乳头状甲状腺癌的颈部淋巴结转移规律与手术方式

目的探讨甲状腺乳头状癌颈部淋巴结的转移规律以及清扫范围的合理选择。方法同顾性分析近4年多米收治的457例乳头状甲状腺癌患者的临床资料。结果全组患者均接受常规甲状腺双侧全切加颈深（Ⅲ＋Ⅳ区）组技巾央（Ⅵ区）组颈部淋巴结清扫术。颈部淋巴结总转移发生率为63．67％（291／457），中央组淋巴结转移发生率为59．08％（270／457），颈深组淋巴结转移发生率为29．76％（136／457）。当癌肿直径〉1cm或癌肿突破甲状腺包膜、侵犯肌肉时各区淋巴结转移的发生率明显增加（P〈0．05）。全组无手术或住院期间死亡。结论乳头状甲状腺癌最常见的淋巴结转移为巾央组淋巴结，其次为颈深组（Ⅲ＋Ⅳ区）的淋巴结，初次手术应常规清扫双侧中央组淋巴结，当肿块直径〉1cm或癌肿突破甲状腺包膜和／或侵犯肌肉时宜同时，清扫同侧的颈深组淋巴结。     

选择性颈淋巴结清除术在乳头状甲状腺癌手术治疗的临床应用

目的:探讨乳头状甲状腺癌选择性颈淋巴结清除术的手术指征、手术方法和效果。方法:回顾性分析2007年7月—2011年1月的544例早中期(I期364例,II期89例,III期91例)乳头状甲状腺癌患者施行甲状腺切除加选择性颈淋巴结清除术的临床资料。对手术指征、手术方法、并发症和术后颈淋巴结的病理结果进行分析。结果:544例中,150例行中央组(VI组)清除;325例(59.7%)的清除范围≤3组。此544例均采用普通颈部横切口完成手术。总的淋巴结阳性率67.4%(367/544)。其中,VI组阳性率为54.4%(296/544),IV组44.2%(174/394),III组45.9%(181/394),II组34.2%(68/199)和V组9.0%(6/65)。VI组阳性率与IV,III,II组比较差异无统计学意义(P>0.05)。39例标本中找到1枚误切的甲状旁腺(7.2%,39/544);86例有一过性低钙表现(15.8%,86/544),无永久性者;26例有暂时性喉返神经麻痹(4.8%,26/544),无永久性者。544例随访时间超过半年者时颈部超声未见淋巴结肿大。结论:在早中期乳头状甲状腺癌患者实施选择性淋巴结清除术是合理的,它是一种规范的、个体化的手术方式,具有较高的临床实用价值。     

微小乳头状甲状腺癌行颈淋巴结清扫术的必要性探讨

目的：探讨微小乳头状甲状腺癌手术行颈部淋巴结清扫术的必要性。 方法：分析1999年5月—2009年10月收治的微小乳头状甲状腺癌手术患者的临床病理资料。分为单发灶组（42例）和多发灶组（27例）,均行中央组（Ⅵ区）、同侧或双侧颈深组 （Ⅲ+Ⅳ区）淋巴结清扫术。 结果：Ⅵ区淋巴结转移发生率单发灶组与多灶组分别为2例（4.8%）与7例（25.9%）,Ⅲ+Ⅳ区淋巴结转移发生率单发灶组与多发灶组分别为0例（0）与3例（11.1%）。两组Ⅵ,Ⅲ+Ⅳ区淋巴结转移率差异具有统计学意义（P＜0.05）。术后4例发生一过性低钙血症,3例短暂性喉返神经麻痹,1例淋巴瘘,1例多灶组术后7个月复发,1例单灶组术后42个月复发。无1例死亡病例。 结论：多发灶性的微小癌应积极施行淋巴结清扫; 单发灶性微小癌可在定期随诊观察下暂不行预防性的颈淋巴结清扫术,既不会影响患者的生存率又能提高生存质量。     

