Optimizing surgical outcomes: preoperative embolization with graft placement in hypervascular, locally advanced high-grade differentiated thyroid carcinoma - a case report and review of the literature.

Authors

Erwin Danil Yulian, Patrianef Darwis, Agnes Stephanie Harahap, Alvita Dewi Siswoyo, Faisal Mohammad Rifqi Aqil

Published in

International journal of surgery case reports. Volume 138. Issue 11. Pages 4857-4864. Epub Sep 29, 2026.

Abstract

A highly vascularized thyroid carcinoma presents a treatment challenge and may constitute a medical emergency. We report a rare case of preoperative embolization for the treatment of profuse bleeding from thyroid carcinoma and review the relevant literature.
A 52-year-old male presented with a bleeding neck mass, pain, and dysphagia. The mass enlarged within 1 year to 15 × 13 × 10 cm with prominent ulceration, necrosis, pus, and bleeding. A CT scan showed a solid mass in the right neck originating from the right lobe and isthmus of the thyroid, compressing the larynx, trachea, hypopharynx, and esophagus, and displacing the right sternocleidomastoid and strap muscles. CT angiography showed a hypervascular tumor with multiple branches originating mainly from the right external carotid artery. Bleeding subsided after multiple vascular interventions consisting of embolization and placement of a BeGraft stent between the right common carotid artery and right internal carotid artery. The patient subsequently underwent debulking followed by total thyroidectomy with a double deltopectoral flap. Immunohistochemistry confirmed differentiated high-grade thyroid carcinoma.
Management of locally advanced thyroid cancer requires a multidisciplinary approach, emphasizing complete resection while preserving vital structures. In this case, significant vascular involvement necessitated resection of the internal jugular vein and preoperative embolization, which reduced intraoperative blood loss. Although rare, preoperative embolization appears to be safe and beneficial in selected cases of thyroid cancer.
This case underlines the importance of a personalized multidisciplinary approach in the treatment of highly aggressive thyroid cancer. A review of similar studies shows that preoperative embolization is safe and effective in the initial treatment of highly vascularized thyroid carcinoma.

PMID:
43006088
Bibliographic data and abstract were imported from PubMed on 10 Nov 2026.

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