Answer for BIR CoW 07 Jan 2024
Papillary carcinoma of Thyroid
Findings
CECT neck :3.5 cm x2.8 cm x 4.6 cm relatively well defined heterogenously enhancing heterodense lesion with multiple fine punctate intralesional calcifications noted involving the right lobe of the thyroid with multiple heterogenously enhancing cervical lymph nodes in bilateral level II , III ,IV and V ,largest measuring 4.5cmx 3.5cm in right level V. USG neck: Fairly defined predominantly solid anti parallel oriented hypoechoic lesion with multiple punctate calcifications showing mixed vascularity involving right lobe of thyroid and Multiple enlarged hypoechoic bilateral level III ,IV and V nodes with internal cystic changes- TIRADS SCORE 5
Discussion
Papillary carcinoma is the most common type of thyroid cancer. Most common in females. most indolent course,90% 10 year survival.it is associated with risk factors such as exposure to ionizing radiation, especially childhood head and neck irradiation, family history of thyroid cancer.it is Characterized by microcalcifications, multifocality and nodal metastasis. Thyroglobulin is a tumor marker. Imaging findings:90% of them are hypoechoic and rarely of mixed or isoechoic echotexture.Fine, punctate, intralesional microcalcifications (Psammomatous) are considered characteristic of papillary carcinomas. .Papillary carcinoma has the highest incidence of all the thyroid malignancies for cervical lymph node spread, seen in up to 50% of cases .Regional nodal metastasis from thyroid cancer occur in the lateral cervical lymph chains (levels III-V) and central compartment (level VI) in the majority of cases. Cystic papillary carcinoma, a rare variant consists of a predominantly cystic lesion associated with protruding, mural, solid, hypervascular tissue (excrescences) and microcalcifications. Follicular variant of papillary thyroid carcinoma (FVPTC) is the second most common variant of thyroid carcinoma . FVPTC have been reported to have a lower incidence of lymph node metastasis and capsular invasion as well as higher rates of lung and bone metastasis as compared to conventional PTC. They are usually solitary and slightly more aggressive than papillary carcinomas if vascular invasion is present
Findings
CECT neck :3.5 cm x2.8 cm x 4.6 cm relatively well defined heterogenously enhancing heterodense lesion with multiple fine punctate intralesional calcifications noted involving the right lobe of the thyroid with multiple heterogenously enhancing cervical lymph nodes in bilateral level II , III ,IV and V ,largest measuring 4.5cmx 3.5cm in right level V. USG neck: Fairly defined predominantly solid anti parallel oriented hypoechoic lesion with multiple punctate calcifications showing mixed vascularity involving right lobe of thyroid and Multiple enlarged hypoechoic bilateral level III ,IV and V nodes with internal cystic changes- TIRADS SCORE 5
Discussion
Papillary carcinoma is the most common type of thyroid cancer. Most common in females. most indolent course,90% 10 year survival.it is associated with risk factors such as exposure to ionizing radiation, especially childhood head and neck irradiation, family history of thyroid cancer.it is Characterized by microcalcifications, multifocality and nodal metastasis. Thyroglobulin is a tumor marker. Imaging findings:90% of them are hypoechoic and rarely of mixed or isoechoic echotexture.Fine, punctate, intralesional microcalcifications (Psammomatous) are considered characteristic of papillary carcinomas. .Papillary carcinoma has the highest incidence of all the thyroid malignancies for cervical lymph node spread, seen in up to 50% of cases .Regional nodal metastasis from thyroid cancer occur in the lateral cervical lymph chains (levels III-V) and central compartment (level VI) in the majority of cases. Cystic papillary carcinoma, a rare variant consists of a predominantly cystic lesion associated with protruding, mural, solid, hypervascular tissue (excrescences) and microcalcifications. Follicular variant of papillary thyroid carcinoma (FVPTC) is the second most common variant of thyroid carcinoma . FVPTC have been reported to have a lower incidence of lymph node metastasis and capsular invasion as well as higher rates of lung and bone metastasis as compared to conventional PTC. They are usually solitary and slightly more aggressive than papillary carcinomas if vascular invasion is present
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!