分化型甲状腺癌137例临床诊治分析

目的分析分化型甲状腺癌治疗的临床效果,探讨其合理的治疗方式。方法回顾性分析2002-2012年期间在我院普外科诊治的137例分化型甲状腺癌患者的临床及术后随访资料。结果本组137例分化型甲状腺癌患者均行个体化手术、Ⅵ区淋巴结常规清扫及术后综合治疗。淋巴结转移率为53．28％（73／137）,Ⅵ区淋巴结术中病理证实为阳性者加行Ⅱ＋Ⅲ＋Ⅳ区淋巴结清扫,术后病理证实淋巴结转移率为41．10％（30／73）。多因素分析显示是否穿透被膜、病理类型及TNM分期是影响Ⅵ区淋巴结转移的独立危险因素（P〈0．05）。本组无围手术期死亡病例发生,住院期间出现暂时性声音嘶哑4例（2．92％）,短期低钙血症11例（8．03％）。术后随访1-10年（平均6．5年）,发现局部复发5例（3．65％）;颈淋巴结转移11例（8．03％）;远处转移3例（2．19％）,其中1例骨转移,2例肺转移;再手术16例（11．68％）。结论个体化手术方式选择、Ⅵ区淋巴结常规清扫、密切随访管理是减少术后并发症发生及保障分化型甲状腺癌治疗效果的有利因素。     

分化型甲状腺癌颈淋巴结转移规律的研究

目的 探讨分化型甲状腺癌患者颈淋巴结的转移规律及分化型甲状腺癌颈部淋巴结外科处理模式.方法 回顾性分析2003年1月至2007年6月104例(117侧)行颈淋巴结清扫术的分化型甲状腺癌患者的临床病理资料,其中男性29例,女性75例,年龄12～79岁,中位年龄39岁.根据术前临床体检和影像学检查结果分为临床淋巴结阳性(cN+)和阴性(cNO)两组,分别与术后病理结果作比较.结果 cN+组69侧颈清扫标本中pN+者63侧(91.3%),pNO者6侧(8.7%);oNO组48侧中pN+者25侧(52.1%),pNO者23侧(47.9%).颈部转移淋巴结的分布以Ⅵ区最为常见,为64.1%,其次为Ⅱ、Ⅲ、Ⅳ区,分别为31.6%、44.4%、40.2%,V区较少见为12.0%,I区最少见为3.2%;cN+组pN+者86.7%(54/63)为多个分区转移,cNO组pN+者64.0%(16/25)为单个分区转移.结论 分化型甲状腺癌颈淋巴结转移以Ⅱ、Ⅲ、Ⅳ、Ⅵ区为主,尤以Ⅵ区最常见.cN+组以多个分区转移为主,cNO组以单个分区转移为主,二组患者颈淋巴结的外科处理方式也应有所不同.     

分化型甲状腺癌行颈部淋巴结清扫的意义及方式探讨

目的探讨分化型甲状腺癌行颈部淋巴结清扫的意义及手术方式的选择。方法自2007年1月至2010年6月山东省聊城市人民医院手术治疗分化型甲状腺癌病人428例(506侧),其中在标准甲状腺癌改良根治术基础上简化操作过程(简称简化术式)完成手术349例侧。术后分组检测各区淋巴结转移发生率,比较不同手术方法术后并发症。结果本组中行中央区淋巴结(Ⅵ区)清扫者441例侧,转移发生率为52.83%(233/441);行颈侧区淋巴结清扫(Ⅱa、Ⅲ、Ⅳ、Ⅴb区)者385例侧,转移发生率为44.42%(171/385),其中Ⅱa区23.98%、Ⅲ区67.84%、Ⅳ区53.80%、Ⅴb区4.68%。结论分化型甲状腺癌即便是微小癌也有较高的颈部淋巴结转移发生率。对于临床颈侧区淋巴结阴性(cN0)病人也应常规行颈部淋巴结清扫术,以消除病变遗漏及复发隐患,全面准确评价颈部淋巴结状态。简化甲状腺癌改良根治术最大程度的降低了创伤,更加符合功能性根治的原则,适应证广泛,值得推广应用。     

