J Korean Thyroid Assoc.  2015 May;8(1):103-107. 10.11106/cet.2015.8.1.103.

Poorly Differentiated Thyroid Carcinoma with Gross Internal Jugular Vein Invasion and Multiple Lung Metastases

  • 1Department of Pathology, Chungbuk National University College of Medicine, Cheongju, Korea.
  • 2Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea. bksgs@yonsei.ac.kr
  • 3Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea.


A rare case of poorly differentiated thyroid carcinoma (PDTC) with gross intraluminal invasion to the internal jugular vein whose clinical manifestation was multiple lung metastases is described. A 66-year-old man was referred to the outpatient clinic of the Department of Internal Medicine, hemato-oncology subdivision for multiple lung nodules found by his regular health check-up. These lung nodules showed variable sizes with irregular shapes, and typical distributions throughout the parenchyma, which were consistent with metastatic nodules. Ultrasonography revealed a 4.5 cm sized hypoechoic mass with irregular shape in his left thyroid lobe and a huge thrombus in the left internal jugular vein. PDTCs associated with gross intraluminal invasion to the great cervical vein and multiple lung nodules as their first clinical manifestation are extremely rare. We would emphasize the importance of preoperative detailed evaluation of the disseminated disease by ultrasonography in suspected patients.


Poorly differentiated thyroid carcinoma; Internal jugular vein; Lung; Invasion; Metastasis

MeSH Terms

Ambulatory Care Facilities
Internal Medicine
Jugular Veins*
Neoplasm Metastasis*
Thyroid Gland
Thyroid Neoplasms*


  • Fig. 1. Radiologic evaluations. Multiple small nodules (arrows) were found in lung parenchyma, which showed irregular shape, but well-defined border on simple chest X-ray (A) and chest CT scan (B). (C) Ultrasonography of transverse section of the left internal jugular vein. A solid tumor thrombus (arrow) in the lumen are shown. (D) With color Doppler ultrasonography of a transverse section applied, Doppler signal of moving blood flow can be observed around the tumor thrombus (arrow) in the lumen of the left internal jugular vein.

  • Fig. 2. Intraoperative and microscopic features. (A) A gross intraluminal tumor thrombus (arrow) are shown with hard and whitish tumor mass in the left thyroid lobe. (B) After dissection, tumor thrombus (arrow) are clearly found in the lumen of left internal jugular vein. (C) The tumor has an insular pattern of growth with absence of conventional nuclear features of papillary carcinoma. Atypical mitoses (up to 4/10 HPF, arrow) and (D) microscopic vascular invasion are detected (x400).



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