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A Rare Presentation of Autonomously Functioning Papillary Thyroid Cancer: Malignancy in Marine-Lenhart Syndrome Nodule.
Case Rep Surg. 2016; 2016:8740405.CR

Abstract

Objective.

Marine-Lenhart Syndrome (MLS) is defined as concomitant occurrence of autonomously functioning thyroid nodule (AFTN) with Graves' disease (GD). Malignancy in a functional nodule is rare. We aimed to present an extremely rare case of papillary thyroid cancer in a MLS nodule with lateral lymph node metastases. Case. A 43-year-old male presented with hyperthyroidism and Graves' ophthalmopathy. On Tc99m pertechnetate scintigraphy, a hyperactive nodule in the left upper thyroid pole was detected and the remaining tissue showed a mildly increased uptake. The ultrasonography demonstrated 15.5 × 13.5 × 12 mm sized hypoechoic nodule in the left upper pole of the thyroid and round lymph nodes on the left side of the neck. Fine needle aspiration biopsy (FNAB) of the nodule and lymph node revealed cytological findings consistent with papillary cancer. Total thyroidectomy with central and left modified radical neck dissection was performed. On pathologic examination, two foci of micropapillary cancer were detected. The skip metastases were present in three lymph nodes on the neck.

Conclusion.

AFTN can be seen rarely in association with GD. It is not possible to exclude malignancy due to the clinical and imaging findings. In the presence of suspicious clinical and sonographic features, FNAB should be performed.

Authors+Show Affiliations

Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey.Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey.Department of Radiology, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey.Department of Endocrinology and Metabolism, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey.Department of Radiology, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey.Department of Pathology, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey.Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey.Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey.Department of General Surgery, Bahcesehir University Medical Faculty, 34353 Istanbul, Turkey.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27110424

Citation

Uludag, Mehmet, et al. "A Rare Presentation of Autonomously Functioning Papillary Thyroid Cancer: Malignancy in Marine-Lenhart Syndrome Nodule." Case Reports in Surgery, vol. 2016, 2016, p. 8740405.
Uludag M, Aygun N, Ozel A, et al. A Rare Presentation of Autonomously Functioning Papillary Thyroid Cancer: Malignancy in Marine-Lenhart Syndrome Nodule. Case Rep Surg. 2016;2016:8740405.
Uludag, M., Aygun, N., Ozel, A., Yener Ozturk, F., Karasu, R., Ozguven, B. Y., Citgez, B., Mihmanli, M., & Isgor, A. (2016). A Rare Presentation of Autonomously Functioning Papillary Thyroid Cancer: Malignancy in Marine-Lenhart Syndrome Nodule. Case Reports in Surgery, 2016, 8740405. https://doi.org/10.1155/2016/8740405
Uludag M, et al. A Rare Presentation of Autonomously Functioning Papillary Thyroid Cancer: Malignancy in Marine-Lenhart Syndrome Nodule. Case Rep Surg. 2016;2016:8740405. PubMed PMID: 27110424.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Rare Presentation of Autonomously Functioning Papillary Thyroid Cancer: Malignancy in Marine-Lenhart Syndrome Nodule. AU - Uludag,Mehmet, AU - Aygun,Nurcihan, AU - Ozel,Alper, AU - Yener Ozturk,Feyza, AU - Karasu,Rabia, AU - Ozguven,Banu Yilmaz, AU - Citgez,Bulent, AU - Mihmanli,Mehmet, AU - Isgor,Adnan, Y1 - 2016/03/27/ PY - 2015/12/07/received PY - 2016/03/13/accepted PY - 2016/4/26/entrez PY - 2016/4/26/pubmed PY - 2016/4/26/medline SP - 8740405 EP - 8740405 JF - Case reports in surgery JO - Case Rep Surg VL - 2016 N2 - Objective. Marine-Lenhart Syndrome (MLS) is defined as concomitant occurrence of autonomously functioning thyroid nodule (AFTN) with Graves' disease (GD). Malignancy in a functional nodule is rare. We aimed to present an extremely rare case of papillary thyroid cancer in a MLS nodule with lateral lymph node metastases. Case. A 43-year-old male presented with hyperthyroidism and Graves' ophthalmopathy. On Tc99m pertechnetate scintigraphy, a hyperactive nodule in the left upper thyroid pole was detected and the remaining tissue showed a mildly increased uptake. The ultrasonography demonstrated 15.5 × 13.5 × 12 mm sized hypoechoic nodule in the left upper pole of the thyroid and round lymph nodes on the left side of the neck. Fine needle aspiration biopsy (FNAB) of the nodule and lymph node revealed cytological findings consistent with papillary cancer. Total thyroidectomy with central and left modified radical neck dissection was performed. On pathologic examination, two foci of micropapillary cancer were detected. The skip metastases were present in three lymph nodes on the neck. Conclusion. AFTN can be seen rarely in association with GD. It is not possible to exclude malignancy due to the clinical and imaging findings. In the presence of suspicious clinical and sonographic features, FNAB should be performed. SN - 2090-6900 UR - https://www.unboundmedicine.com/medline/citation/27110424/A_Rare_Presentation_of_Autonomously_Functioning_Papillary_Thyroid_Cancer:_Malignancy_in_Marine_Lenhart_Syndrome_Nodule_ L2 - https://dx.doi.org/10.1155/2016/8740405 DB - PRIME DP - Unbound Medicine ER -
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