甲状腺乳头状癌淋巴结转移规律的研究

目的探讨甲状腺乳头状癌淋巴结转移的规律,为临床行选择性颈淋巴结清扫术提供依据。方法回顾性分析华中科技大学附属协和医院乳腺、甲状腺外科中心2003年6月至2006年6月间行甲状腺癌根治＋颈淋巴结清扫术,且颈清扫的淋巴结数目大于8枚的83例甲状腺乳头状癌临床资料。结果甲状腺乳头状癌最容易转移至Ⅵ区（单侧甲癌72.3%,双侧甲癌88.9%）,其次是Ⅲ、Ⅳ区（单侧甲癌57.9%,双侧甲癌50%～66.7%）,Ⅴ区和Ⅰ区较少发生淋巴结转移（单侧甲癌0%～20.1%,双侧甲癌25%～33.3%）。侵犯甲状腺包膜（88%）和滤泡亚型（85.7%）的甲状腺癌容易发生颈淋巴结转移。良性病变局部恶变（27.3%）和包膜型（25%）甲状腺癌,较少发生颈淋巴结转移。甲状腺上极的肿瘤可以先出现颈外侧区淋巴结转移。结论甲状腺乳头状癌的淋巴结转移的研究有助于确定选择性颈淋巴结清扫术范围,建议甲状腺乳头状癌常规清扫Ⅵ区淋巴结,肿瘤位于甲状腺下极者需清扫对侧下极淋巴结;对于肿瘤位于甲状腺上极的患者,应增加清扫Ⅱ、Ⅲ区的淋巴结。对风险较高的滤泡亚型及侵犯包膜的甲状腺乳头状癌清扫范围要更大,应清扫Ⅱ～Ⅵ区淋巴结。     

前哨淋巴结活检在CN0分化型甲状腺癌的应用体会

目的 研究前哨淋巴结活检（SLNb）在CN0分化型甲状腺癌（DTC）治疗中的临床应用及其对颈淋巴转移的预测价值。方法 运用美蓝染色法对疑为CN0PTC患者行前哨淋巴结活检,对术中冰冻证实为乳头状腺癌（PTC）的42例患者常规行改良颈廓清术（MRND）,观察对照SLN术中冰冻与术后颈清淋巴结病理的淋巴转移情况。结果 42例患者中有40例检出前哨淋巴结,SLN检出率为95％,术中冰冻SLN发现16例淋巴结转移,并得到术后病理证实,有2例SLN假阴性,淋巴结隐匿转移率为45％。Ⅳ区SLN阳性率明显高于Ⅲ、Ⅳ区,与MRND术后总体淋巴结转移情况相符,淋巴结转移与肿块大小有一定关系。结论 美蓝染色法进行前哨淋巴结活检能够预测CNOPTC颈淋巴转移情况,对CNODTC患者常规行选择性淋巴清扫具有重要的治疗意义。【摘要】目的研究前哨淋巴结活检（SLNb）在cNn分化型甲状腺癌（DTC）治疗中的临床应用及其对颈淋巴转移的预测价值。方法运用美蓝染色法对疑为CN。PTC患者行前哨淋巴结活检,对术中冰冻证实为乳头状腺癌（PTC）的42例患者常规行改良颈廓清术（MRND）,观察对照SLN术中冰冻与术后颈清淋巴结病理的淋巴转移情况。结果42例患者中有40例检出前哨淋巴结,SLN检出率为95％,术中冰冻SLN发现16例淋巴结转移,并得到术后病理证实,有2例SLN假阴性,淋巴结隐匿转移率为45％。IV区SLN阳性率明显高于Ⅲ、Ⅳ区,与MRND术后总体淋巴结转移情况相符,淋巴结转移与肿块大小有一定关系。结论美蓝染色法进行前哨淋巴结活检能够预测CNOPTC颈淋巴转移情况,对CNODTC患者常规行选择性淋巴清扫具有重要的治疗意义。     

甲状腺癌再次手术72例临床分析

目的分析甲状腺癌再次手术原因,探讨再次手术的时机和方式。方法回顾性分析2003年6月至2006年8月间收治的72例甲状腺癌再次手术患者的临床资料。再次手术原因主要为首次手术不当致肿瘤残留、肿瘤复发或颈淋巴结转移和^131Ⅰ治疗前的甲状腺清除。再次手术方式：病灶≤2cm的单个肿瘤,行患侧加峡部切除;其余行双侧甲状腺全切;怀疑及确诊为淋巴结转移者,加选择性颈淋巴结清扫术。结果术后病理证实,腺体肿瘤残留率47．1％（32／68）,淋巴结肿瘤残留率81．4％（35／43）。术后暂时性和永久性喉返神经损伤发生率分别为5．6％（4／72）及1．4％（1／72）。暂时性和永久性甲状旁腺损伤发生率分别为26．4％（19／72）及1．4％（1／72）。结论对于有肿瘤残留或复发的甲状腺癌患者,再次手术是必要的。最佳手术方式是双侧甲状腺全切加中央组淋巴结清扫和术中冰冻切片检查。     

