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Hu C, Zhang H, Chu L, Qiu T, Lu H. Clinicopathological features of incidentally detected metastatic thyroid papillary carcinoma in cervical lymph nodes of non-thyroid cancer patients: a retrospective analysis of 31cases. Diagn Pathol 2023; 18:82. [PMID: 37454141 DOI: 10.1186/s13000-023-01370-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND The incidental finding of thyroid inclusions in lymph nodes of neck dissections of non-thyroid cancer patients is an unusual event. It is still controversial for pathologists about whether this represents benign inclusions or metastatic papillary thyroid carcinoma (PTC). This study is to analyze clinicopathological features of such cases in an attempt to explore their clinical implications. METHODS Pathological data were searched for incidentally detected PTC of cervical lymph nodes in non-thyroid cancer cases. Clinicopathological characteristics were reevaluated and recorded. BRAF V600E protein expression and sequencing analysis was then performed in cases with sufficient tissues. RESULTS 31 patients had an incidental finding of PTC in lymph nodes of patients with non-thyroid cancer. BRAF immunohistochemical staining were performed in 17 metastatic lymph nodes with sufficient tumor tissues, and 6 were positive. BRAF V600E point mutation was detected in 5 of 6 BRAF V600E positive cases. Subsequent imaging examinations of the thyroid showed no nodules or calcifications/benign nodules in 20 patients, and suspected malignant nodules in 5 patients. 12 patients underwent total thyroidectomy or ipsilateral lobectomy, and 6 showed PTC in postoperative pathological examinations. The remaining 19 patients without surgery were kept under active surveillance, and no one had recurrence of PTC. CONCLUSION Incidentally discovered PTC in lymph nodes has usually interpreted as metastasis from a clinical occult thyroid primary cancer, but primary PTC was not always detected. This suggests it could be double occult lesions. With regards to concurrence with highly malignant tumor, most patients could keep regular surveillance.
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Affiliation(s)
- Chunfang Hu
- Department of Pathology, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haifeng Zhang
- Department of Pathology, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lixia Chu
- Department of Pathology, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tian Qiu
- Department of Pathology, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Haizhen Lu
- Department of Pathology, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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2
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Ning X, Hittman J, Lubek J, Malek R. Thyroid carcinoma discovered incidentally during surgical resection of head and neck squamous cell carcinoma: A case series. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:e190-e197. [PMID: 34511345 DOI: 10.1016/j.oooo.2021.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 11/16/2022]
Abstract
The occurrence of 2 synchronous primary cancers of different origin in the head and neck region is rare. The incidence of thyroid carcinoma found during surgical resection of primary oral squamous cell carcinoma (SCCa) is about 0.3% to 1.9% of patients. Because of the rarity of cases, there is no consensus on management. To clarify significance and management of such lesions, we report 13 cases in which incidental thyroid carcinoma was discovered during surgical resection for primary oral SCCa. A total of 1295 cases of head and neck SCCa from a 4-year period were reviewed, of which we found 13 cases of concurrent thyroid malignancy, providing an incidence rate of approximately 1%. Of these patients, 61.5% received a total or hemithyroidectomy and, of those, 62.5% received radioactive iodine for their thyroid carcinoma; 38.4% did not receive treatment for their thyroid malignancy. The mortality rate for this case series was 23%, of which all deaths were attributed to complications from SCCa. There were no cases where mortality was related to the thyroid carcinoma. Overall, this is consistent with the consensus that incidental thyroid carcinoma found during oral SCCa resection is insignificant compared with the aggressiveness of the primary malignancy.
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Affiliation(s)
- Xinyuan Ning
- Department of Internal Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Jaimie Hittman
- Department of Pathology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Joshua Lubek
- Division of Oral-Head & Neck Surgery/Microvascular Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Rana Malek
- Division of Endocrinology, Diabetes, and Nutrition, University of Maryland Medical Center, Baltimore, MD, USA.
