Hypopharyngeal and Parapharyngeal Space Metastasis of Papillary Thyroid Carcinoma: A Case Report

Abstract

Carcinoma of the thyroid gland is one of the most commonly encountered endocrine malignancies (1). Among all of the thyroid malignancies, papillary carcinoma is the most often encountered histological type and its pattern of metastasis is usually lymphatic (2). Around 30-80% of patients with papillary carcinoma develop lymphatic metastases (3). Haematogenic and distant metastases seem to be rare but, if present, the bone, lungs, skin, and brain are the most common localisations. Involvement of the recurrent laryngeal nerve, larynx, pharynx, trachea, and oesophagus occurs through direct infiltration (4, 5).Metastasis to the hypopharynx and parapharyngeal space seems to be straightforward due to the close anatomical localisation, but a few cases of parapharyngeal (6, 7) and hypopharyngeal involvement (8, 9) have appeared in the literature. In our case, we present papillary thyroid carcinoma metastasis involving both the hypopharynx and the parapharyngeal space. CASE PRESENTATIONA 70-year-old female patient was referred to our clinic with dysphagia and dyspnoea. The patient had undergone a total thyroidectomy ten years previously and the histological diagnosis was papillary thyroid carcinoma. Eight years after this surgery, a left modified radical neck dissection had been performed and histological examination showed papillary carcinoma metastasis in three lymph nodes. Indirect laryngoscopy revealed a sub-mucosal mass in the left lateral pharyngeal wall, which extended towards the midline. The larynx was deviated to the right and the left vocal cord was paralytic. Axial MRI section of the neck revealed a mass that was 2.4x1.3 cm in size narrowing the airway in the lateral wall of the hypopharynx. Sagittal MRI section of the neck showed that the mass was lining from the tracheal cartilage level to the parapharyngeal space ( Figure 1). The tumour was dissected upwards from the left sinus pyriformis and the great horn of the thyroid cartilage through the retropharyngeal space to the parapharyngeal space and the base of the skull. The 10 cm long tumour was excised totally (Figure 2). The hypopharyngeal defect was repaired with primary sutures. A histopathological evaluation showed a papillary structure under the epithelium. The diagnosis was a papillary carcinoma metastasis (Figure 3). Informed consent was taken from the patient.Background: Carcinoma of the thyroid gland is one of the most commonly encountered endocrine malignancies. Papillary carcinoma is the most common histological type, and its spread is usually lymphatic. About 30-80% patients with papillary carcinoma develop lymphatic metastases. Case Report: We present here the case of a 70-year-old female patient who had undergone total thyroidectomy 10 years previously, with a histological diagnosis of papillary thyroid carcinoma. A neck dissection was performed ten years after the primary operation due to a mass in the parapharyngeal space and hypopharynx. The mass was diagnosed histologically as papillary thyroid cancer metastasis after the operation. Concl...

Transoral robotic surgery approach for relapse in parapharyngeal space of papillary thyroid carcinoma: Case series

“…1 However, TORS can be used in cases of isolated and well-encapsulated nodes due to the limited surgical access obtained, therefore it should not be performed in cases where ENE is suspected. 10…”

“…Minimally invasive procedures allow a clear identification of critical surgical landmarks, provide an almost bloodless surgical field, reducing complications associated, 1 offer minimal facial scaring and faster rehabilitation 1 . However, TORS can be used in cases of isolated and well‐encapsulated nodes due to the limited surgical access obtained, therefore it should not be performed in cases where ENE is suspected 10 …”

Metastatic Papillary Thyroid Cancer Mimicking Hypopharyngeal Carcinoma

“…[1][2][3][4] Anatomical variation of the lymphatic bundle connecting the posterior and superior compartments of the lateral thyroid lymph vessels to the retropharyngeal lymphatic system is considered to be the metastatic pathway. 1 Although comparatively limited in prethyroidectomy evaluation, 5,6 18 F-FDG PET/CT is useful in detecting dedifferentiated recurrent thyroid carcinoma that is losing iodine-concentrating ability. 7,8 In this rare case, hypopharynx metastasis from PTC is visible on PET/CT with marked FDG uptake, which should be distinguished from hypopharyngeal squamous cell carcinoma with lymph node metastasis.…”

“…Both lesions were confirmed to be classic subtype of PTC metastases. Although direct infiltration of PTC to the laryngopharynx is well recognized, lymphatic and vascular metastases to the laryngopharynx are rarely reported 1–4 . Anatomical variation of the lymphatic bundle connecting the posterior and superior compartments of the lateral thyroid lymph vessels to the retropharyngeal lymphatic system is considered to be the metastatic pathway 1 .…”

“…Although direct infiltration of PTC to the laryngopharynx is well recognized, lymphatic and vascular metastases to the laryngopharynx are rarely reported 1–4 . Anatomical variation of the lymphatic bundle connecting the posterior and superior compartments of the lateral thyroid lymph vessels to the retropharyngeal lymphatic system is considered to be the metastatic pathway 1 . Although comparatively limited in prethyroidectomy evaluation, 5,6 18 F-FDG PET/CT is useful in detecting dedifferentiated recurrent thyroid carcinoma that is losing iodine-concentrating ability 7,8 .…”