case_images: PMC6896907_01
case_images: Axial view of CT scans of the neck showing regression of the primary lesion and metastatic lymph node. (A) Before treatment, there was a 7.6 x 4.2 cm mass in the thyroid, (B) Before treatment, there was a 1.3 x 1.1 cm left lateral neck metastatic lymph node (arrow), (C) Thirty weeks after treatment, the mass shrank to 6.1 x 3.0 cm, demonstrating a 19.7% decrease in the longest diameter of the lesion, (D) Thirty weeks after treatment, the metastatic lymph node was 0.9 x 0.7 cm in size (arrow).
case_images: OTT-12-10495-g0001.jpg
case_images: PMC6896907_01_OTT-12-10495-g0001.jpg
case_images: F0001
case_images: Baseline computed tomography images showed a 7.6 x 4.2 cm thyroid mass involving the trachea (Figure 1). The therapeutic response sustained more than 30 weeks when cervical CT illuminated a stable disease with a best response of 19.7% of baseline in the longest diameter of the primary lesion and shrinkage of metastatic lymph node according to Response Evaluation Criteria in Solid Tumors version 1.1 (Figure 1).
case_images: Pathological findings of ultrasound-guided core-needle puncture tissue. (A) Hematoxylin and eosin staining (x200). The tumor cells lack conventional papillary thyroid carcinoma nuclei and nested or papillary growth pattern, (B) Immunohistochemical staining for VEGFR-2 (x200). Brown color indicates the presence of VEGFR-2, which is observed not only in blood vessels (arrows) but also in the cytoplasm of the cancer cells.
case_images: OTT-12-10495-g0002.jpg
case_images: PMC6896907_01_OTT-12-10495-g0002.jpg
case_images: F0002
case_images: Thyroglobulin, Thyroid Transcription Factor-1, Cytokeratin (CK) 19, CK 20 and Villin, but positive for CKpan, Vimentin, CK 7, Ki 67 (60% +), which revealed the diagnosis of ATC with positive expression of VEGFR-2 (Figure 2; rabbit polyclonal antibody, 1:100 dilution; ZSGB-BIO, China). The staging was performed with a positron emission tomography/CT fusion image showing the hypermetabolic thyroid mass and a left lateral neck lymph node metastasis (Figure 3).
case_images: 18F-Fluorodeoxyglucose PET/CT showing a thyroid mass with SUVmax of 17.8 and a metastatic lymph node in the left neck with SUVmax of 8.6. Non-specific inflammation of the small mediastinal lymph nodes, physiological uptake in the heart, liver, and spleen, and radioactive excretion through the intestine and kidneys were verified. (A) Maximum intensity projection of PET, (B) Fusion of PET/CT image of the thyroid lesion; (C) Fusion of PET/CT image of the nodal metastasis.
case_images: OTT-12-10495-g0003.jpg
case_images: PMC6896907_01_OTT-12-10495-g0003.jpg
case_images: F0003
case_images: Thyroglobulin, Thyroid Transcription Factor-1, Cytokeratin (CK) 19, CK 20 and Villin, but positive for CKpan, Vimentin, CK 7, Ki 67 (60% +), which revealed the diagnosis of ATC with positive expression of VEGFR-2 (Figure 2; rabbit polyclonal antibody, 1:100 dilution; ZSGB-BIO, China). The staging was performed with a positron emission tomography/CT fusion image showing the hypermetabolic thyroid mass and a left lateral neck lymph node metastasis (Figure 3).
case_images: Photographs of the patient's left neck demonstrating obvious shrinkage of the thyroid mass. (A) Photograph before treatment, showing a large left-sided neck mass, (B) Four weeks after the treatment, the mass shrank notably, (C) Thirty weeks after the treatment, the mass seemed to shrink a bit more.
case_images: OTT-12-10495-g0004.jpg
case_images: PMC6896907_01_OTT-12-10495-g0004.jpg
case_images: F0004
case_images: The mass shrank notably 4 weeks after the initiation of therapy (Figure 4).