A case of multiple occult thyroid cancers with tracheal stenosis by invasion from metastatic lymph node

A 59-old woman visited to our hospital with complaint of uttering stenotic sound at expiratory stage. Her chest X-ray film showed a suspicious intratracheal tumor, which was arising from the left side of the tracheal wall and confirmed 4 cm from the vocal cord by bronchofiber scope. The biopsy specimens showed well differentiated papillary adenocarcinoma. The lesion was judged to be a intrathoracic thyroid carcinoma and to infiltrate the trachea. Her air way failed to be ensured with YAG-LASER. Therefore, a subemergency operation was done. The intrathoracic lesion had no sequence of the thyroid gland. Two occult thyroid carcinomas were intraoperatively discovered. She underwent total thyroidectomy and sleeve trachectomy whose anastomosis was wrapped up in an omental flap. The intraluminal part of the tumor histologically showed poorly differentiated carcinoma, in contrast to the extratracheal part of the tumor showing well differentiated carcinoma. She was treated with radioactive iodine due to her positive 131I scintigraphy. Nine months later, a very similar lesion newly developed at the left side of trachea and made same symptoms.