Identification of a Neck Lump as a Lymph Node Metastasis from an Occult Contralateral Papillary Microcarcinoma of the Thyroid: Key Role of Thyroglobulin Assay in the Fine-Needle Aspirate

Bruno, Rocco; Giannasio, P.; Chiarella, R.; Capula, Carmelo; Russo, Diego; Costante, Giuseppe

doi:10.1089/thy.2009.0049

Cited by 18 publications

(14 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In ours and a few other cases, 14,16 FNB cytology revealed epithelial malignancy but could not define the origin of the tumor cells. In this setting, imaging with CT or MRI does not seem to help locate primary lesions in the thyroid and their role should be limited to disease staging.…”

Section: Discussioncontrasting

confidence: 78%

“…40 FNB-Tg has been reported to be more sensitive than FNB cytology in differentiating LNMs from PTMCs. 16,39 Macroscopically, the aspirates from such lesions are often, but not always, red or brown in color because of the presence of Tg. 41 However, this technique requires acquisition of a relatively liquid specimen, which is more feasible in nodes with cystic degeneration rather than in solid nodes, as in our case, where solid cytologic material with abundant cells was obtained; furthermore, the result may be affected by the presence of anti-Tg, which were positive in our patient.…”

Section: Discussionmentioning

confidence: 99%

“…It has been ascertained that thyroglobulin (Tg) measurement in the washout liquid of the needle used for FNB (FNB-Tg) of a neck mass can help distinguish neck masses of thyroid origin from other masses. 16 Herein, we report a patient with multifocal PTMC, presenting as a solitary ipsilateral lymph node metastasis, with no evidence of thyroid disease on thorough thyroid imaging. A systematic review was subsequently performed; previously reported similar cases as well as relevant diagnostic dilemmas are summarized.…”

Section: Introductionmentioning

confidence: 97%

See 2 more Smart Citations

Papillary thyroid microcarcinoma presenting as lymph node metastasis – a diagnostic challenge: case report and systematic review of literature

Anastasilakis¹,

Polyzos²,

Makras³

et al. 2012

View full text Add to dashboard Cite

Papillary thyroid microcarcinomas (PTMcs) have an excellent prognosis, although a few may metastasize to cervical lymph nodes. However, an infiltrated palpable neck node without evidence of thyroid disease at presentation is uncommon. We report a patient with PTMc presenting as a solitary lymph node metastasis without evidence of primary thyroid tumor in thyroid imaging and with inconclusive lymph node fine-needle biopsy (FNB) cytology. In our case, node excision and histological examination set the diagnosis and immunocytochemical staining of the FNB specimens verified it. A systematic review of reported similar cases was performed; relevant diagnostic dilemmas were also summarized. The clinical presentation of this type of papillary carcinoma becomes evident at a relatively younger age and affects almost equally the two genders; the enlarged lymph node is almost exclusively ipsilateral to the primary tumor, which may be unifocal or multifocal and is difficult to detect by thyroid imaging modalities. Lymph node FNB cytology, thyroglobulin (Tg) measurement in the washout liquid of the FNB needle, FNB immunocytochemistry and lymph node excision accompanied by histological examination provide a stepwise diagnostic approach. We conclude that PTMc may present as a lymph node metastasis without evidence of a primary thyroid tumor. In such cases, thyroid malignancy should be suspected and, in the presence of negative or non-diagnostic lymph node FNB cytology, measurement of Tg in the fluid aspirate should be performed.

show abstract

Section: Discussioncontrasting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Papillary thyroid microcarcinoma presenting as lymph node metastasis – a diagnostic challenge: case report and systematic review of literature

Anastasilakis¹,

Polyzos²,

Makras³

et al. 2012

View full text Add to dashboard Cite

show abstract

“…Moreover, in addition to fine needle aspiration biopsy cytology (FNAC) examination, thyroglobulin (Tg) measurements from FNAB washout fluid have been reported as an important supplemental tool for diagnosis of metastatic thyroid cancer with excellent diagnostic performance 2,3,5-18. However, various threshold Tg values have been reported.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Performance of Thyroglobulin Value in Indeterminate Range in Fine Needle Aspiration Washout Fluid from Lymph Nodes of Thyroid Cancer