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3
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Jaafari-Ashkavandi Z, Danesteh H, Keshvari H. Papillary Thyroid Carcinoma Coexistent with Oral Squamous Cell Carcinoma: A Case Report and Review of Literature. JOURNAL OF DENTISTRY (SHIRAZ, IRAN) 2019; 20:215-219. [PMID: 31579698 PMCID: PMC6732177 DOI: 10.30476/dentjods.2019.44901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Multiple primary tumors may develop in patients with head and neck squamous cell carcinoma. The coincidence of head and neck squamous cell carcinoma with papillary thyroid carcinoma is a rare finding. This study reports a case of papillary thyroid carcinoma, which was incidentally detected during the microscopic examination of lymph nodes of a patient diagnosed as gingival squamous cell carcinoma. A review of literature is also presented.
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Affiliation(s)
- Zohreh Jaafari-Ashkavandi
- Dept. of Oral and Maxillofacial Pathology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Danesteh
- Dept. of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Haleh Keshvari
- Postgraduate Student, Dept. of Oral and Maxillofacial Pathology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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4
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Mandapathil M, Lennon P, Ganly I, Patel SG, Shah JP. Significance and management of incidentally diagnosed metastatic papillary thyroid carcinoma in cervical lymph nodes in neck dissection specimens. Head Neck 2019; 41:3783-3787. [DOI: 10.1002/hed.25905] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/26/2019] [Accepted: 07/22/2019] [Indexed: 12/28/2022] Open
Affiliation(s)
- Magis Mandapathil
- Department of Surgery, Head & Neck ServiceMemorial Sloan Kettering Cancer Center New York New York
| | - Paul Lennon
- Department of Surgery, Head & Neck ServiceMemorial Sloan Kettering Cancer Center New York New York
| | - Ian Ganly
- Department of Surgery, Head & Neck ServiceMemorial Sloan Kettering Cancer Center New York New York
| | - Snehal G. Patel
- Department of Surgery, Head & Neck ServiceMemorial Sloan Kettering Cancer Center New York New York
| | - Jatin P. Shah
- Department of Surgery, Head & Neck ServiceMemorial Sloan Kettering Cancer Center New York New York
- Department of Oncology, Radiotherapy and Plastic SurgerySechenov University Moscow Russia
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5
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Xu YM, Gong ZJ, Wu HJ. Papillary Thyroid Carcinoma Incidentally Found in Cervical Lymph Nodes During Neck Dissection for Patients With Tongue Squamous Cell Carcinoma: A 3-Case Report and Literature Review. J Oral Maxillofac Surg 2018; 76:2454.e1-2454.e6. [PMID: 30107162 DOI: 10.1016/j.joms.2018.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 02/02/2023]
Abstract
The incidence of papillary thyroid carcinoma (PTC) found in the cervical lymph nodes during neck dissection for patients with tongue squamous cell carcinoma (SCC) is infrequent, with the coexistence of PTC and SCC in the same cervical lymph node being the rarest. Some of these patients present with primary lesions in the thyroid gland, whereas others have no obviously malignant thyroid lesion. The reasons behind this clinical phenomenon and the relationship between tongue SCC and PTC found in the cervical lymph nodes are unclear. Moreover, for surgeons, making the choice between thyroid surgery and follow-up is still a clinical dilemma. Of the 956 patients who underwent neck dissection owing to maxillofacial tumors from January 2011 through December 2017 at Second Xiangya Hospital of Central South University, 3 with tongue SCC presented with PTC in the cervical lymph nodes. Neither the preoperative physical examination nor ultrasonography after surgery showed substantial nodules in the thyroid glands of these patients, so none of them underwent thyroid surgery or chemoradiotherapy. At follow-up (1 to 6.5 years), we found no obviously malignant lesions in the patients' thyroid glands or related metastatic disease. Our study suggests that tongue SCC may not affect the occurrence and development of PTC in the cervical lymph nodes. For patients with tongue SCC presenting with PTC in the cervical lymph nodes, it is not necessary to carry out thyroid surgery immediately if ultrasonography shows no substantially malignant lesion in the thyroid gland. Nevertheless, conducting periodic follow-up is very important.
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Affiliation(s)
- Yu-Ming Xu
- Resident, Department of Stomatology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhao-Jian Gong
- Associate Professor, Department of Stomatology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Han-Jiang Wu
- Professor and Department Head, Department of Stomatology, Second Xiangya Hospital, Central South University, Changsha, China.
