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Table of Contents
LETTER TO THE EDITOR
Year : 2016  |  Volume : 20  |  Issue : 5  |  Page : 735-736

Voluminous lateral lymph node metastasis from papillary thyroid microcarcinoma


Department of Endocrinology, Faculty of Medicine, University of Tunis El Manar, 1007; Department of Endocrinology, Charles Nicolle Hospital, Tunis, Tunisia

Date of Web Publication14-Sep-2016

Correspondence Address:
Ibtissem Oueslati
Boulevard du 9 Avril, Bab Souika, 1006, Tunis
Tunisia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-8210.190567

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How to cite this article:
Oueslati I, Khiari K, Elfeleh E, Abdallah NB. Voluminous lateral lymph node metastasis from papillary thyroid microcarcinoma. Indian J Endocr Metab 2016;20:735-6

How to cite this URL:
Oueslati I, Khiari K, Elfeleh E, Abdallah NB. Voluminous lateral lymph node metastasis from papillary thyroid microcarcinoma. Indian J Endocr Metab [serial online] 2016 [cited 2020 Jul 4];20:735-6. Available from: http://www.ijem.in/text.asp?2016/20/5/735/190567

Sir,

Thyroid microcarcinomas are defined as a tumor of a maximum diameter of 10 mm or less.

Papillary thyroid microcarcinomas have an excellent prognosis. However, a few may metastasize to cervical lymph nodes.

Cervical lymph node metastases usually spread in a contiguous fashion. [1] The skip metastasis to the lateral compartment of the neck in the absence of central metastasis is uncommon. [2]

Herein, we report a case of a voluminous lateral lymph node metastasis from papillary thyroid microcarcinoma.

A 68-year-old woman was referred to our department with a gradually enlarging right cervical mass. She presented with dysphagia for solids and dyspnea. There was no history of radiation exposure and no family history of thyroid cancer.

Physical examination revealed a firm, painful, and plunging multinodular goiter with a voluminous right lateral cervical mass [Figure 1]. Thyroid functions tests were normal.
Figure 1: Voluminous right lateral cervical mass

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Chest radiography showed mediastinal enlargement with tracheal deviation [Figure 2]. Cervical ultrasonography revealed an enlarged heterogeneous multinodular thyroid gland. Computed tomography scan showed plunging multinodular goiter with tracheal compression and displacement. The lateral cervical mass measured 10 cm × 13 cm and had a predominantly cystic composition [Figure 3].
Figure 2: Chest radiography showed mediastinal enlargement with tracheal deviation

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Figure 3: Computed tomography scan showed lateral cervical mass measured 10 cm × 13 cm and had a predominantly cystic composition

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Total thyroidectomy with lymph node dissection was performed to the patient, and postoperative histopathological examination showed the right papillary thyroid carcinoma measuring 1 cm. There were no central lymph metastases. The histopathological examination of the right mass was revealed as lateral lymph node metastasis from papillary thyroid carcinoma.

The patient underwent a radioactive iodine ablation therapy and treated with levothyroxine.

In this case, according to the presence of a compressive goiter with a voluminous lateral mass, malignancy was high probable, and thyroidectomy was indicated. However, the diagnosis of papillary thyroid microcarcinoma was not expected. In fact, lateral cystic lymph node metastasis is not common. It occurs in a minority of patients with papillary thyroid microcarcinoma.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Chung YS, Kim JY, Bae JS, Song BJ, Kim JS, Jeon HM, et al. Lateral lymph node metastasis in papillary thyroid carcinoma: Results of therapeutic lymph node dissection. Thyroid 2009;19:241-6.  Back to cited text no. 1
    
2.
Roh JL, Park JY, Rha KS, Park CI. Is central neck dissection necessary for the treatment of lateral cervical nodal recurrence of papillary thyroid carcinoma? Head Neck 2007;29:901-6.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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