We present a case report describing an unexpected anomaly encountered during a total thyroidectomy for a patient with papillary carcinoma of the left lobe of the thyroid with retrosternal extension. Intraoperatively, we discovered that the left lobe of the thyroid gland had extended posteriorly, invading the carotid space and displacing the carotid sheath anteriorly. The vagus nerve was identified as a cord-like structure abutting the anterior surface of the tumor, in close relation to the strap muscles. This case highlights the importance of careful dissection and identification of anatomical structures during thyroidectomy procedures to avoid inadvertent nerve injury. We discuss the significance of meticulous dissection-wide exposure and advocate for greater awareness and vigilance among surgeons.

Lipoid lesions of the thyroid gland are very rare. Fat-containing thyroid lesions include a variety of clinical-pathological disorders, such as adenolipomas, thyrolipomatosis, and lipomatous tissue, in the event of amyloidosis. Herein, we report a case of diffuse thyrolipomatosis with amyloidosis and incidentally detected papillary carcinoma of the thyroid in a 51-year-old female patient who clinically presented with a multinodular goiter. Amyloidosis in papillary carcinoma of the thyroid is very rare and can be primary or secondary amyloidosis. Thyrolipomatosis, amyloid goiter, and papillary carcinoma of the thyroid is a rare combination, and to our knowledge, this is the third reported case in the literature. The association of amyloidosis and the rare occurrence of a differentiated carcinoma have to be considered, as in the case of thyroid lipomatosis.

Posterior reversible encephalopathy syndrome (PRES) is an uncommon transient neuroradiological phenomenon that develops vasogenic cerebral edema and could be caused by some pharmacological agents, such as molecular-specific target agents. Lenvatinib belongs to the tyrosine kinase inhibitors and was approved in 2015 for progressive locally advanced or metastatic thyroid cancer refractory to radioactive iodine (I-131) treatment. Herein, we present the case of a 65-year-old woman who, while receiving treatment with lenvatinib for radioiodine-refractory metastatic papillary thyroid carcinoma, developed PRES without hypertension at the initial evaluation. Her clinical and radiological findings improved after withdrawing from the mentioned therapy, and later it was possible to re-incorporate lower doses of the medication, as described in the other three case reports found in the worldwide medical literature. The recognition of this entity is essential to timely suspend the drug and avoid greater comorbidity. This is the first paper reporting this kind of adverse event using lenvatinib in a Hispanic population.

Lateral aberrant thyroid(LAT) belongs to subset of ectopic thyroid, mostly presenting as asymptomatic lateral neck swelling and are challenging to diagnose without histopathological examination. Malignant transformation in LAT is even rare and is best managed by surgical excision. Here, we report a case of papillary carcinoma of LAT, but with an unusual post-operative finding, revealing papillary carcinoma of thyroglossal duct cyst.

Occurrences of lymphoma and differentiated thyroid cancer are rare. Usually, involvement of the thyroid gland is seen as a part of extranodal involvement or as a part of radiation-induced malignant transformation in previously treated lymphoma patients. The incidence of synchronous hematological malignancy with differentiated thyroid cancer is 7%. The synchronous occurrence of differentiated thyroid cancer and lymphoma poses a significant diagnostic and treatment dilemma. Here we report a case series of four patients with lymphoma and differentiated thyroid cancer. All four patients had lymphoma treated first followed by definitive management of thyroid malignancy.

Thyroid cancer has a good prognosis among all cancers, the disease being confined to the thyroid gland for a long time. Thyroid cancer with the direct invasion of internal jugular vein and SCM muscle is a rare condition. In carcinoma thyroid, extensive vascular invasion is considered as a risk factor for distant metastasis and early relapse. We report a case of carcinoma thyroid with internal jugular vein tumor thrombosis and sternocleidomastoid muscle invasion with review of literature.

131I is widely used for the treatment of goiter and residual and metastatic thyroid cancer. Uptake of 131I is mainly due to the expression of sodium-iodide symporter in the target tissues. Incidental third space accumulation in the pleural and pericardial cavity can be encountered due to passive diffusion of tracer into these cavities. We present an interesting finding of 131I accumulation in the scrotal hydrocele in a 70-year-old patient with a metastatic classical variant of papillary thyroid carcinoma, who was treated with 200 m Ci of 131I.

UNASSIGNED: Lymph node metastasis (LNM) is evident in about 20-50% of cases at presentation in papillary carcinoma thyroid (PTC). There are no clear recommendations for the need and extent of lateral and central compartment dissection in PTC.
UNASSIGNED: A total of 83 patients who underwent total thyroidectomy and bilateral selective neck dissection for diagnosed PTC from September 2011 to October 2017 were retrospectively analyzed.
UNASSIGNED: Tumor site was bilobar or involving isthmus in 40 patients. Contralateral LNM was seen in 42 patients. Both radiological (median size 2.6 cm, P = 0.051) and pathological (median size 3.65 cm, P = 0.015) size of tumor, tumor involving isthmus or bilateral lobes (P = 0.006), and lymphovascular invasion (LVI) (P = 0.026) had significant correlation with contralateral LNM.
UNASSIGNED: Size and site of tumor, ipsilateral lateral compartment nodes involvement, and LVI status of tumor significantly increases the probability of contralateral LNM in patients of PTC.

Papillary carcinoma of thyroid (PCT) commonly shows metastasis to central and lateral cervical compartment neck nodes. Submental nodes are rarely involved by PCT. Thus, its management is not clear. We report two young men who presented with submental nodal metastasis from PCT. Both underwent total thyroidectomy with central compartment neck dissection and modified radical neck dissection (MRND). Probable factors which might influence submental nodal metastasis are analyzed. We conclude that physicians should be aware of the possibility of submental nodal metastasis from PCT. A selective approach for neck dissection can be an alternative to MRND, reducing the morbidity in management of such cases.

BACKGROUND: Papillary carcinoma of thyroid (PTC) is usually indolent with good prognosis and excellent long-term survival. However, PTC sometimes presents itself in unusual situations, posing diagnostic and therapeutic challenges. Owing to paucity of data, there is lack of consensus as to what treatment should be prescribed in patients with loco-regional spread other than the usual sites.
METHODS: Six patients of PTC presenting with involvement of the aero-digestive tract, retropharyngeal, and para-pharyngeal lymph nodes and great vessels of the neck are included in this case series.
CONCLUSIONS: Though rare, unusual loco-regional presentation of PTC poses challenges in diagnosis and treatment. A keen clinical sense is paramount in effectively diagnosing these cases. Aggressive surgical resection and reconstruction results in good functional and aesthetic outcomes. Further studies are required for establishing specific guidelines on the approach to the treatment of these cases.