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6
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Incidental nodal metastasis of differentiated thyroid carcinoma in neck dissection specimens from head and neck cancer patients. The Journal of Laryngology & Otology 2017; 131:368-371. [PMID: 28244844 DOI: 10.1017/s002221511700024x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Occult differentiated thyroid carcinomas are not uncommon. The initial presentation of a thyroid carcinoma is often detection of a metastatic cervical lymph node. METHODS A retrospective review was performed of the medical records of 304 patients who underwent neck dissection between 1996 and 2008 for squamous cell carcinoma of the head and neck. RESULTS Ten patients (3.3 per cent) had nodal metastasis originating from papillary thyroid cancer. All of these patients underwent thyroidectomy and post-operative 131iodine radiometabolic therapy. No patient developed a thyroid tumour after surgery. CONCLUSION Despite its metastatic spread, thyroid cancer does not affect the overall prognosis of patients who are already being treated for a more aggressive malignancy. However, in otherwise healthy patients, it is worth treating this second malignancy to avoid potential complications related to local disease or metastatic thyroid cancer.
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Périé S, Torti F, Lefevre M, Chabbert-Buffet N, Jafari A, Lacau St Guily J. Incidental cervical metastases from thyroid carcinoma during neck dissection. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133:383-386. [DOI: 10.1016/j.anorl.2016.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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8
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Triantafyllou A, Williams MD, Angelos P, Shah JP, Westra WH, Hunt JL, Devaney KO, Rinaldo A, Slootweg PJ, Gnepp DR, Silver C, Ferlito A. Incidental findings of thyroid tissue in cervical lymph nodes: old controversy not yet resolved? Eur Arch Otorhinolaryngol 2016; 273:2867-75. [PMID: 26459007 PMCID: PMC5525538 DOI: 10.1007/s00405-015-3786-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 09/14/2015] [Indexed: 12/21/2022]
Abstract
The clinical significance of papillary or follicular thyroid tissue incidentally discovered in cervical lymph nodes during pathological assessment of neck dissections for non-thyroid cancers of the upper aero-digestive tract is critically reviewed. Special emphasis is given to controversies over normal-looking, nodal, thyroid follicles. Arguments for and against the benign nature of these follicles are considered together with processes that could be involved in their formation. The admittedly limited evidence suggests that benign, thyroid follicular inclusions rarely occur in cervical lymph nodes. Histological criteria that could be helpful in recognizing the inclusions, which include assessing their extent in conjunction with the size of the node, are discussed. Finally, an algorithm based on collaboration between specialists, correlating histological findings with imaging and loco-regional control of the upper aero-digestive tract cancer, is suggested for the management of patients with incidentally discovered, nodal thyroid tissue.
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Affiliation(s)
- Asterios Triantafyllou
- Oral and Maxillofacial Pathology, School of Dentistry, University of Liverpool and Pathology Department, Liverpool Clinical Laboratories, Liverpool, UK
| | - Michelle D Williams
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Angelos
- Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Jatin P Shah
- Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William H Westra
- Departments of Pathology and Otolaryngology-Head and Neck Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Jennifer L Hunt
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | - Pieter J Slootweg
- Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Douglas R Gnepp
- University Pathologists, Providence, RI and Fall River, MA, USA
| | - Carl Silver
- Departments of Surgery and Otolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy.
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9
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Olthof DC, Bun RJ, Dutrieux RP, Houdijk APJ. An unexpected finding in the resection specimen of a carcinoma of the oral cavity: A case report. Int J Surg Case Rep 2015; 19:55-9. [PMID: 26710330 PMCID: PMC4756081 DOI: 10.1016/j.ijscr.2015.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/01/2015] [Accepted: 12/13/2015] [Indexed: 11/11/2022] Open
Abstract
The occurrence of two synchronous, primary cancers is rare. Thyroid carcinoma is incidentally found in the resection specimen after surgery for head and neck cancer in 0.3–1.9% of the patients. A papillary thyroid carcinoma was found coincidentally in lymph nodes recovered after a ‘commando’ procedure for carcinoma of the oral cavity. A tailor made therapeutic approach of incidental thyroid gland carcinoma in head and neck cancer depends on prognosis and life expectancy.
