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CASE REPORT
Year : 2022  |  Volume : 55  |  Issue : 2  |  Page : 70-74

Case report of delayed metastasis from thyroid micropapillary carcinoma to the deltoid muscle in a patient with thyroglobulin elevated negative iodine scintigraphy (TENIS)


Department of General Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India

Correspondence Address:
Riju Ramachandran
Ag-1, Sterling Sarovar, Kosseri Lane, Edapally, Kochi, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/fjs.fjs_243_21

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Differentiated thyroid cancers are common but distant metastasis to the muscles is rare. We present a case of 64-year-old male who underwent thyroidectomy for a suspicious thyroid lesion. His histopathology was reported as widely invasive follicular carcinoma of the thyroid with a focus of micropapillary carcinoma (MPC). He underwent radioiodine ablation. On follow-up, he had a serial increase in thyroglobulin but a whole-body radioiodine scan failed to detect any lesion. An 18-fluorodeoxyglucose positron emission tomography (PET)-computed tomography scan picked up a lesion in the left deltoid muscle. An intraoperative ultrasound localization was done and the nonpalpable lesion was successfully removed surgically. The deltoid lesion was a delayed metastasis of a thyroid MPC. A rising thyroglobulin level in a patient with negative iodine scintigraphy warrants further evaluation with PET since rare distant metastasis may be present. A surgeon performing intraoperative ultrasound is useful in effectively identifying and removing occult lesions with small incisions.


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