在甲状腺乳头状癌中施行保留颈丛的改良颈清扫术

目的探讨保留颈丛的功能性颈清扫术在分化性甲状腺癌手术中的临床应用。方法回顾性分析18例施行保留颈丛的改良性颈淋巴结清扫的甲状腺乳头状癌患者的临床资料，选取同期的甲状腺癌颈淋巴结转移行不保留颈丛的改良性清扫的患者20例，观察并比较两组术后出现相应颈丛损伤的功能障碍发生率。结果保留颈丛者出现局部麻木者耳垂区22．2％（4／18）、颈部16．7％（3／18）、锁骨区16．7％（3／18），不保留颈丛组出现局部麻木者耳垂区100．0％（20／20）、颈部55．0％（11／20）、锁骨区55．0％（11／20）。前者功能障碍的发生率明显低于后者（P〈O．05）。结论保留颈丛的改良性颈清扫术在甲状腺乳头状癌手术中不会增加淋巴结转移率．有效地保留了耳垂区、颈部、锁骨区的感觉，提高了患者的生存质量。     

纳米碳示踪剂在甲状腺癌根治术中的应用

目的:探讨纳米碳示踪剂在甲状腺癌根治术中的应用价值。方法:将2013年1月—2014年5月收治的80例甲状腺癌患者随机均分为试验组与对照组,试验组术中甲状腺内注入纳米碳混悬液后按黑染淋巴结的范围清扫患侧VI区淋巴结,对照组常规清扫患侧VI区淋巴结。比较两组淋巴结清扫数、癌转移淋巴结数及术后甲状旁腺损伤发生率。结果:试验组共清扫461枚,其中黑染淋巴结441枚,对照组共清扫淋巴结272枚;试验组中发现癌转移淋巴结数量为197枚,而对照组中为106枚,以上指标两组间差异均有统计学意义(均P0.05)。试验组与对照组癌细胞淋巴结转移率无明显差异(42.73%vs.38.97%,P0.05)。试验组术后病理未找到甲状旁腺组织,也未出现低钙血症,而对照组有5例找到甲状旁腺组织,同时5例出现低钙血症,但两组间差异未达统计学意义(P=0.055)。结论:纳米碳在甲状腺癌根治术中能够使VI区淋巴结得到很好的显影,利于淋巴结彻底清扫,同时碳不会黑染甲状旁腺,可以避免甲状旁腺的误切。     

Is Thymectomy Worthwhile in Central Lymph Node Dissection for Differentiated Thyroid Cancer?

Background

Clinical guidelines edited in 2006 by the American Thyroid Association (ATA) and stated in the European Thyroid Association Consensus (ETA) recommend routine central lymph node dissection (level VI neck dissection) in addition to thyroidectomy for the surgical treatment of differentiated thyroid cancer. This central dissection increases the incidence of postoperative hypocalcemia, which is related to the resection or devascularization of the inferior parathyroids together with bilateral thymectomy. Some authors perform unilateral thymectomy in order to minimize this complication. Our aim was to study the benefit/risk (incidence of thymic lymph node metastases versus postoperative hypocalcemia) of both procedures.

Methods

We retrospectively reviewed the records of 138 patients who underwent total thyroidectomy with central neck lymph node dissection for differentiated thyroid cancer between 2004 and 2007. Bilateral thymectomy was performed in 45 patients (group 1, 15 males and 30 females) and unilateral thymectomy was performed in 93 patients (group 2, 27 males and 66 females). Forty-two papillary and 3 medullary cancers were found in group 1, and 75 papillary, 2 follicular, and 17 medullary cancers were found in group 2. The presence of thymic metastases at pathology and the occurrence of postoperative hypocalcemia were reviewed.

Results

Two cases of papillary thymic metastases were found in group 1. These were lymph node micrometastases localized in the ipsilateral side of the primary tumor in both cases. Transient hypocalcemia was significantly more frequent (P < 0.001) in group 1 than in group 2: 16 patients (35.5%) versus 10 (10.7%). There was one case of permanent hypocalcemia in group 1 after the follow-up period.

Conclusions

Bilateral thymectomy risk outweighs any likely carcinologic benefit. We do not recommend routine bilateral thymectomy during central neck dissection for differentiated thyroid cancer.     

