Papillary Thyroid Carcinoma: Four Cases Required Caution during Long-Term Follow-Up
A 68-year-old female patient, who was diagnosed with PTC and underwent the total thyroidectomy 10 years prior, had a hypoechoic neck lymph node enlargement revealed on follow-up neck sonography (). We performed a fine needle aspiration biopsy of the enlarged lymph node, and the biopsy results showed recurrent metastatic PTC. We planned immediate surgical intervention, however, in the process of preparing for the surgery, the patient complained of a mild degree of dyspnea accompanied by chest pain on the right side. When chest X-rays were taken, we observed pleural thickening and pleural fluid on the right side. We performed a pleural biopsy, and biopsy findings indicated metastasis of PTC. Two days later, the patient's dyspnea was even more aggravated, and we noted compression of trachea caused by mediastinal lymph node enlargement and a rapid increase in the amount of pleural fluid on subsequent chest CT (). The patient died 3 weeks after the diagnosis of metastasis of PTC in spite of conservative palliative treatment. The cause of death was suggested to be the aggressive anaplastic change of PTC or aggressive malignancy of other organ including esophagus or lung.