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case_images: Ultrasound imaging of multiple thyroid cancers (A, B tumor in the left lobe; C tumor in the isthmus, and D tumor in the right lobe; indicated by arrows).
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case_images: Thyroid ultrasound (US) revealed the presence of five hypoechoic nodules (two in the inferior pole of the left lobe, two in the middle pole of the right lobe, and one in the isthmus of the thyroid gland) with irregular margins, variable diameters (3-13 mm), and microcalcification (Figures 1A-D).
case_images: Ultrasound image of an enlarged inhomogeneous hypoechoic cervical lymph node with irregular morphology in level IV on the right side (indicated by arrows; plus sign indicates the measurement of lymph node size, which was 1.5 cm x 0.9 cm).
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case_images: The18-fluorodeoxyglucose positron emission tomography-computed tomography scan (FDG PET/CT) of the lung revealed multiple bilateral pulmonary hypermetabolic foci.
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case_images: The 18-fluorodeoxyglucose positron emission tomography-computed tomography scan (FDG PET/CT), which was performed for further evaluation, revealed multiple bilateral pulmonary hypermetabolic foci (Figure 3, maximum standard uptake value: 4.7) with indistinct borders and multiple bilateral hypermetabolic lymph nodes (maximum size: 24 mm, maximum standard uptake value up to 20) in the neck, bilateral axillae, and mediastinum (stations 2R, 3A, 4R/L, and 5-8); bone destruction with hypermetabolic foci was also observed in the sacrum, right scapula, vertebral arch of L2, and vertebral body of L4.
case_images: Pathological map of two metastatic tumor components. Thyroid cancer (delineated in yellow on the left and lower side) and lung cancer (delineated in red on the right and upper side) in an enlarged cervical lymph node (hematoxylin and eosin, x 200).
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case_images: IHC findings from the tissue obtained on biopsy of the right axillary lymph nodes were as follows: CK20 (-), CK5/6 (+), CK7 (+), napsin A (+), P63 (+), TIF-1 (+), 34BE12 (+), Ki67 (60%+), TG (-), CDX-2 (-), AB (+), and P40 (weakly +). In particular, components of both malignancies were detected simultaneously in one right-sided cervical lymph node (Figure 4).
case_images: PMC10801227_03