Protruding Huge Thyroid Mass Concurrent Hemorrhage and Skin Necrosis: A Case Report

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Abstract
Papillary thyroid carcinoma (PTC), a prevalent subtype of thyroid cancer, is typically characterized by slow growth and a favorable prognosis. However, this report presents an unusual case of PTC with tall cell features that exhibited rapid growth, extensive extrathyroidal extension and skin necrosis. The patient’s thyroid mass, considerably increased in size within a few weeks, reaching over 10 cm in diameter. The mass was associated with skin necrosis and hemorrhage and consisted of both cystic and solid components. Due to the risk of hemorrhage, preoperative fine needle aspiration biopsy was not performed. A computed tomography scan confirmed a large mixed cystic and solid mass with tracheal deviation and enlarged lymph node (LN). Total thyroidectomy with lateral neck dissection, and wound reconstruction was performed. Pathological examination revealed PTC with tall cell features and LNs were harvested in a total of 28, with only one LN showing confirmed metastasis. In clinical practice, encountering patients with rapidly growing, exceptionally large cystic masses should raise awareness about the potential presence of PTC, as demonstrated in this case.

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