ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2008) 16 P714

Giant subcutaneous hemorrhage mimicking anaplastic thyroid carcinoma

Igor Tauveron1, Marie Batisse1, Frederic Somda1, Pascal Chabrot2, Eugenio Rosset3, Philippe Thieblot1, Jean-Louis Kemeny4 & Louis Boyer2

1Endocrinologie CHU, Clermont-Ferrand, France; 2Imagerie Medicale CHU, Clermont-Ferrand, France; 3Chirurgie Vasculaire CHU, Clermont-Ferrand, France; 4Anatomie Pathologique CHU, Clermont-Ferrand, France.

A 63-year-old woman was referred by her cardiologist because of rapid growth of an anterior cervical mass. The patient had a history of severe vascular atherosclerotic disease, requiring multiple prosthetic vascular surgery, among which thoracic aorta surgery, atrial fibrillation requiring coumadin and chronic respiratory failure. On admission, the patient presented with a 7 cm firm mass, regularly growing for 2 months, adherent to the cervical skin, highly suggestive of thyroid anaplastic carcinoma. Immediately performed, a CT scan demonstrated an anterior cervical lesion, possibly related to an old hematoma. Fine needle biopsy aspiration revealed after thin prep filtration inflammatory cells (macrophages, neutrophil leukocytes and lymphocytes), but no tumor cell. Needle evacuation was poorly successful, and further, regular follow up was decided. No change in the cervical mass volume was observed.

Discussion: A firm rapidly and regularly growing anterior cervical swelling is highly suggestive of anaplastic thyroid carcinoma. Lymphomas and Riedel’s thyroiditis may also be evoked. By contrast, intrathyroidal hemorrhage is usually acute and painful. Hematomas of the thyroid region (except after thyroidectomy) are rather unusual. In our case, it was induced by venous flow changes as a consequence of surgical ligation of left innominate vein following aortic replacement, leading to highly increased subcutaneous straining of turgescent collateral veins. Blood leakage was probably enhanced by antivitamin K treatment (especially when irregularly controlled and excessive) and an initial muscular effort (carrying a sofa).

Conclusion: Regularly growing cervical hematomas may occur months after aortic surgery, due to venous straining rearrangement and enhanced by anticoagulation, and therefore clinically mimic anaplastic thyroid carcinoma.

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