Complications of neck dissection for thyroid cancer

rophylactic and therapeutic neck dissections are used to control or eliminate local nodal disease in patients with thyroid cancer. The purpose of this study was to evaluate the results and complications of neck dissection. From 1992 to 1999 a series of 115 consecutive neck dissections were performed in 74 patients (32 men, 42 women; mean age 48 years) with thyroid cancer and nodal metastases. Operations included central compartment, lateral modified, and suprahyoid dissection with and without total or completion thyroidectomy. Sixty-four percent of the patients had papillary, 4% follicular, and 32% medullary thyroid cancer. Complications included transient hypocalcemia (23%) defined by a postoperative serum calcium level of <2.0 mmol/L (8.0 mg/dl), one neck hematoma (0.9%), and one cardiac death (0.9%). There were no permanent recurrent nerve palsies. Hypocalcemia occurred more frequently when neck dissection was combined with total thyroidectomy than without it (p <0.005). In this group, the incidence of hypocalcemia was higher after central, than lateral, neck dissection. When neck dissection was performed without thyroidectomy, there was no difference in the rates of hypocalcemia between central, lateral, or central with lateral neck dissection (p = NS). Hypocalcemia did not increase with repeated neck dissectionsp = NS). Permanent hypoparathyroidism occurred in 0.9%. There were no complications after suprahyoid dissection. The median duration of hospitalization was 1 day. Therapeutic neck dissection or repeated neck dissection can be performed relatively safely in patients with thyroid cancer. Hypocalcemia occurs most frequently when neck dissection is combined with total thyroidectomy.     

甲状腺癌根治术致甲状旁腺功能减退的危险因素及预防

目的:探讨甲状腺癌根治术中可能导致甲状旁腺功能减退的危险因素及预防措施。方法:回顾性分析首都医科大学附属北京同仁医院普通外科2014年全年由同一外科医师实施的75例甲状腺癌手术的临床资料。结果:全组术后发生甲状旁腺功能减退20例(26.67%),其中暂时性甲状旁腺功能减退19例(25.33%),永久性甲状旁腺功能减退1例(1.33%)。甲状腺全切术患者甲状旁腺功能减退发生率明显高于甲状腺近全切除术患者(46.88%vs.11.63%,P0.05);行VI区淋巴结清扫患者甲状旁腺功能减退发生率明显高于未行VI区淋巴结清扫患者(45.71%vs.10.00%,P0.05);同时行自体甲状旁腺移植术患者甲状旁腺功能减退发生率高于未行甲状旁腺移植患者,但差异无统计学意义(50.00%vs.22.22%,P0.05)。结论:甲状腺全切和Ⅵ区淋巴结清扫是导致甲状旁腺功能减退的危险因素。术中精细解剖甲状腺后被膜,尤其是尽可能保留下甲状旁腺血运,术后应用预防性药物可能有助于甲状旁腺功能的保护。     

结节性甲状腺肿合并分化型甲状腺癌诊断与治疗

目的：探讨结节性甲状腺肿合并分化型甲状腺癌的临床特点及诊治原则。 方法：回顾性分析2003年10月—2011年10月收治的47例结节性甲状腺肿合并分化型甲状腺癌的临床资料。 结果：患者均表现为颈部包块或颈部增粗,术前B超显示结节伴细沙粒样钙化者19例（40.43%）。47例患者均行手术治疗,术后经病理学检查确诊为分化型甲状腺癌（其中乳头状癌36例,占76.60%;滤泡样癌11例,占23.40%）,手术方式包括：患侧腺叶+峡部全切术+VI区淋巴结清扫;两侧腺叶+峡部全切术+VI区淋巴结清扫;颈部淋巴结肿大、转移者加行改良颈清扫术。术后均给予左旋甲状腺素片治疗。47例患者术后随访6~36个月,平均为（15.6±8.9）个月,3例分别于术后16~33个月复发,再次手术,效果良好。全组无死亡病例。 结论：结节性甲状腺肿合并甲状腺癌术前诊断困难,术前超声检查可提供可考依据,术中快速冷冻切片病理学检查是提高甲状腺癌检出率的关键;个体化、精细规范的手术治疗对结节性甲状腺肿合并分化型甲状腺癌有良好的治疗效果。     

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??Preservation of the cervical plexus with a selective neck dissection through a low-collar incision in patients with differentiated thyroid carcinoma: an analysis of 112cases SUN Tuan-qi, WU Yi. Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center (FUSCC)??Department of Oncology, Shanghai Medical College of Fudan University, Shanghai200032, China
Corresponding author: WU Yi, E-mail: ywu@rddb.shanghai.gov.cn
Abstract Objective To determine the utility and experiences of preserving the cervical plexus in selective neck dissections for differentiated thyroid carcinoma (DTC). Methods Preservation of the cervical plexus was used for selective neck dissection through a low-collar incision in 112 cases of DTC from January 2009 to December 2010 in the Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center. Results The most common site of cervical lymph node metastases was level VI (78.8%), followed by level IV (72.9%) and III (60.2%). The metastasis rates in level II and VB were 43.8% and 16.9%, respectively. No impairment of sensation of ears, lower necks and upper shoulders was found. There was no local recurrence at the time of follow-up for 1 to 25 months. Conclusion If utilized in the appropriate patient population, a selective neck dissection through a low-collar incision for DTC can be a successful alternative to the modified or radical neck dissection. It could be performed in N1b patients when there is no level VA lymph node metastasis, or when the metastasis is not aggressive.     

