Picture quiz: A swelling of the arm
A GP referred a 73 year old woman with a one day history of sudden painful swelling in her left arm. She was clinically well, and, apart from diffuse swelling of the whole of her left arm, physical examination was unremarkable. Doctors did a number of investigations, including a chest x ray and a computed tomography (CT) scan (figs 1-3).
The incidence of papillary carcinoma of the thyroid is slightly higher in men. The age distribution is biphasic; the condition is more common between the ages of 30 and 40 years and 60 and 70 years. The size of the primary tumour at diagnosis varies from a small nodule to a massive tumour. In most cases, patients with papillary carcinoma will have an asymptomatic thyroid mass on examination. Large tumours can obstruct the trachea, cause paralysis of a vocal cord, or spread to distant organs and lymph nodes. Papillary carcinoma