Parapharyngeal lymph node metastasis: An unusual presentation of papillary thyroid carcinoma

Lombardi, Davide; Nicolai, Piero; Antonelli, A.; Maroldi, Roberto; Farina, Davide; Shaha, Ashok R.

doi:10.1002/hed.10341

Cited by 49 publications

(57 citation statements)

References 22 publications

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“…Patients presented with recurrent disease in RPLN can be diagnosed with either CT or magnetic resonance imaging (MRI) (3)(4)(5)(6)(7)(8)(11)(12)(13). In our case, the physical exam and the flexible laryngoscopy were able to detect the retropharyngeal mass.…”

Section: Discussionmentioning

confidence: 74%

“…In the first scenario, initially a RPLN mass is detected and there is no evidence of a primary thyroid neoplasm (6). After removing the RPLN and getting a histologic confirmation of metastatic PTC, an occult primary thyroid carcinoma is identified 1 to 6 months later (3,5,10,11,13). Probably this occurs due to a lymphatic pathway, described by Rouviere, connecting the posterior surface of the thyroid gland to the retropharyngeal lymphatic system (15).…”

Section: Discussionmentioning

confidence: 99%

“…RPLN can be surgically excised via transcervical, transmandibular or transoral approaches (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). The transcervical approach provides a wide exposure of the retropharyngeal space, but the morbidity of such an extensive approach is rarely justified in the treatment of a metastatic differentiated thyroid cancer.…”

Section: Discussionmentioning

confidence: 99%

“…High serum thyroglobulin levels in recurrent cases of RPLN metastasis can also direct the clinician towards the diagnosis of metastatic PTC. FNA of the RPLN can be done either transcervically or transorally under CT or US guidance (3,4,6,7,12). However, FNA is not always accurate: non-diagnostic samples or even benign cytology has been reported with a proven metastatic disease (3).…”

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confidence: 99%

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Locally advanced asymptomatic papillary thyroid cancer presenting with retropharyngeal lymph node metastasis symptoms

et al. 2017

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Papillary thyroid cancer (PTC) rarely metastasizes to the retropharyngeal lymph nodes.Managing patients with locally advanced primary PTC and metastasis located in distant anatomical areas is challenging. Herein, we report a 56-year-old patient with locally advanced asymptomatic PTC, who presented with obstructive airway symptoms due to the metastatic retropharyngeal lymph node. The patient underwent simultaneous total thyroidectomy, central lymph node dissection, en bloc resection of strap muscle and left laryngeal nerve via cervical approach and transoral resection of the metastatic retropharyngeal lymph node. Metastatic PTC should be included in the differential diagnosis of a retropharyngeal masses.Simultaneous total thyroidectomy of the primary thyroid cancer via a cervical approach and transoral resection of an isolated retropharyngeal metastasis is safe and feasible. with calcification and minimal vascularity, the mass appeared to invade the strap muscle (Figures 5,6). No discrete nodules were noted in the right thyroid lobe. Ultrasound-guided fine needle aspiration (FNA) of the left thyroid nodule was Gland Surg 2017;6(6):733-737 gs.amegroups.com positive for PTC.We decided to perform simultaneous transoral excision of the retropharyngeal mass, and total thyroidectomy via the transcervical approach. First, the parapharyngeal mass was excised through a transoral 1.5 cm vertical incision over the mass and the cystic-appearing firm lymph node was dissected circumferentially safely. Then cervical incision was performed. We identified that the strap muscle was invaded by the left thyroid mass. The left recurrent laryngeal nerve was completely encased by the mass. We performed total thyroidectomy with en bloc resection of the strap muscles and en bloc resection of the left recurrent laryngeal nerve with central lymph node dissection (level IV).Histopathology of the left thyroid lobe revealed a 2.5 cm × 2.0 cm papillary carcinoma, classic type, stage pT4aN1aM0, BRAF V600E mutant, and the left retropharyngeal lymph node was also positive for metastatic PTC. There was extrathyroidal extension present but the surgical margins were uninvolved by carcinoma. Nine of the twelve lymph nodes of the left central compartment were positive for metastatic PTC. Postoperative period was uneventful except for hoarseness. Her voice was strong subjectively and objectively. The patient received radioactive iodine postoperatively and continued to show no evidence of recurrence after 2 years of follow-up. DiscussionPapillary thyroid carcinoma is the most common and fortunately the least aggressive type of thyroid cancers. It usually grows slowly and has a favorable prognosis (14). However, PTC can be locally aggressive, and directly invading the nearby tissues. PTC most commonly metastasizes into the central compartment (level VI) lymph nodes, then the lateral (levels II, III, IV, and V) compartment nodes (2). Metastasis of PTC to the retropharyngeal lymph nodes (RPLN) is very rare and few cases are reported in the lit...

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Locally advanced asymptomatic papillary thyroid cancer presenting with retropharyngeal lymph node metastasis symptoms

et al. 2017

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“…The English language literature reported 24 cases of retropharyngeal metastases 14,[16][17][18][19][20] and 22 cases of parapharyngeal metastases. 15,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Reports of metastatic medullary thyroid cancer in retropharyngeal and parapharyngeal space nodes also exist. 20,31,37 Eight of our 9 patients had abnormal nodes in the retropharyngeal space, whereas 1 had an abnormal node in the level II nodes of the parapharyngeal space.…”

Section: Discussionmentioning

confidence: 99%

The Role of MR Imaging in Detecting Nodal Disease in Thyroidectomy Patients with Rising Thyroglobulin Levels

Kaplan

Mandel²,

Müller³

et al. 2008

AJNR Am J Neuroradiol

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Anatomy of thyroid and parathyroid glands and neurovascular relations

2011

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Historically, thyroid surgery has been fraught with complications. Injury to the recurrent laryngeal nerve, superior laryngeal nerve, or the parathyroid glands may result in profound life-long consequences for the patient. To minimize the morbidity of the operation, a surgeon must have an in-depth understanding of the anatomy of the thyroid and parathyroid glands and be able to apply this information to perform a safe and effective operation. This article will review the pertinent anatomy and embryology of the thyroid and parathyroid glands and the critical structures that lie in their proximity. This information should aid the surgeon in appropriate identification and preservation of the function of these structures and to avoid the pitfalls of the operation.

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Parapharyngeal lymph node metastasis: An unusual presentation of papillary thyroid carcinoma

Cited by 49 publications

References 22 publications

Locally advanced asymptomatic papillary thyroid cancer presenting with retropharyngeal lymph node metastasis symptoms

Locally advanced asymptomatic papillary thyroid cancer presenting with retropharyngeal lymph node metastasis symptoms

The Role of MR Imaging in Detecting Nodal Disease in Thyroidectomy Patients with Rising Thyroglobulin Levels

Anatomy of thyroid and parathyroid glands and neurovascular relations

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