Internal jugular vein tumor thrombus in papillary thyroid cancer: our institution's experience and systematic review of the literature Authors

Bryce Laurin ^1* Robert Ballard ^2* Ifthikar Malik ^3* Janeil Mitchel ^4*

• ¹ School of Medicine, Medical College of Wisconsin, Milwaukee, United States
• ² Department of Vascular Surgery, Fox Valley Surgical Specialist, Appleton, Wisconsin, United States
• ³ Division of Endocrinology, Fox Valley Surgical Specialist, Appleton, Wisconsin, United States
• ⁴ Division of Endocrine Surgery, Department of General Surgery, Fox Valley Surgical Specialist, Appleton, Wisconsin, United States

Abstract Papillary thyroid tumor thrombosis of the internal jugular vein (IJV) is a rarely observed phenomena with under 30 cases reported to date. Clinical features and underlying pathogenesis of tumor thrombosis is not well-elucidated. A PRISMA-compliant systematic review was conducted yielding 20 studies eligible for analysis. Additionally, we describe a case of papillary thyroid cancer (PTC) tumor thrombus involving the IJV with solitary metastasis to the ipsilateral kidney. The majority of patients in the cohort presented in an asymptomatic state (n = 14) with variable timepoints in diagnosis: preoperative (n = 9), intraoperatively (n= 1) and postoperative period (n =11), up to 30 years post-thyroidectomy. Primary tumor sizes ranged widely, with mean of 4.22 cm ± 2.64cm. Most patients (85.7%) presented with nodal involvement, and a few (n =4) had distant metastases with pulmonary involvement most-commonly reported. Open tumor thrombectomy was performed 10 (52.6%) cases and extensive vascular reconstruction was required in 8 (42%). Adjuvant treatment including radioactive iodine ablation (36.8%) and external beam radiation (21.1%) were also employed. Patient clinical factors, presentation, diagnosis and management of PTC vascular tumor thrombus is heterogeneous. It occurs in patients with solitary small primary tumors as well as patients with heavy locoregional disease burden and presents as isolated and extensive thrombotic burden, the latter requiring complex open cardiovascular reconstruction in some patients. The rarity of disease and diverse clinical presentation reporting remains a challenge in the understanding of pathogenesis, optimal management and outcomes in PTC-related thrombosis.