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JAMA Oncology Clinical Challenge
June 2017

Rapidly Enlarging Thyroid Mass in a Patient With History of Multiple Cancers

Author Affiliations
  • 1Department of Endocrinology, Mayo Clinic, Jacksonville, Florida
  • 2Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida
JAMA Oncol. 2017;3(6):853-854. doi:10.1001/jamaoncol.2016.7084

A woman in her 30s noticed a painless left neck mass. She had no history of dysphagia, dyspnea, recent upper respiratory tract infection, injury, or surgery. She also had no weight loss, pain, or fever and had no history of tobacco or alcohol use, radiation exposure, family history of thyroid cancer, and no previous thyroid dysfunction. Thyroid function test results were normal. Physical examination revealed a palpable nontender, firm mass and no cervical lymphadenopathy. She had a medical history of high-grade osteosarcoma with areas of leimyosarcoma of the tibia which had been treated with right above-knee amputation and chemotherapy 4 years prior to presentation. She was followed up in the oncology clinic without any recurrence or metastases. Her last visit was 6 months earlier. She was also diagnosed with squamous cell carcinoma of the cervix 2 months earlier and was awaiting surgery. Computed tomography (CT) of the neck revealed a 6.0 × 3.4 × 4.4-cm calcified left thyroid lobe mass (Figure, A). Positron emission tomography–computed tomographic (PET-CT) imaging showed increased uptake in the left thyroid gland. She underwent a left thyroid lobectomy. The neoplastic cells were positive for p53, vimentin, and smooth muscle actin, and negative for S-100, thyroid transcription factor-1 (TTF-1), and CD34 (Figure, B).

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