Introduction The occurrence of two synchronous, primary cancers is rare. Thyroid carcinoma is incidentally found in the resection specimen after surgery for head and neck cancer in 0.3–1.9% of the patients. Presentation of case In this report, we describe the case of a 72-year-old patient in whom a primary (synchronous) papillary thyroid carcinoma was found coincidentally upon pathologic examination of lymph nodes recovered from the cervical neck lymph node dissection specimen after a ‘commando’ procedure for carcinoma of the oral cavity. Discussion and conclusion There is no gold standard concerning treatment of the incidentally discovered thyroid gland carcinoma. The decision to perform surgery depends on the life expectancy of the patient, whether the thyroid gland demonstrates clinical or radiologic lesions, the already completed treatment for the head and neck cancer and should always be adjusted to the specific patient.
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Affiliation(s)
- D C Olthof
- Department of Surgery, Medical Center Alkmaar, Postbus 501, 1800 AM Alkmaar, The Netherlands.
| | - R J Bun
- Department of Head and Neck surgery, Medical Center Alkmaar, Postbus 501, 1800 AM Alkmaar, The Netherlands.
| | - R P Dutrieux
- Department of Pathology, Medical Center Alkmaar, Postbus 501, 1800 AM Alkmaar, The Netherlands.
| | - A P J Houdijk
- Department of Surgery, Medical Center Alkmaar, Postbus 501, 1800 AM Alkmaar, The Netherlands; Trial Center Holland Health, Alkmaar, The Netherlands.
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10
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Primary papillary carcinoma arising from ectopic thyroid tissue in the cervical lymph node: A case report. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2015. [DOI: 10.1016/j.ajoms.2014.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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11
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Abstract
BACKGROUND Coincident thyroid and head and neck squamous cell carcinomas are rare. This paper presents a case of synchronous laryngeal squamous cell carcinoma, follicular thyroid carcinoma and micropapillary thyroid carcinoma. METHODS A PubMed search was performed for articles describing synchronous thyroid and head and neck squamous cell carcinomas, using the search terms 'thyroid cancer', 'cancer of the head and neck', 'synchronous' and 'synchronous neoplasm'. RESULTS The literature suggests that the head and neck squamous cell carcinoma stage is a better predictor of outcome than the extent of surgical treatment of the thyroid gland in synchronous malignancies. CONCLUSION The decision regarding surgical treatment of the thyroid in synchronous thyroid and head and neck squamous cell carcinomas should take several factors into account. The head and neck squamous cell carcinoma stage is the strongest predictor of outcome, although patient-related factors and the location of malignant thyroid tissue may also affect management.
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12
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Gilbert MR, Kim S. Incidental thyroid cancer found during surgery for head and neck squamous cell carcinoma. Otolaryngol Head Neck Surg 2012; 147:647-53. [PMID: 22714422 DOI: 10.1177/0194599812451559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To quantify the incidence of occult thyroid cancer encountered during neck dissection in patients with head and neck squamous cell carcinoma (HNSCC), to discuss the management of these patients, and to assess the need for further treatment of the incidentally discovered thyroid cancer. STUDY DESIGN Case series with chart review. SETTING University-based tertiary care hospital. METHODS The authors retrospectively reviewed 2538 neck dissections performed at their institution over a 15-year period. Twenty-nine patients had an incidental pathologic finding of thyroid cancer at surgery. The authors reviewed demographics, diagnoses, histopathology, initial and subsequent management, and outcome. RESULTS Well-differentiated thyroid cancer (WDC) was found in every case in this cohort. Fifteen patients died during the period of the study (2.4-year follow-up), with 14 patients still alive (4.3-year follow-up). Seven patients, all of whom are still alive, received further treatment for their thyroid cancer: 2 with completion thyroidectomy, 2 with I-131 ablation, and 3 with both. There was no clinical evidence of recurrence of thyroid cancer in any of the patients who died, and none died as a result of thyroid cancer. In addition, none of the patients still alive have biopsy-proven evidence of thyroid cancer recurrence. CONCLUSION None of the patients in this cohort died as a result of their thyroid disease, and none of the patients had evidence of recurrence of their WDC during the follow-up period. The results suggest that further management of occult WDC discovered in patients receiving neck dissections for HNSCC is not necessary.
