Recurrent papillary thyroid carcinoma with lymph node metastases involving skin and blood vessels

We present a clinical case of a 73-year-old female with a history of papillary thyroid carcinoma (PTC) since 1982 when thyroidectomy and adjuvant radioiodine (radioactive iodine [RAI]) treatment were performed. The patient was lost to follow-up until 2007 when a recurrence/persistence of the same PTC was present. The second operation and RAI treatment were performed. Around 2015, she noticed a lump in the same region, and in 2016, SPEC-CT revealed 131-I uptake in the left cervical lymph metastases with massive skin invasion. In May 2017, two skin ulcerations on the left neck and jugulum due to skin infiltration and tumor necrosis were present. Fine-needle biopsy proved infiltration by papillary carcinoma without dedifferentiation. Ultrasound examination revealed a massive tumor invasion of the internal jugular vein with tumor thrombosis. This case emphasizes the importance of methodical follow-up as recommended for early detection and adequate treatment of recurrent and/or persistent disease till the end of the patient's life.