甲状腺乳头状癌Ⅵ区淋巴结的归属

目的 评价临床颈侧区淋巴结阴性(cN0)的甲状腺乳头状癌(PTC)患者行选择性颈侧淋巴结清扫的价值。方法 通过分析139例PTC患者(初治时为cN0)的复发和(或)转移部位(甲状腺,Ⅵ区,颈侧区,远处),把Ⅵ区淋巴结转移归入原发灶复发,明确与颈侧区淋巴结转移的区分,逆向分析评价cN0 PTC患者选择性颈侧清扫的临床价值。结果 PTC患者甲状腺复发83％(73／88),Ⅵ区转移76％(67／88),17例为已作选择性颈侧淋巴结清扫,占65％(17／26)。颈侧区淋巴结转移为17％(17／98),其中5例发生于已作选择性颈侧淋巴结清扫,占19％(5／26)。结论 支持对cN0 PTC患者行患侧腺叶切除加Ⅵ区清扫,不支持颈侧区(Ⅱ-V)的选择性颈侧淋巴结清扫。而对初治时为cN0,但术前超声和CT为N 的患者,则支持行颈侧区淋巴结的选择性清扫。在甲状腺癌诊治中,CT检查是必要的。     

221例甲状腺癌的外科治疗体会

目的 探讨甲状腺癌的诊断和外科治疗方法。方法 回顾性分析我院2003年1月-2007年12月间收治的221例甲状腺癌患者的临床资料。甲状腺次全切除161例，甲状腺全切57例，姑息性手术3例。除3例行姑息性手术外其余所有患者均常规颈部中心区淋巴清扫。结果 术后病理检查证实有淋巴转移者为40．3％（89／221）。术后并发症包括5例短暂喉返神经麻痹，37例短暂低血钙抽搐，1例永久性甲状旁腺功能低下，2例术后颈部血肿。本组患者术前B超检查均发现甲状腺内实性或囊实性低回声结节，其中结节内伴微钙化灶者79例（35．7％）。获得随访187例患者，随访率为84．6％，随访6月～5年，除未分化癌患者术后7月死亡，其余患者均存活。结论 患侧甲状腺＋峡部＋对侧甲状腺大部分切除＋中心区淋巴清扫是甲状腺癌的主要手术方式，术前高频B超检查提示甲状腺结节内沙砾微钙化灶对甲状腺癌的术前诊断有重要意义。     

Papillary carcinoma arising from thyroglossal duct cyst with thyroid and lateral neck metastasis

INTRODUCTIONThyroglossal duct carcinomas (TGDC) are rare, with approximately 274 reported cases since the first report in 1915. The prevalence of carcinomas in surgically removed thyroglossal duct cyst (TGD) is less than 1%. The usual recommended treatment for this condition is the Sistrunk operation, but controversies remain regarding the need for total or partial thyroidectomy.PRESENTATION OF CASEA 28-year-old woman was admitted to our hospital with the symptoms of painless midline neck swelling and growing mass. A preoperative computed tomography (CT) showed a 4 cm sized heterogeneous mass at the infrahyoid anterior neck. Ultrasonography of the neck additionally showed suspicious metastatic lymph node at right level VI, both level VI. The patient underwent a Sistrunk operation. The frozen section revealed papillary carcinoma arising from TGDC and also revealed metastatic papillary carcinoma in the right thyroid, at right level III and level VI. Total thyroidectomy, right modified radical neck dissection and central neck dissection were performed. The thyroid gland and TGD were confirmed papillary carcinoma. The dissected neck lymph nodes revealed metastatic papillary carcinoma.DISCUSSIONThe usual recommended treatment for TGD is the Sistrunk procedure. There is controversy regarding whether total or partial thyroidectomy should be performed.CONCLUSIONPhysicians should be aware of extended operation, including thyroidectomy and/or neck node dissection for TGDC with metastatic lesion of thyroid and neck node.