CASE REPORT

Female patient aged 58 years with the main complaint of lumps in the neck and left
armpit. The patient also complained of shortness of breath during activities accompanied by
coughing and hoarseness. Neck lumps are on both sides (right and left) which are felt to be
getting bigger since 4 years ago. Currently the lump is the size of a tennis ball with a diameter of
7cm and 6cm with a dense consistency, the same skin color as its surroundings, warm touch,
fixed, moving along when swallowing. 4 months earlier the lump was only the size of a chicken
egg with a diameter of 2cm and 3cm.
The second lump was in the left armpit which was getting bigger since the previous 2
months. The lumps are 2 cm and 3 cm in size, solid, reddish in color, and fixed. about 2 weeks
earlier, the lump burst and caused sores with blood (+), fluid (+), pus (+), and foul smelling. The
patient received PTU therapy but there was no change. The results from the biopsy of a lump in
the neck showed papillary cancer of the thyroid.
To establish the diagnosis, several supporting examinations are carried out. A neck
biopsy revealed thyroid papillary cancer. The chest X-ray showed the impression of pneumonia
which could be a pneumonic type pulmonary metastase (Figure 3). Meanwhile, X-ray of the left
humerus region shows the conclusion that there is a soft tissue mass in the left axilla region
(Figure 4).
Ultrasound examinations are performed on the thyroid and abdomen to assess lesions and
tumor metastases. Thyroid ultrasound showed an impression of a bilateral thyroid mass
supporting the malignancy as well as a solid mass in the bilateral parotid and bilateral coli where
a metastatic mass is likely (Figure 5). Abdominal ultrasound showed the conclusion of the
absence of tumor metastases to the abdominal area (figure 6).
An MRI examination is performed to determine further metastases of this tumor. The
MRI results showed a bilateral malignant thyroid mass with expansion of the infraauricula, colli,
submandibular, supraclavicula, and bilateral infraclavicula, infiltrating m. Bilateral
sternoclaidomastoid, m. Sternohyoid, m. Sternothyroid, m. Spinalis cervicis, and m.
Multifundus. The mass narrows the airway as high as VC 6-7, VTh 8. There is no visible
intracerebral expansion of the mass and no metastasis to the cervical spine corpus (Figure 7). A
biopsy is performed on the neck and left axilla. The results of the left axilla biopsy showed
metastases of the papillary carcinoma of the thyroid gland (Figure 8).