Transoral resection of thyroid cancer metastasis to lateral retropharyngeal nodes

Shellenberger, Thomas D.; Fornage, Bruno D.; Ginsberg, Lawrence E.; Clayman, Gary L.

doi:10.1002/hed.20513

Cited by 53 publications

(62 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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: 75%

“…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%

“…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).…”

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%

See 4 more Smart Citations

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

et al. 2017

View full text Add to dashboard Cite

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...

show abstract