Parapharyngeal Lymph Node Metastasis From Papillary Thyroid Carcinoma

Abstract

Metastatic parapharyngeal lymph nodes (LNs) from papillary thyroid carcinomas (PTC) are uncommon and can easily remain undetected. We describe a case that involves a 62-year-old woman treated for a PTC, who presented a rise in serum thyroglobulin (TG) levels. A computed tomography scan was performed, and revealed metastatic nodes in the left parapharyngeal space (PPS). A surgical resection of the nodes was performed with external cervical approach. A histological exam confirmed the diagnosis of a metastatic LN of a PTC. The aim of this report is to emphasize on the possibility of parapharyngeal metastatic nodes in PTC and to describe the diagnosis methods, treatment options, and impact on the prognosis.

Parapharyngeal Metastasis of Papillary Carcinoma of Thyroid Gland: A Case Report and a Review of the Literature

“…Other methods include endoscope-assisted, VITOM ® 3D-assisted, and transoral robotic resections [ 22 ].…”

“…The most frequent and fearsome complications of the surgery are palatal insufficiency, tongue weakness, Horner’s syndrome, vocal cord paralysis, facial nerve weakness, and hemorrhage [ 22 ].…”

Collaborative Approach for Patient Management: Parapharyngeal Metastasis of Papillary Thyroid Carcinoma

“…20-50% of well-differentiated thyroid cancers have regional lymph node metastasis, normally along the internal jugular and recurrent laryngeal lymph nodes [2]. Lymphatic metastasis of thyroid cancer normally occurs initially to central neck levels 6 and 7, then to lateral neck levels 3, 4 and 5 [3]. Common distal metastatic sites include bones and lungs [4].…”

“…64% of parapharyngeal lymph nodes metastasis are found in the context of recurrence after previous surgery [2]. It is proposed that this could be due to retrograde lymphatic drainage secondary to scarring from previous surgery [3]. Less commonly parapharyngeal metastasis can be found as part of the disease at initial diagnosis, or as the only nodal involvement at initial diagnosis [2].…”

“…Wang, et al performed a retrospective study on 25 patients with parapharyngeal metastasis of differentiated thyroid cancer [6]. 42% of patients had preop symptoms related to parapharyngeal mass, including globus sensation, dysphagia, neck pain, headache, cough, painless mass under the angle of the mandible, Horner syndrome, Vernet syndrome, and involvement of mandibular division of trigeminal nerve [3]. There are also cases reporting symptoms of unilateral aural fullness and facial numbness [1].…”