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Affiliation(s)
- Mark R Gilbert
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA
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13
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Kr A, Sebastian P, Somanathan T, George NA, Jayasree K. Significance of incidentally detected thyroid tissue in lymph nodes of neck dissections in patients with head and neck carcinoma. Int J Surg Pathol 2012; 20:564-9. [PMID: 22674918 DOI: 10.1177/1066896912449042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The incidental discovery of thyroid tissue in lymph nodes of neck dissections performed for a separate primary head and neck cancer is an unusual clinical entity. Careful screening of large number of lymph nodes in the neck dissection specimens by the pathologist is critical in picking up such cases. There is controversy regarding clinical significance of such incidentally detected thyroid tissue in cervical nodes as to whether these represent benign inclusions or whether they represent metastatic focus of an underlying thyroid cancer. The appropriate clinical approach in such cases is less clear because it occurs in the context of another malignancy, usually squamous cell carcinomas with a more aggressive potential. MATERIALS AND METHODS On reviewing the records of 1602 neck dissections done in patients with head and neck cancers over the years 2007-2011, this study identified 5 patients with incidentally detected thyroid tissue with features of malignancy in cervical lymph nodes. Subsequent thyroidectomies done in 4 cases showed primary thyroid cancer. CONCLUSION The study's results emphasize the need for the clinician to do an accurate reevaluation and follow-up of patients with incidental occult metastasis for detection of primary thyroid tumor. A thorough sampling and screening of lymph nodes in neck dissection specimens by the pathologist is also essential. Incidentally discovered thyroid tissue in cervical lymph nodes need not always be benign inclusions. Aggressive therapy, however, may not be needed in all cases.
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Affiliation(s)
- Anila Kr
- Regional Cancer Centre, Thiruvananthapuram, Kerala, India.
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14
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Luna M. Pathology of Neck Dissections. SURGICAL PATHOLOGY OF THE HEAD AND NECK, THIRD EDITION 2008:1135-1146. [DOI: 10.3109/9781420020373-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Yamamoto T, Tatemoto Y, Hibi Y, Ohno A, Osaki T. Thyroid Carcinomas Found Incidentally in the Cervical Lymph Nodes: Do They Arise From Heterotopic Thyroid Tissues? J Oral Maxillofac Surg 2008; 66:2566-76. [DOI: 10.1016/j.joms.2008.06.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Revised: 01/05/2008] [Accepted: 06/16/2008] [Indexed: 10/21/2022]
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16
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Elias da Cruz Perez D, Paes de Almeida O, de Abreu Alves F, Paulo Kowalski L. Metastases of well-differentiated thyroid and oral squamous cell carcinoma to the same neck lymph node. Pathol Res Pract 2008; 204:143-5. [DOI: 10.1016/j.prp.2007.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Revised: 09/27/2007] [Accepted: 10/22/2007] [Indexed: 11/17/2022]
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17
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Veras E, Sturgis EM, Luna MA. Heterotopic parathyroid inclusion in a cervical lymph node. Head Neck 2007; 29:1160-3. [PMID: 17615563 DOI: 10.1002/hed.20647] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND During the pathologic examination of neck dissection specimens, unexpected findings within the lymph nodes may be discovered. Such findings may include benign epithelial inclusions, a second primary tumor, or chronic inflammatory diseases. METHODS We report a case of a 59-year-old man who underwent a laryngectomy and bilateral neck dissection for a right transglottic squamous carcinoma of the larynx. During the procedure, a large lymph node measuring 2.5 x 2.2 x 0.8 cm was found at the right level IV. RESULTS Histologic examination of the neck dissection specimen revealed benign parathyroid inclusions in the enlarged lymph node. The heterotopic cells expressed parathyroid hormone. This case represents a unique example of heterotopic parathyroid inclusions in a cervical lymph node. CONCLUSION Parathyroid tissue should be included in the differential diagnosis of cervical intranodal epithelial inclusions.
