Shib Shankar Paul1, Saradindu Ghosh2
A 61 years old woman, resident of Mukundapur, Kolkata, presented at H & N
outpatient department (OPD) of SGCCRI on 29 July 2017, with complaints of lump
in front of neck since the past one year, which was initially small. The lump
gradually increased in size but it followed rapid progression in size within the next
5 to 6 months. Initially, it was not associated with pain, but she started
experiencing pain at anterior neck since the last 3 months, dull aching, radiating
to the back and chest. The pain aggravates on swallowing solid foods. She then
had change of voice since the last 2 months followed by difficulty in breathing &
swallowing for the past 2 weeks. She had an apparent weight loss of approx. 10
kgs since the last 1 year.
On examination, her general survey was essentially normal. On local
examination of the neck, there was a 7 cm x 6 cm ovoid, firm to hard, solitary
lump at anterior neck (left side), involving the thyroid region, extending laterally
up to anterior border of left sternocleidomastoid (SCM) muscle; above up to the
lower border of the thyroid cartilage & below at the level of supra sternal notch,
but no retrosternal extension. Medially, it crosses the midline of neck, involving
the right lobe of thyroid. The surface of the tumour is smooth at periphery &
roughness at the center with diffuse inferior margin. The skin over the lump
pigmented with purulent discharge. The local temperature was raised with severe
tenderness. There is fixity of overlying skin to the lump. The mobility of the lump
is restricted with slight movement on deglutition. There are no palpable cervical
lymph nodes, no signs of thyrotoxicosis. The patient had hoarseness of voice and
odynophagia on solid foods. Prior to attending SGCCRI, she took consultation at
another multispecialty hospital in Kolkata, where she underwent ultrasonography
(USG) of neck (heterogeneous right lobe of thyroid measuring 1.36 x 1.11 cm.
Isthmus heterogeneous. Complex, heterogeneous space occupying lesion (SOL)
occupying entire left thyroid fossa encroaching the surrounding soft tissues,
measuring 3.95 x 2.87 cm. No significantly enlarged neck nodes. Thyroid imaging
reporting and data systems (TIRADS) 5. Common carotid artery (CCA) & internal
jugular vein (IJV) of both sides look normal.); Fine needle aspiration cytology
(FNAC) (in addition to routine test).
