Axillary Lymph Node Metastasis from Papillary Thyroid Carcinoma: Report of a Case

We report a case of axillary lymph node metastasis (LNM) from papillary thyroid carcinoma (PTC) in a 21-year-old man. The patient presented with bilateral cervical and right axillary lymphadenopathy, and computed tomography (CT) showed a primary tumor of the thyroid and gross lymphadenopathy from the neck to the right axilla. We performed a total thyroidectomy with therapeutic nodal dissection. The resection of the primary thyroid tumor and all the node metastases was curative. Pathological examination confirmed that the resected lesions were PTC and nodal metastases from the primary tumor. Six years after the operation, cervical, upper mediastinal, and axillary lymph node recurrence developed and multiple lung metastases were found on a CT scan. He was treated with radioactive iodine therapy. Axillary LNM from PTC is unusual and seems to be associated with a poor prognosis. Thus, comprehensive treatment strategies are needed to improve the outcome of patients with PTC who present with axillary LNM.     

临床颈淋巴结阴性的甲状腺癌181例治疗分析

通过对临床颈淋巴结阴性的甲状腺癌治疗结果分析,提出采用甲状腺腺叶加峡部切除加中央区颈淋巴清扫术的治疗方法可获长期治愈的结果。方法:回顾分析1985年1月至2000年6月181例临床颈淋巴结阴性的甲状腺癌采用上法治疗的结果。结果:181例病人中仅12例(6.6%)补充作了同侧的颈淋巴结清扫术;12例行颈清扫术者中有10例见淋巴结转移。结论:对临床颈淋巴结阴性的甲状腺癌可以采用甲状腺腺叶加峡部切除加中央区淋巴结清扫术,其长期疗效同传统的甲状腺癌联合根治术,但生活质量却大为提高,值得临床推广。     

Thyroid Papillary Carcinoma Recurring as Squamous Cell Carcinoma: Report of a Case

We report a case of local squamous cell carcinoma recurrence of thyroid papillary carcinoma, 4 years after subtotal thyroidectomy, in an 82-year-old woman. The papillary cancer of the right thyroid was histopathologically classified as T2a, N0, M0, Ex1; pT2a, pN1b, pEx1; Stage III. Fine-needle aspiration cytology of the recurrent tumor revealed atypical squamous epithelium-like cells with keratinization. The tumor was judged cytologically to be class III, defined as a suspicious malignancy and, after reoperation, it was diagnosed histopathologically as papillary carcinoma recurrence with extensive squamous metaplasia. The recurrent papillary carcinoma was thought to have changed to a squamous cell carcinoma because most of the tumor was occupied by atypical squamous cells, with a small amount of glandular tissue. The primary tumor was histologically diagnosed as a well-differentiated papillary carcinoma at the initial operation. It contained numerous tall neoplastic cells with eosinophilic granules and pseudostratified nuclei, indicating that it could potentially transform into squamous cell carcinoma. We report this case as an example of how squamous cell carcinoma of the thyroid can develop.     

Metastatic Papillary Thyroid Carcinoma of the Submandibular Lymph Nodes with Extensive Squamous Metaplasia: Report of a Case

We report a unique case of metastatic papillary thyroid carcinoma of the submandibular lymph nodes with extensive squamous metaplasia. A 48-year-old man was referred to our hospital for treatment of a thyroid tumor and right submandibular masses. A tumor, 2cm in its largest dimension, was palpated in the right lobe of the thyroid gland. The masses in the submandibular region measured up to 3cm in diameter. Each submandibular tumor had a cystic cavity containing slightly opaque fluid. Aspiration cytology of the thyroid established a diagnosis of papillary carcinoma. Aspirated material from the cystic cavity of one of the submandibular masses contained only keratinized material with a thyroglobulin level of 175ng/ml. The patient underwent a total thyroidectomy with modified radical neck dissection. Microscopic examination of the resected specimen confirmed a diagnosis of papillary carcinoma of the thyroid, as well as well-differentiated squamous cell carcinoma with cystic changes in the submandibular lymph nodes. Focal immunoreactivity for thyroglobulin, combined with the absence of any other possible primary lesions in the head and neck region, suggested metastatic papillary thyroid carcinoma of the submandibular lymph nodes with extensive squamous metaplasia.     

