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Case Reports in Surgery
Volume 2016, Article ID 8740405, 5 pages
http://dx.doi.org/10.1155/2016/8740405
Case Report

A Rare Presentation of Autonomously Functioning Papillary Thyroid Cancer: Malignancy in Marine-Lenhart Syndrome Nodule

1Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey
2Department of Radiology, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey
3Department of Endocrinology and Metabolism, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey
4Department of Pathology, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey
5Department of General Surgery, Bahcesehir University Medical Faculty, 34353 Istanbul, Turkey

Received 7 December 2015; Accepted 13 March 2016

Academic Editor: Boris Kirshtein

Copyright © 2016 Mehmet Uludag et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective. Marine-Lenhart Syndrome (MLS) is defined as concomitant occurrence of autonomously functioning thyroid nodule (AFTN) with Graves’ disease (GD). Malignancy in a functional nodule is rare. We aimed to present an extremely rare case of papillary thyroid cancer in a MLS nodule with lateral lymph node metastases. Case. A 43-year-old male presented with hyperthyroidism and Graves’ ophthalmopathy. On Tc99m pertechnetate scintigraphy, a hyperactive nodule in the left upper thyroid pole was detected and the remaining tissue showed a mildly increased uptake. The ultrasonography demonstrated 15.5 × 13.5 × 12 mm sized hypoechoic nodule in the left upper pole of the thyroid and round lymph nodes on the left side of the neck. Fine needle aspiration biopsy (FNAB) of the nodule and lymph node revealed cytological findings consistent with papillary cancer. Total thyroidectomy with central and left modified radical neck dissection was performed. On pathologic examination, two foci of micropapillary cancer were detected. The skip metastases were present in three lymph nodes on the neck. Conclusion. AFTN can be seen rarely in association with GD. It is not possible to exclude malignancy due to the clinical and imaging findings. In the presence of suspicious clinical and sonographic features, FNAB should be performed.