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Thyroid/parathyroid » General
Papillary carcinoma of the thyroid
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Presentation A 57 year old woman with left thyroid lobe enlargement. An ultrasound of the neck was performed.
Caption: Sagittal image of the left thyroid lobe
Description: Two nodules are seen. The larger one in the mid-pole shows peripheral dense calcification causing near-complete shadowing. The nodule in the upper lobe exhibits clumps of calcification within a poorly marginated lesion.
Caption: Transverse view of the left upper pole of thyroid
Description: The lesion margins and calcifications within the upper nodule are better seen in this view using a proprietary image enhancement scheme.
Caption: Sagittal color Doppler image
Description: There appears to be marginal increase in the peripheral vascularity of the nodule in the upper lobe. The mid-pole nodule shows no increased vascularity.
Differential Diagnosis Benign calcified nodules, malignant nodule in the upper lobe of the left thyroid gland.
Final Diagnosis The left upper lobe nodule was a papillary carcinoma of the thyroid. The other nodule was benign.
Discussion The sonographic features of papillary carcinoma of the thyroid have been discussed in another case [click here to view].

This case is presented to demonstrate the one uncommon appearance of a malignant nodule - large areas of calcification . Papillary carcinoma generally presents with either no calcification or a few scattered microcalcifications. Only very rarely does this lesion present as a nodule with large, irregular clumps of calcification as seen in this case.
Case References
  1. Chan BK, Desser TS, McDougall IR, Weigel RJ, Jeffrey RB Jr. Common and uncommon sonographic features of papillary thyroid carcinoma. J Ultrasound Med. 2003 Oct;22(10):1083-90.
Technical Details Proprietary image enhancement technology: XRes (TM), Philips Corporation.
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