Dados do Trabalho

Título

Ultrasound evaluation of extra-thyroid extension of differentiated thyroid cancer

Descrição sucinta do(s) objetivo(s)

-To present, through a series of cases, the relationship between the involvement of the extrathyroidal compartments and tissues and the prognosis and treatment of the patient.

História clínica

Case 1: 76-year-old female. The right thyroid nodule (previously biopsy Besthesda VI) compromises the capsule in its right side appearance and also the esophageal tracheal juice. It is accompanied by thrombosis, probably tumoral, of the lower thyroid vein and some intra-thyroid branches, the thrombose extends to the chest, without apparent involvement of the brachiocephalic trunk.
Case 2: 48-year-old male. Ultrasound confirms the large neoplastic mass that almost completely replaced the thyroid that contacts strongly in the surrounding muscular plane, with some areas that are invaded especially in the central and left portion. Move right and compress strongly the carotid vessels. Towards the left side, it compresses and displaces the esophagus and the trachea, without a clear plane of clivage with these structures, and with likely extension to the trachea.
Case 3: 84-year-old female. Ultrasound and MRI of the neck showed a large solid mass that completely replaces the middle and upper third of the right thyroid lobe. This thyroid mass encompasses the carotid vessels, without a clear plan of clivage. Compromises and trombosis the inner jugular vein. It extends to the peritiroid muscle planes, reaching and compromising the sternocleidomastoid.

Discussão e diagnóstico

Thyroid staging is a tool for the pre-surgical staging of differentiated thyroid cancer. Knowing the plans and the cervical fascia will be useful to carry out a correct report of the study. According to the latest modification in the eighth edition of the AJCC/UICC TNM staging system, the classification T4b, involving invasion of the prevertebral fascia, the carotid artery or the mediastinic vessels, is a criterion of irresecability. In the series of cases presented, one of the cases had internal carotid artery compromise, so it was managed with palliative treatment.

Conclusões

Extracapsular vascular invasion is a good indicator for the evaluation of benign and malignant nodules. Using it as an indicator provides physicians with a potential tool for the prediction of ETE.

Palavras Chave

Extrathyroid extension (ETE); ultrasonography; thyroid carcinoma

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