Thyroid Metastasis from Gastric Carcinoma: Report of a Case

Thyroid metastasis from gastric carcinoma is rare. In this report, we describe the case of a patient in whom a rapidly growing thyroid metastasis was found 3 months after an operation for gastric carcinoma. Received: June 28, 1999 / Accepted: March 24, 2000     

Axillary Lymph Node Recurrence of Papillary Thyroid Microcarcinoma: Report of a Case

We report a case of axillary lymph node recurrence of thyroid papillary microcarcinoma (PMC) in a 51-year-old woman who had undergone thyroidectomy with lymph node dissection 5 years earlier. We performed residual thyroid resection with cervical and bilateral axillary lymph node dissection, and pathological examination revealed well-differentiated papillary carcinoma, with partial poor differentiation. Postoperative radioiodine therapy was ineffective, and the patient died of systemic dissemination of the recurrence 8 months after her second operation. The positive cell rates of proliferating cell nuclear antigen and Ki-67 were clearly higher in the recurrent lymph nodes than in the primary thyroid tumor, suggesting increased cell proliferation in the recurrent lymph nodes. Thyroid papillary carcinoma rarely recurs in the axillary lymph nodes, but its possibility must be kept in mind, especially in patients with remarkable cervical lymph node metastasis and those who undergo extensive lymph node dissection.     

Case Report: Metastases from Thyroid and Nasopharyngeal Carcinomas in the Same Lymph Node Following Chemotherapy for Mantle Cell Lymphoma

We report a case of metastatic papillary thyroid carcinoma and undifferentiated nonkeratinizing nasopharyngeal carcinoma to the same cervical lymph node following chemotherapy for mantle cell lymphoma. Total thyroidectomy, right cervical nodal dissection, radioactive iodine-131 therapy and radiotherapy to the nasopharynx and the neck resulted in remission of both tumors. No recurrence was noted in follow-up for 48 months.     

Metastatic Papillary Thyroid Carcinoma to the Maxilla: Case Report and Literature Review

Metastatic tumors to the oral cavity are uncommon and a thyroid origin is considered exceedingly rare. A case of metastatic papillary thyroid carcinoma (PTC) presenting as a painful swelling in the right posterior maxilla of a 63-year-old male is reported here. The patient had been diagnosed with PTC 2 years ago and treated with thyroidectomy and radioactive iodine treatment. Radiographically, the metastatic lesion presented as a poorly-defined radiolucent lesion around an impacted maxillary third molar in the right maxilla. Histopathologic examination revealed features of PTC which was immunohistochemically positive for pancytokeratin, keratin 19 and thyroglobulin. Imaging studies revealed the presence of residual maxillary and neck disease as well as additional metastatic lesions in the sternum, ribs, and left tibia. A thorough review of the English language literature revealed only 36 previously published cases of thyroid cancer metastases to the oral cavity, the demographic and clinicopathologic features of which are summarized.     

Anaplastic Thyroid Carcinoma Associated with Granulocyte Colony-Stimulating Factor: Report of a Case

A 75-year-old woman was hospitalized due to a right axillary mass. She had undergone a resection of thyroid carcinoma 13 years earlier, followed by two subsequent operations for recurrent thyroid disease. A physical examination revealed a right axillary mass associated with skin ulceration. Persistent bleeding was observed at the skin ulcer associated with the right axillary lymph node, despite conservative treatment for the lesion. Surgery was thus performed to control persistent bleeding from the axillary ulcer, and a histopathological examination resulted in a diagnosis of poorly differentiated thyroid carcinoma. The postoperative course was uneventful, but marked leukocytosis and extensive skin metastases were recognized 30 days postoperatively. A systemic examination revealed no other lesions associated with marked leukocytosis, but elevated levels of granulocyte colony-stimulating factor were noted in a blood examination. As a result, her general condition deteriorated rapidly and the patient died 2 weeks after the onset of leukocytosis.     

Unusual Metastatic Spread of Follicular Thyroid Carcinoma: Report of a Case

Concurrent skull and liver metastases from follicular thyroid carcinoma is a very rare event. We herein present the case of a 72-year-old woman who initially presented with a swelling in the right supraorbital region that proved to be metastasis from a well-differentiated follicular thyroid carcinoma of clear-cell type. The metastatic workup disclosed a huge liver metastasis and an additional metastasis in the left iliac fossa. The treatment of this patient included a total thyroidectomy, an excision of the skull lesion, and the administration of radioiodine therapy, as well as thyroid-stimulating hormone (TSH) suppression therapy. However, the course of her disease was relentless. Although well-differentiated thyroid carcinoma tends to show an excellent course, the presence of metastatic disease leads to a very dismal prognosis.An erratum to this article can be found at     

