J Korean Soc Radiol.  2017 Feb;76(2):138-141. 10.3348/jksr.2017.76.2.138.

Simultaneous Seeding of Follicular Thyroid Adenoma Both Around the Operative Bed and Along the Subcutaneous Tunnel of the Upper Chest Wall after Endoscopic Thyroidectomy

• Jung JS
• Kim SY
• Jung HY
• Han SW
• Lee JE
• Lee DY

• KMID: 2367861
• DOI: http://doi.org/10.3348/jksr.2017.76.2.138

Abstract

Endoscopic thyroidectomy is considered appropriate for follicular neoplasms, but on occasion, it leads to unexpected complications such as seeding along the port insertion site. Only 4 cases of operative track seeding after endoscopic thyroidectomy have been reported. Furthermore, simultaneous seeding at both operative track of upper chest wall and operative bed is also very rare. We present a case of thyroid follicular adenoma seeding at both the subcutaneous tunnel of the upper chest wall and the operative bed after endoscopic thyroidectomy, with an emphasis on magnetic resonance imaging and ultrasonography with pathologic correlations.

MeSH Terms

Adenoma
Magnetic Resonance Imaging
Neoplasm Seeding
Thoracic Wall*
Thorax*
Thyroid Gland*
Thyroid Neoplasms*
Thyroidectomy*
Ultrasonography

Figure

• 

  Fig. 1 Simultaneous seeding of follicular thyroid adenoma around both the operative bed and along the subcutaneous tunnel of the upper chest wall after endoscopic thyroidectomy in a 14-year-old female. Preoperative US shows a 3.8 cm sized, smooth, oval, heterogeneous, hypoechoic mass in the left thyroid bed (A). Postoperative follow-up, transverse, US images show an approximately 1.9 cm sized, circumscribed, oval hypoechoic nodule along the right upper chest wall close to the right clavicle and along the subcutaneous tract of the prior endoscopic thyroidectomy (B), and about 1.1 cm sized, smooth, oval, heterogeneous, isoechoic nodule in the left operative bed (C). Post-gadolinium enhanced axial MRI images (D-F) show variable-sized, well-enhancing masses in the left thyroid operative bed (arrow on D), in the right infraclavicular area (arrows on E), and in the subcutaneous layer of the right upper chest wall (arrow on F). Schematic illustration shows seeded nodules in the operative bed and along the subcutaneous tunnel of the upper chest wall (G). Microscopic examination of the mass resected from the upper chest wall shows a well-encapsulated nodular lesion (× 20) (H). Higher magnification shows that the tumor cells form microfollicles and are without nuclear atypia (× 40) (I). MRI = magnetic resonance imaging, US = ultrasonography

Reference

1. Beninato T, Kleiman DA, Scognamiglio T, Fahey TJ, Zarnegar R. Tract recurrence of a follicular thyroid neoplasm following transaxillary endoscopic thyroidectomy. Thyroid. 2012; 22:214–217.

2. McHenry CR, Phitayakorn R. Follicular adenoma and carcinoma of the thyroid gland. Oncologist. 2011; 16:585–593.

3. Kim JH, Choi YJ, Kim JA, Gil WH, Nam SJ, Oh YL, et al. Thyroid cancer that developed around the operative bed and subcutaneous tunnel after endoscopic thyroidectomy via a breast approach. Surg Laparosc Endosc Percutan Tech. 2008; 18:197–201.

4. Shimazu K, Shiba E, Tamaki Y, Takiguchi S, Taniguchi E, Ohashi S, et al. Endoscopic thyroid surgery through the axillo-bilateral-breast approach. Surg Laparosc Endosc Percutan Tech. 2003; 13:196–201.

5. Choe JH, Kim SW, Chung KW, Park KS, Han W, Noh DY, et al. Endoscopic thyroidectomy using a new bilateral axillo-breast approach. World J Surg. 2007; 31:601–606.

6. Hur SM, Kim SH, Lee SK, Kim WW, Choi JH, Kim JH, et al. Is a thyroid follicular neoplasm a good indication for endoscopic surgery? Surg Laparosc Endosc Percutan Tech. 2011; 21:e148–e151.

7. Keiko K, Hiroshi N, Kazushige F, Masato O, Michiko H, Toshio O, et al. A case of port-site implantation in the breast after endoscopic thyroid surgery. J Japan Surgl Assoc. 2010; 71:25–30.