A 23-year-old man presented with an enlarging left neck mass. He had no dysphagia or hoarseness. Fine needle aspiration showed a small blue cell tumor consistent with medullary carcinoma of the thyroid. Serum calcitonin was greater than 10,000 and carcinoembryonic antigen (CEA) was 426. Workup for pheochromocytoma was negative. Proto-oncogene was negative. The patient was taken to the operating room for total thyroidectomy, right radical (see classical Hayes Martin radical neck dissection) and left modified radical neck dissection.
Axial MRI at the level of the thyroid shows enhancement of the left lobe of the gland with adjacent enlarged internal jugular nodes deep to the carotid and extending laterally over the anterior scalene muscle.
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