Sclerosing Papillary Carcinoma Arising in a Lingual Thyroid: Report of a Case

Ectopic lingual thyroid tissue is an uncommon congenital anomaly. Tumors with identical pathological characteristics to those arising in thyroid tissue may be present in ectopic locations, but there are very few cases of malignant ectopic thyroid tumors reported in the literature. We present a review of this phenomenon and report a case of papillary carcinoma of the base of the tongue, located in ectopic lingual thyroid tissue, in a 30-year-old woman. The patients presenting symptoms were dysphagia and oral bleeding, and we performed radical resection of the neoformation at the base of the tongue with part of the muscles of the floor of the mouth and the body of the hyoid bone, as well as total thyroidectomy. Histological examination revealed a sclerosing papillary carcinoma. The patient was treated with ¹³¹I and substitutive thyroid hormonal therapy. An ultrasonogram done 5 years later showed bilateral laterocervical lymph node recurrence, which was effectively treated with bilateral laterocervical lymphectomy.     

Solitary Brain Metastasis from Papillary Thyroid Carcinoma in a Patient with Depression: Report of a Case

Papillary carcinoma of the thyroid is a common thyroid malignancy with a relatively good prognosis. However, distant metastases may develop and become threatening, particularly to older patients, in a more aggressive manner. We report herein the clinical, radiological, and pathological findings of a patient with papillary thyroid carcinoma who had a solitary cerebral metastasis. The patient had been suffering from depression and had already undergone a hemithyroidectomy for primary thyroid carcinoma, and was known to have metastatic thryoid carcinoma of the lungs and bone. After the removal of the remnant thyroid gland prior to radioiodine (¹³¹I) therapy, he developed additional problems related to depression. Electroencephalography played an important role in identifying suspected brain metastasis and computed tomography demonstrated a space-occupying lesion in the left cerebral hemisphere. Consequently, an early removal of intracranial mass could be performed without any further life-threatening complications. Moreover, after removal of the brain mass the patient's depression improved immediately without the use of any antidepressants. This case report indicates the possibility that a patient's depression might be associated with brain metastasis from papillary thyroid carcinoma, and also suggests that an early diagnosis with the appropriate surgical management of a brain metastasis followed by radioiodine therapy could be valuable for achieving a prolonged disease-free period. Received: August 17, 1999 / Accepted: March 24, 2000     

Kidney Metastasis of Resected Early Gastric Carcinoma: Report of a Case

We report a rare case of kidney metastasis of resected early gastric cancer in a 67-year-old man. We performed distal gastrectomy with D2 lymph node dissection for early gastric cancer, which was histologically diagnosed as moderately differentiated adenocarcinoma (T1N0M0, stage IA). Preoperatively, his serum carcinoembryonic antigen (CEA) level was 9.5 ng/ml, and this dropped to 7.0 ng/ml postoperatively. However, 1 year 10 months after the operation, we performed partial kidney resection and the lesion was confirmed to be a metastasis of the gastric cancer. Unfortunately, 5 months later, multiple liver metastasis was found, accompanied by a further increase in the serum CEA level to 2 650.8 ng/ml. This case illustrates the poor prognosis associated with a high preoperative serum CEA level, even if early gastric cancer is resected curatively.     

合并转移的甲状腺微小癌诊治(附16例分析)

目的：探讨合并转移的甲状腺微小癌的危害性及其诊断和治疗。方法：总结我科１９７８～２０００年收治的合并转移的甲状腺微小癌１６例,结合文献进行临床分析。结果：术中及住院期间无一死亡。５例发生术后转移（３１.２５％）,远处转移为主,与同期无转移的甲状腺微小癌９２例相比（仅２例复发）,具有明显统计学意义上的差别（Ｐ＜０．００１）。病理切片结果提示本组资料的癌灶均已穿透包膜,存在包膜外血管浸润。其中７例因远处转移于术后５年内死亡。结论：应高度重视本病的危害性。掌握本病的临床特点,甲状腺Ｂ超检查结合转移灶穿刺活检可提高其诊断率。手术为首选治疗方法。术后可辅以甲状腺素Ｉ同位素或化疗等治疗。     

Liver Metastasis from Thyroid Carcinoma 32 Years After Resection of the Primary Tumor: Report of a Case