2012

View full text Add to dashboard Cite

PurposeThe purpose was to compare the frequency of metastatic and nonmetastatic lymph nodes diagnosed by fine needle aspiration biopsy cytology (FNAC) and thyroglobulin concentration from fine needle aspiration biopsy washout fluid (FNAB-Tg) in an indeterminate range (0.2-100 ng/mL), and to evaluate the most appropriate threshold value of FNAB-Tg in an indeterminate range.Materials and MethodsWe performed ultrasound-guided FNAB and FNAB-Tg in suspicious metastatic cervical lymph nodes of papillary thyroid carcinoma and performed surgery. Ninety-five lymph nodes with indeterminate values of FNAB-Tg ranging from 0.2-100 ng/mL in ninety-two patients were included in this study. The diagnostic performances in multiple Tg levels (0.7, 1.0, 5.0, 10.0, 20.0, 50.0) were evaluated to compare with FNAB cytology using sensitivity, specificity, and accuracy with area under the curve (AUC) analysis.ResultsForty-two were metastatic lymph nodes and fifty three were nonmetastatic lymph nodes. FNAB-Tg ranged from 0.22 to 90.9 ng/mL in metastatic lymph nodes (mean; 34.3±33.3 ng/mL) and 0.20 to 56.7 ng/mL in nonmetastatic lymph nodes (mean; 4.9±11.1 ng/mL) (p<0.001). The most excellent diagnostic performance was displayed in 5 ng/mL of FNAB-Tg with AUC of 0.76, sensitivity, specificity, accuracy, 69.0, 83.0, and 76.8, respectively. However, there was no significant difference from 10 ng/mL FNAB.ConclusionWe ascertained that 5 ng/mL yielded the most excellent diagnostic performance among FNAB-Tg levels in the present setting with a large series with the indeterminate range (0.2-100 ng/mL) of FNAB-Tg values. These results need additional confirmation under different laboratory conditions.

show abstract

“…It is obviously fundamental to exclude a metastasis from a well differentiated thyroid cancer, even if the primary thyroid carcinoma is not demonstrable preoperatively. In this regard, ultrasound-guided fine needle aspiration biopsy (FNAB) with thyroglobulin measurements in FNAB washout may be of crucial importance 35. We did not perform thyroglobulin measurement, but the results would have not been conclusive because thyroglobulin values are obviously also high in the FNAB washout of thyroid tissue.…”

Section: Discussionmentioning

confidence: 99%

Ectopic submandibular thyroid tissue with a coexisting normally located multinodular goitre: case report and review of the literature

Piantanida

Compri²,

Lai³

et al. 2009

Case Reports

View full text Add to dashboard Cite

The simultaneous finding of submandibular ectopic thyroid tissue and functional orthotopic thyroid gland is an extremely rare event. The present report describes the case of a woman presenting with a left submandibular mass, distant from a palpable multinodular goitre. Ultrasonography showed an ovoidal solid mass adjacent to the lower margin of the left submandibular gland. Cytological specimens showed colloid material and thyroid follicular cells with no malignant features. A preoperative CT scan demonstrated a very thin connection between the thyroid and the submandibular mass. The patient underwent total thyroidectomy and excision of the submandibular mass. The histopathological diagnosis of the thyroid tissue was multinodular goitre, and the submandibular mass was ectopic thyroid tissue showing a hyperplastic pattern. The main differential diagnosis of the submandibular mass was a metastasis from a well differentiated cancer. This case illustrates that an ectopic thyroid off the midline may not necessarily be a metastasis from a thyroid cancer.

show abstract

Identification of a Neck Lump as a Lymph Node Metastasis from an Occult Contralateral Papillary Microcarcinoma of the Thyroid: Key Role of Thyroglobulin Assay in the Fine-Needle Aspirate

Abstract: We describe the first case of contralateral lymph node metastasis from a unifocal micro-PTC identified by the detection of high Tg levels in the wash-out liquid of FNAB.

Cited by 18 publications

References 21 publications

Papillary thyroid microcarcinoma presenting as lymph node metastasis – a diagnostic challenge: case report and systematic review of literature

Papillary thyroid microcarcinoma presenting as lymph node metastasis – a diagnostic challenge: case report and systematic review of literature

Diagnostic Performance of Thyroglobulin Value in Indeterminate Range in Fine Needle Aspiration Washout Fluid from Lymph Nodes of Thyroid Cancer

Ectopic submandibular thyroid tissue with a coexisting normally located multinodular goitre: case report and review of the literature

Contact Info

Product

Resources

About