Papillary thyroid carcinoma with coexisting venous hemangioma mimicking locally invasive disease: A case report

Primary thyroid hemangioma is a rare entity whose radiologic and intraoperative features may resemble those of a malignant disease, increasing the risk of misdiagnosis. Herein, we report a case of papillary thyroid carcinoma coexisting with a venous hemangioma that mimicked locally invasive cancer, which complicated surgical planning. A 48-year-old man presented with a thyroid nodule confirmed as papillary thyroid carcinoma. Preoperative imaging suggested extrathyroidal extension toward the esophagus and trachea, raising concern for locally invasive disease. Because vascular features were also suspected, total thyroidectomy was planned with an intraoperative reassessment of the surgical extent. Intraoperatively, the lesion was identified as a dilated vascular structure rather than an infiltrative tumor, allowing the procedure to be limited to thyroidectomy. Final histopathology confirmed papillary thyroid carcinoma with a coexisting venous hemangioma without true capsular invasion. This case highlights an important diagnostic pitfall: vascular lesions may mimic aggressive thyroid carcinoma and lead to overtreatment. A careful integration of imaging, intraoperative assessment, and pathology is essential for the appropriate management of primary thyroid hemangioma.