Papillary thyroid carcinoma presenting as miliary nodules on chest roentgenogram in the paediatric setting: A case report
| Autor: | Nandi Viljoen, Alessandro Pietro Aldera, Eugenio Panieri, Marc Hendricks |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Tuberculosis endocrine system diseases Constitutional symptoms Article Thyroid carcinoma 03 medical and health sciences 0302 clinical medicine Cervical lymphadenopathy Biopsy medicine Adjuvant therapy Carcinoma Endocrine pathology medicine.diagnostic_test business.industry medicine.disease 030220 oncology & carcinogenesis Papillary thyroid carcinoma Lymphangitic carcinomatosis 030211 gastroenterology & hepatology Surgery Radiology Differential diagnosis medicine.symptom business |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| Popis: | Highlights • Papillary thyroid carcinoma (PTC) is the most common carcinoma encountered in the paediatric setting. • PTC often presents with advanced locoregional disease in children and pulmonary metastasis are seen in up to 46% of cases. • Miliary nodules on chest roentgenogram may be caused by miliary tuberculosis but other causes including metastatic carcinoma should be considered. Introduction Papillary thyroid carcinoma (PTC) is the most common carcinoma to occur in childhood with a peak incidence between 11–17 years, and typically presents with advanced locoregional disease. Pulmonary metastases are seen in up to 46% of cases and should enter the differential diagnosis of miliary nodules seen on chest roentgenogram, even in regions where tuberculosis is endemic. Presentation of case An 11-year-old male presented with a short history of cough, shortness of breath and constitutional symptoms. Examination revealed cervical lymphadenopathy and diffuse bilateral nodular infiltrates on the chest roentgenogram. Investigation for Mycobacterium tuberculosis was negative and this initiated biopsy of a cervical lymph node. Histopathological examination revealed metastatic PTC. Ultrasonography and magnetic resonance imaging (MRI) were performed for preoperative staging. The patient subsequently underwent total thyroidectomy with selective neck dissection. Discussion There are several potential causes when dealing with miliary nodules on chest roentgenogram. Thorough interrogation of the clinical, radiological, pathological and microbiological data is required to arrive at the correct diagnosis. Postoperative adjuvant therapy with radioactive iodine is recommended in children with metastatic disease, but this should be restricted preferably to a single dose to avoid the complication of pulmonary fibrosis. Conclusion This case highlights the differential diagnostic considerations of a patient presenting with constitutional symptoms and a miliary pattern on chest roentgenogram. Carcinomas are uncommon in children but should not be forgotten. |
| Databáze: | OpenAIRE |
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