Venous obstruction of thyroid malignancy origin: the Antoine Lacassagne Institute experience

Table 1 Cases of great vein involvement by thyroid malignancy at the Antoine Lacassagne Institute since 1991

(Case) TNM stage	Gender Age (years)	Status at Diagnosis	Histology Lobar tumor Size (mm)	Vein Involvement (Imaging)	Treatment Modality	Survival (months)	Progression-Free Survival (months)
(1) T4bN1bM1	M 68	Inaugural SVCS	Papillary (Insular) 87 mm	IJV, SCV, BCV (CT, US)	EBRT	4 DOD	0
(2) T4bN1bM1	M 71	Inaugural SVCS	Anaplastic 79 mm	IJV, BCV, SVC, RA (CT, US)	Supportive care	0.1 DOD	0
(3) T4aN1bM0	F 81	Inaugural SVCS	Follicular (P.D.) 76 mm	IJV, BCV, SVC (CT, US)	Thrombectomy + EBRT + ¹³¹I	50 DOD	40
(4) T4aN0M1	F 72	Arm Swelling LR/Mets	Follicular (P.D.) 23 mm	IJV (US)	EBRT	3 DOD	2
(5) T4aN0M1	M 70	Arm Swelling LR/Mets	Follicular (P.D.) 25 mm	EJV (US)	EBRT	47 DOD	6
(6) T2N1bM0	M 34	Asymptomatic	Papillary 28 mm	IJV (US)	S * + IJV resection + ¹³¹I	72 AWOD	72
(7) T4aN1bM1	F 75	Arm § neck swelling	Papillary (P.D.) 80 mm	IJV (US)	EBRT	1 DOD	0.5
(8) CCRC	M 63	Asymptomatic Mets	Mets 40 mm	IJV (US)	EBRT + Chemotherapy	18 DOD	4
(9) CCRC	M 69	Asymptomatic Mets	Mets 45 mm	IJV (US)	EBRT + Chemotherapy	7 DOD	2

Patient 4 had concomitant rectal cancer; Patient 5 presented with concomitant rectal and renal cancers. Both presented with rising serum levels of thyroglobulin from low levels to 4555 and 5500 u. Immuno-staining was positive for thyroglobulin on biopsy samples. *Patient 6 underwent total thyroidectomy, bilateral central and lateral neck dissection. Patients 8, 9 had previous CCRC and biopsy-proven metastases to the thyroid 46 and 84 months respectively after diagnosis of the primary. Poorly differentiated (PD) carcinomas of the thyroid (cases 1, 3, 4, 5 and 7) represent a heterogeneous but distinct group of tumors, clinically and histopathogenetically intermediate between follicular-derived well-differentiated and anaplastic carcinomas.
Mets: presence of diffuse distant metastases; S: Surgery; SVCS: superior vena cava syndrome; LR: Local recurrence. CCRC: Clear Cell Renal Carcinoma; DOD: dead of disease; AWOD: Alive without disease; EBRT: External beam radiation therapy

ISSN: 1477-7819