Follicular thyroid carcinoma is a differentiated cancer originating from the follicular cells in the thyroid gland. A 73-year-old woman, who had undergone curative resection of thyroid carcinoma 32 years earlier, was referred to our hospital after ultrasonography showed a solid mass in the liver. Laboratory data revealed positive hepatitis B core antibody, but all other values were normal. Computed tomography showed a round tumor, about 1.5cm in diameter, which was enhanced early and washed out later, in segment 5 of the liver. She underwent laparotomy and partial resection of the liver. Microscopic examination showed follicular cells with minimal atypia growing in a thyroid follicular pattern with colloids, whereby a diagnosis of metastatic liver cancer from thyroid follicular carcinoma was made. This is a rare case of solitary liver metastasis appearing 32 years after eradication of primary follicular carcinoma. Although the reason for the delayed presentation of the metastatic lesion remains unclear, this case shows that patients with differentiated thyroid cancer should be followed up for their entire life.     

Thyroid Tuberculosis Mimicking Carcinoma: Report of Two Cases

Among 527 patients with thyroid disease who underwent surgery at our hospital during a 20-year period, 2 (0.4%) had tuberculous thyroiditis mimicking carcinoma. The first patient was a 44-year-old man with a solitary thyroid nodule and the second was a 24-year old man with a thyroid abscess. The unexpected diagnosis was made postoperatively and was based on histological findings in both patients. No primary focus was found elsewhere in either patient, and both responded to antituberculous chemotherapy. Although the diagnosis is usually based on examination of resected specimens, recent reports indicate that find-needle aspiration cytology is a cost-effective technique of diagnosing thyroid tuberculosis. A review of 35 cases reported in the English literature is also discussed.     

Lateral Cervical Lymph Node Metastases from Papillary Thyroid Carcinoma: Pattern of Nodal Metastases and Optimal Strategy for Neck Dissection

Background The pattern of lateral cervical metastases from papillary thyroid carcinoma (PTC) has been reported without a clear understanding of the distribution of central nodes at risk. The present study evaluated the pattern of central and lateral cervical metastases from PTC with respect to recently defined neck sublevels and subsites. Methods Between 2003 and 2006, 52 consecutive patients with lateral cervical metastases from previously untreated PTC underwent total thyroidectomy and therapeutic comprehensive neck dissection of the central and lateral compartments, including five bilateral neck dissections. Neck dissection specimens were separately obtained for analyzing lymph node involvement with respect to neck sublevels and subsites. Results For the lateral compartment, 75.9% of cases showed metastatic disease at level IV, 72.2% at IIa and III, 16.7% at IIb, 13.0% at Vai, 3.7% at Ib and Vb, and 0% at Vas. For the central compartment, 84.6% of cases showed metastatic disease at the ipsilateral paratracheal nodal site, 46.2% at the superior mediastinal, 30.8% at the pretracheal, and 8.9% at the contralateral paratracheal site. Forty-six of 57 lateral neck dissection samples (80.7%) showed multilevel disease, and skip lateral metastasis was found in five patients (9.6%). Level I and V involvements were always associated with multilevel disease. Conclusions Lateral cervical metastasis from PTC is commonly associated with multilevel disease and central nodal involvement. Neck dissection including ipsilateral central and lateral compartments may be the optimal treatment for these patients.     

Long-term Survival After Gastric Cancer and Liver and Paraaortic Lymph Node Metastases: Report of a Case

We report the case of a 46-year-old man in whom successful resection of carcinoma of the stomach with liver and paraaortic lymph node metastases was carried out. The carcinoma was removed completely with combined resection of the lower esophagus, total stomach, distal pancreas, spleen, two metastatic liver nodes, and groups 1 and 2 and abdominal paraaortic lymph nodes. Adjuvant chemotherapy was admin-istered postoperatively. The patient is currently well with a grade 1 performance status and no signs of recurrence 12 years after his operation. This experience suggests that even the presence of metastatic paraaortic lymph nodes and liver metastases is not necessarily a contraindication to surgery when the carcinoma can be resected curatively and safely. Received: January 31, 2000 / Accepted: July 25, 2000     

Patterns of Lymph Node Metastases in Papillary Thyroid Carcinoma: Results from Consecutive Bilateral Cervical Lymph Node Dissection

Background  

In patients with papillary thyroid carcinoma (PTC), the appropriate extent of lymph node dissection has not yet been established due to lack of accurate patterns of lymph node metastases (LNM). The aim of this study was to clarify the LNM pattern in PTC patients based on our institution’s experience with a consistent technique of bilateral neck dissection, and to consider the rational extent of lymph node dissection.