cells with cytoplasmic vacuoles, which appear to be typical of these tumors


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