Imaging revealed a 2.8cm left cervical mass adjacent to the previously excised left thyroid gland. Concurrently, the right medial retropharyngeal lymph node was noted to be mildly enlarged (3.5cm), likely due to compensatory hyperplasia. Surgical removal was elected. The cervical mass and the right medial retropharyngeal lymph node were excised completely with narrow margins.
Histopathology of the left cervical mass revealed epithelial neoplasia of thyroid origin with moderate mitotic activity (10 mitoses per 10 HPF). The neoplastic cells had effaced approximately 95% of the left cervical lymph node. Evaluation of the retropharyngeal lymph node revealed a reactive draining node with small hyperplastic follicles around the periphery and congested subcapsular and medullary sinuses. Both lymph nodes had been completely excised. These results were found to be consistent with metastatic thyroid carcinoma.
There was no evidence of intrathoracic metastatic disease on radiographs, although high potential for further metastasis was noted based on the pathology report. Lulu's family did not opt to pursue traditional chemotherapeutic treatment options and instead, in June 2019, elected to enroll in FidoCure® .