Head & Neck Case Review 2020-10

Head & Neck Case Review

October, 2020

History

A middle-aged man presented with a palpable neck mass and was found to have a complex 8.5 cm mass arising from the left thyroid lobe. He had no notable past medical history and no history of radiation exposure. The patient underwent hemithyroidectomy, with negative margins. Following resection, staging PET/CT/ultrasound did not demonstrate any other lesions.

Two months after hemithyroidectomy, the patient developed neck and supraclavicular swelling. PET/CT demonstrated a mass in the surgical bed extending into the mediastinum, as well as nodules in the contralateral platysma, sternocleidomastoid muscle, and supraclavicular region. A fine needle aspiration was performed of a palpable supraclavicular nodule. Images from the supraclavicular fine needle aspiration and thyroid resection are shown.

Images

Quiz

Q1. Which genetic alteration has been associated with this tumor?

  • A. BRAF V600E mutation
  • B. DICER1 mutation
  • C. RET-PTC3 fusion
  • D. Isochromosome 12p
  • E. PIK3CA mutation

Q2. Tumors occurring in infants and children generally have a favorable prognosis.

  • A. True
  • B. False

Diagnosis

Contributor

Margaret Compton, MD
Assistant Professor
Department of Pathology, Microbiology and Immunology
Vanderbilt University Medical Center, Nashville, TN

Head & Neck Case Review 2020-04

Head & Neck Case Review

April, 2020

History

A 19-year-old female presented with a rapidly enlarging 7.5 cm left-sided thyroid mass. Multiple, bilateral pulmonary nodules measuring up to 2 cm were present on CT scan, consistent with metastatic disease. She underwent total thyroidectomy and left neck dissection followed by radioactive iodine ablation. Images from the thyroid resection are shown below.

Images

Necrosis
Mitoses
TTF-1
Thyroglobulin
Calcitonin

Quiz

Q1. Which gene is most likely to harbor a mutation in this patient’s tumor?

  • A. BRAF
  • B. DICER1
  • C. RAS
  • D. TERT

Q2. The prognosis for this tumor type is better in young people than in older adults.

  • A. True
  • B. False

Diagnosis

Contributor

Rebecca Chernock, M.D.
Associate Professor
Department of Pathology and Immunology
Washington University in St. Louis

Head & Neck Case Review 2020-01

Head & Neck Case Review

January, 2020

History

A 74-year-old woman presented with respiratory failure. The patient had a 3-month history of cough and progressive dyspnea with rapidly increasing neck swelling. CT Imaging revealed massive thyromegaly and lymphadenopathy with metastases to the lung, liver, kidney, and iliac bone. Patient underwent thyroid surgical resection to relieve the airway compression. Gross examination of the thyroid showed diffuse replacement by multiple masses, the largest measuring 7.6 × 5.3 × 2.7 cm, with infiltrative borders and extension into surrounding adipose tissue. H&E slides and immunostains are shown.

Images

Virtual H&E slide

Quiz

Q1. What is the characteristic genetic alteration in this tumor?

  • A. t(12;15)(p13,q25) ETV6-NTRK3
  • B. t(2;22)(q33;q12) FEV-EWS
  • C. t(11;19)(q21;p13) CRTC1-MAML2
  • D. BRAF V600E mutation

Q2. Adjuvant therapy with radioactive iodine would be effective.

  • A. True
  • B. False

Diagnosis

Contributor

Mitra Mehrad, M.D.
Assistant Professor
Department of Pathology, Microbiology and Immunology
Vanderbilt University Medical Center, Nashville, TN