Endocrine Abstracts

A 24-year-old male presented with a gradually enlarging painless neck swelling. Noted to have a multiple nodules in thyroid consistent with multiple lymph nodes with enlarged cervical lymph nodes. Thyroid function noted to be normal. Tumor markers not done. Calcitonin normal. Ultrasonography and contrast-enhanced CT of the neck revealed a well-defined hypoechoic nodule in the left thyroid lobe with multiple cervical lymph nodes, classified as TIRADS-5. Fine-needle aspiration cytology suggested papillary thyroid carcinoma. The patient underwent total thyroidectomy with central neck dissection. Grossly, the left lobe measured 6 × 4.5 × 4 cm and showed a grey-brown friable nodule with papillary projections, while the right lobe appeared grossly unremarkable. Histopathological examination revealed papillary carcinoma, classic subtype, involving the left lobe with microscopic foci in the isthmus and right lobe. The tumor measured 5 × 3.5 × 4.2 cm, with lymphovascular invasion but no perineural invasion or tumor necrosis. Margins were close (<1 mm at multiple sites). Background lymphocytic thyroiditis and nodular goitre were present. A total of 15 lymph nodes were retrieved, 14 of which showed metastatic tumor deposits. The final pathological stage was pT3aN1Mx (AJCC 8th edition). This case highlights multifocal papillary thyroid carcinoma in a young adult with extensive lymph node metastases and lymphovascular invasion on a background of lymphocytic thyroiditis. Early recognition and surgical management with comprehensive histopathological evaluation are essential for prognosis and therapeutic planning.