Transoral Approach to Removal of the Retropharyngeal Lymph Nodes in Well‐Differentiated Thyroid Cancer

Le, T. Domi; Cohen, James I.

doi:10.1097/mlg.0b013e31805819ba

Cited by 25 publications

(37 citation statements)

References 9 publications

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“…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). In the second scenario, recurrence of PTC can present with retropharyngeal lymph node metastasis (4,(6)(7)(8)(9). It is proposed that the lymphatic flow direction could become retrogradely after total thyroidectomy and neck dissection, leading to the RPLN metastasis (6).…”

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%

“…It primarily metastasizes through the lymphatic system to the first echelon-central compartment (level VI) lymph nodes then to the lateral (levels II, III, IV, and V) neck compartments (2). PTC metastasis to the retropharyngeal space is rare with only a few reported cases (Table S1) (4,(6)(7)(8)(9).…”

Section: Introductionmentioning

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: 99%

Section: Discussionmentioning

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.…”

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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“…1 Numerous surgical approaches to tumors of the retropharyngeal and parapharyngeal spaces have been discussed in the literature. [23][24][25][26] The most common are transcervical, transparotid, combined transcervicaltransparotid, transcervical with a mandibulotomy or partial mandibulectomy, and transoral. More aggressive approaches such as a double mandibulotomy with coronoidectomy 25 may be required to approach larger tumors in the lateral parapharyngeal space.…”

Section: Discussionmentioning

confidence: 99%

Transoral Resection of a Retropharyngeal Myxoma: A Case Report

White¹,

Weiss²,

Walvekar³

et al. 2011

Skull Base

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This study was conducted to describe a retropharyngeal myxoma and discuss clinical concerns regarding this pathology and a retropharyngeal site of occurrence. We present a case report and review of literature. A 71-year-old woman presented with mild right neck pressure for 3 weeks. Imaging studies and head neck examination confirmed a 5.3 Â 3.1 Â 1.0 cm retropharyngeal mass with no communication to the vertebral column but was intimately involved with the pharyngeal mucosa. A transoral fine needle aspiration biopsy suggested a possible spindle cell neoplasm. A presurgical swallowing consultation was obtained. A transoral excision of the tumor was possible with no intraoperative complications. Histopathology was a cellular myxoma. Postoperative dysphagia required swallowing therapy and nasogastric tube feeding for 2 weeks before oral intake was possible. The patient has no evidence of clinical or radiological recurrence more than 1 year after surgical intervention. We present the second case of a myxoma in the retropharynx reported in English literature. Transoral excision was safe, feasible, and cosmetically appealing option in our patient. Additional clinical data are required to valid its safety and utility as an approach to tumors in the retropharynx. Postoperative dysphagia can be significant and consequently we recommend preoperative swallowing evaluation and counseling.

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Transoral Approach to Removal of the Retropharyngeal Lymph Nodes in Well‐Differentiated Thyroid Cancer

Cited by 25 publications

References 9 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

Transoral Resection of a Retropharyngeal Myxoma: A Case Report

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