Upper retropharyngeal node involvement in differentiated thyroid carcinoma demonstrated by 131I scintigraphy.

Abstract

We report four patients with papillary thyroid cancer who had upper retropharyngeal node involvement demonstrated by 131I scintigraphy. Three patients presented with a thyroid nodule and enlarged jugular nodes. Total thyroidectomy was performed with node dissection. Pathology demonstrated papillary carcinoma with several metastatic nodes. 131I scanning 4 weeks after surgery demonstrated increased uptake in an upper retropharyngeal node. In one patient, thyroidectomy had been performed 21 years previously. Increased thyroglobulin level led to 131I scanning, which showed focal retropharyngeal uptake. All four patients had asymmetrical uptake at mouth level with focal uptake close to the sagittal plane. A lateral projection showed focal uptake between the base of the skull and the mandibular angle, behind the region of the mouth and nose. CT in all cases and MRI in one case confirmed the presence of an enlarged node. The mass was removed surgically in two patients and pathology confirmed the papillary nature of the metastatic node. Two patients were treated by 131I. Focal uptake of 131I in the region of the mouth is ambiguous, since salivary uptake of 131I is a common finding on scintigraphy. In cases of asymmetrical uptake in the region of the mouth, a lateral projection of the head therefore allows the correct diagnosis.

Metachronous spread of parathyroid carcinoma to a retropharyngeal lymph node

“…2,5,6 There have been no reported cases of parathyroid carcinoma metastatic to retropharyngeal lymph nodes, although metastasis of thyroid cancer to these nodes is well described. 7,8 It would seem logical that efferent parathyroid lymphatic pathways might be similar.…”

Management of Retropharyngeal Node Metastases from Thyroid Carcinoma

“…There were few complications after surgery: hematoma in 1 case [11], paralysis of the soft palate in 2 patients treated by a cervical approach [12], temporary ''aspiration and difficulty in swallowing'' lasting ''a few months,'' [13] ''typical post-tonsillectomy pharyngeal discomfort'' after a transoral approach [14][15][16], and dysphagia lasting 3-6 months after surgery via a cervical approach [4].…”

Retropharyngeal lymphadenectomy with transoral robotic surgery for papillary thyroid cancer

“…While retropharyngeal involvement in papillary thyroid cancer (PTC) is not encountered frequently in routine clinical practice, there are numerous case reports in the literature [2][3][4]. Patterns of nodal disease may be inXuenced by tumor location within the thyroid.…”

“…Thyroid carcinoma metastatic to the retropharyngeal lymph nodes has been reported several times in the literature but is still rarely encountered in practice [1][2][3]. Currently, the mainstay treatment for regional metastatic thyroid carcinoma is surgery.…”