Case Report

Insular Thyroid Microcarcinoma with Precedent Adenopathy – Peculiar Subset of Malignant Tumor

Mihai Radu Diaconescu, Mihai Glod, Mirela Grigorovici and Smaranda Diaconescu
World Journal of Medical and Surgical Case Reports 2013, 2:4

Abstract

Background

A case report of a patient with insular thyroid carcinoma, a poorly differentiated subtype of thyroid tumor with intermediate aggressiveness and prognosis between well-differentiated and anaplastic thyroid malignant lesions is presented.

Case Report

A 59 year old man with an apparent isolated huge lateral cervical adenopathy was directed to our clinic. The thyroid and other cervical structures were clinically inapparent and also could not be identified by imaging methods. Fine-needle aspiration biopsy showed aggregates of small, monomorphic cells with scant cytoplasm, round nuclei with granular chromatin and rare mitosis oriented the diagnosis towards a follicular thyroid carcinoma metastasis.

While intraoperatively completing the selective cervical dissection, a solitary centrolobar micronodule (5 mm) was identified and a total thyroidectomy was done. Microscopy showed neoplastic cells arranged in nests (insulae) separated by hyaline stroma, with grooved nuclei, rare mitosis and necrotic areas diagnostic for insular carcinoma. Complementary radioiodine therapy allowed a stable cure at 36 months follow-up.

Discussion

Appearance of these tumors with rapid evolution in which only precocious diagnosis (although not always possible) orienting the patient towards radical surgery completed by 131 I therapy, both assuring in 1/3 of cases a real chance of cure, to the poorly differentiated thyroid carcinomas is underlined.

Conclusion

Together with the rarity of this subtype of thyroid neoplasia, must be mentioned the precedency of the cervical adenopathy to the primary subclinical microcarcinoma and also the efficacy of the association between radical surgery with 131 I radiation.

Key Words

Insular thyroid microcarcinoma, fine needle-biopsy, prognosis, total thyroidectomy.

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