A 64 year old female presented with a small lump on the left
side of her neck that has been there for about a month. It has not been
increasing in size, was painless and there was no associated obstructive,
malignant or thyroid symptoms. She has a background history of transient
ischemic attack, hypothyroidisim for past 7 years and recently had a left
mastectomy and sentinel node biopsy, which turned out to be grade 2, estrogen
receptor positive and progesterone receptor negative invasive ductal
carcinoma pT2N0I+ (SN). She is still under follow up for it. She is a non-
smoker, drank alcohol sparingly and does not have any family history of CA. Her
medication comprises Eltroxin 100 mcg and Asprin 75 mg both taken once daily.
On examination, she was found to be euthyroid; however, she
had a firm, smooth surfaced oval nodule measuring about 2 cm by 5 cm. The lump
was non-tender with no associated skin changes. Although not attached to
overlying skin, it moved with swallowing but not on protrusion of the tongue.
There was also no evidence of retrosternal extension. All other systems were
essentially normal. Thyroid ultrasound
done showed two small nodules, one on each lobe of the thyroid. The left
measuring about 2 cm by 4 cm while the right one measured 2 cm in diameter. The
Isthmus was normal and the lesions were reported as benign looking.
However a fine needle biopsy done demonstrated pale,
enlarged cells with occasional spindled, nucleolated cells devoid of colloid
but with occasional grooves and possible pseudo inclusions on the left side. An
impression of possible neoplastic process of the Papillary CA variant was made.
On the right, there were several lymphoid follicles and Hurthle cells. In view
of the size of the nodule, and advice from the regional multidiciplinary team,
total thyroidectomy was performed.
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