case_images: PMC5817257_01
case_images: (a) B Ultrasound. Blue arrow for the low echo tubercle in the thyroid isthmus. (b) CT Scan. Yellow arrow for thyroid multiple lower density nodule; blue arrow for calcification. (c) FNA. Red arrow for cell nucleus ditch.
case_images: CRIE2018-7618456.001.jpg
case_images: PMC5817257_01_CRIE2018-7618456.001.jpg
case_images: fig1
case_images: Multiple dot-like calcification and blood flow signals could be observed (Figure 1(a)). Multiple nodular shadows of lower density could be observed in thyroid and some were calcified with a larger one located in isthmus, about 17 x 10 mm, and the rest were normal (Figure 1(b)). Cell nucleus ditches could be observed (Figure 1(c)).
case_images: (a) Intraoperative frozen pathology of right thyroid lobe: red arrow for psammoma body. (b) Intraoperative frozen pathology of thyroid isthmus: red arrow for heterocyst; blue arrow for psammoma body; green arrow for papillary structure. (c) Intraoperative frozen pathology of left thyroid lobe: red arrow for psammoma body.
case_images: CRIE2018-7618456.002.jpg
case_images: PMC5817257_01_CRIE2018-7618456.002.jpg
case_images: fig2
case_images: However, the intraoperative frozen section not only confirmed the preoperative diagnosis of PTC on the thyroid isthmus, in which disordered and branched papillary structure, scattered psammoma bodies, frosted-glass-like cell nucleus, larger nucleus, nucleus grooves, and intranuclear pseudoinclusions were found (Figure 2(b)), but also showed multifocal papillary thyroid carcinoma (MPTC) in right thyroid lobe as multiple psammoma bodies and papillary structure could be found in it (Figure 2(a)). Multiple psammoma bodies and heterotypic cells were also found in left thyroid lobe on intraoperative frozen section (Figure 2(c)).
case_images: Red triangle for large carcinoma lesions at the lower right corner; red arrow for small lesions composed of dozens of heterocyst reunion on the left side.
case_images: CRIE2018-7618456.003.jpg
case_images: PMC5817257_01_CRIE2018-7618456.003.jpg
case_images: fig3
case_images: Postoperative pathology showed that micropapillary carcinomas scattered around a major thyroid carcinoma (22 x 11 x 20 mm) in thyroid isthmus, and scattered micropapillary carcinoma also existed on both thyroid right lobe and left lobe (Figures 3-5). A larger carcinoma lesion (lower and right corner) with some small lesions composed of tens of heterocysts (upper-left section) can be observed in Figure 3.
case_images: Red triangle for large carcinoma lesions; yellow arrow for tracer dye black lymphatic vessels.
case_images: CRIE2018-7618456.004.jpg
case_images: PMC5817257_01_CRIE2018-7618456.004.jpg
case_images: fig4
case_images: Postoperative pathology showed that micropapillary carcinomas scattered around a major thyroid carcinoma (22 x 11 x 20 mm) in thyroid isthmus, and scattered micropapillary carcinoma also existed on both thyroid right lobe and left lobe (Figures 3-5). A spread lesion in the lymph-vessel blackened by nanometer carbon tracer and blackened lymph-vessels in the lesion were showed in Figure 4.
case_images: (a) Pathology section of right thyroid lobe: red arrow for psammoma body. (b) Pathology section of thyroid isthmus: red triangle for large carcinoma lesions; red arrow for small lesions composed of dozens of heterocyst. (c) Pathology section of left thyroid lobe: red arrow for psammoma body.
case_images: CRIE2018-7618456.005.jpg
case_images: PMC5817257_01_CRIE2018-7618456.005.jpg
case_images: fig5
case_images: Postoperative pathology showed that micropapillary carcinomas scattered around a major thyroid carcinoma (22 x 11 x 20 mm) in thyroid isthmus, and scattered micropapillary carcinoma also existed on both thyroid right lobe and left lobe (Figures 3-5). The number of satellite lesions in the right lobe is more than that in left lobe (Figure 5).