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Affiliation(s)
- Emanuela Veras
- Department of Pathology and Laboratory Medicine, The University of Texas Medical School at Houston, Texas, USA
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18
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Guzzo M, Quattrone P, Seregni E, Bianchi R, Mattavelli F. Thyroid carcinoma associated with squamous cell carcinoma of the head and neck: which policy? Head Neck 2007; 29:33-7. [PMID: 16983696 DOI: 10.1002/hed.20474] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thyroid carcinoma occurring as a second primary associated with head and neck squamous cell carcinoma (HNSCC) is unusual. The clinical management of thyroid cancer in such cases has been debated. METHODS Between 1975 and 2004, we collected 33 cases. The associated thyroid carcinoma was diagnosed either during or as a consequence of surgery planned as head and neck cancer treatment. RESULTS The associated thyroid carcinoma was never seen to recur. Five-year overall survival was 41%. Disease-free survival after 40 and 66 months was 11.1% and 5.6%, respectively. CONCLUSIONS We consider the treatment of thyroid cancer to be complete when the thyroid gland, either with or without lymph nodes, has been included in the specimen obtained during surgery for HNSCC. In the group of cases in which associated thyroid carcinoma was only found within the neck lymph nodes and the thyroid gland has not been treated, we discourage further surgical treatment or radioactive iodine therapy.
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Affiliation(s)
- Marco Guzzo
- Otorhinolaryngology Unit, Istituto Nazionale Tumori, Milan, Italy
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19
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Lin ZM, Chang YL, Lee CY, Wang CP, Hsiao TY. Simultaneous typical carcinoid tumour of larynx and occult papillary thyroid carcinoma. The Journal of Laryngology & Otology 2007; 122:93-6. [PMID: 17359556 DOI: 10.1017/s0022215107006494] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractTypical carcinoid tumour of the larynx is extremely rare. We report the case of a 43-year-old man initially diagnosed with typical carcinoid tumour of the larynx, presenting with a foreign body sensation in his throat. Coincidentally, an occult papillary thyroid carcinoma was diagnosed, following detection of a suspicious lymph node on pre-operative imaging studies, and confirmation by neck dissection and subsequent total thyroidectomy. Following surgery and radioiodine therapy for these cancers, the patient was alive, well and free of disease two years later. Typical carcinoid tumour of the larynx with a synchronous occult papillary thyroid carcinoma has not previously been reported. The optimal treatment strategy for this case is also discussed.
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Affiliation(s)
- Z-M Lin
- Department of Otolaryngology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan
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20
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León X, Sancho FJ, García J, Sañudo JR, Orús C, Quer M. Incidence and significance of clinically unsuspected thyroid tissue in lymph nodes found during neck dissection in head and neck carcinoma patients. Laryngoscope 2005; 115:470-4. [PMID: 15744160 DOI: 10.1097/01.mlg.0000157841.63283.87] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS The objectives were to quantify the incidence of clinically unsuspected thyroid tissue in cervical lymph nodes encountered during neck dissection in patients with head and neck carcinoma, to describe the location and histological aspect of these inclusions, and to assess their clinical significance. STUDY DESIGN Retrospective study. METHODS The histological records of 1123 neck dissections in 752 patients with head and neck carcinoma were reviewed. In cases with thyroid inclusions, the pathological diagnosis was reviewed and an immunohistochemical study against thyroglobulin and calcitonin was carried out. RESULTS Clinically unsuspected thyroid tissue was found in lymph nodes in 11 of the 752 patients with head and neck carcinoma treated with neck dissection. In five cases, the thyroid inclusion was compatible with a metastases of an occult papillary thyroid carcinoma. In the other six cases, a collection of thyroid follicles without malignant characteristics was found beneath the lymph node capsule. These latter cases were considered benign thyroid inclusions. A thyroidectomy was performed in three of the patients with lymph node metastases of the papillary carcinoma. An occult papillary carcinoma was found in only one case. The other two patients had been treated previously with radiotherapy for an early-stage glottic carcinoma. Immunohistochemical study did not find calcitonin-positive cells within the benign thyroid inclusions. After a follow-up period ranging from 1.2 to 8.2 years, no patient had any kind of local, regional, or distant relapse related to the thyroid disease. CONCLUSION The incidence of unsuspected thyroid tissue in lymph nodes of patients with head and neck carcinoma treated with neck dissection was 1.5%. Both lymph node metastases of a papillary carcinoma and benign thyroid inclusions were found. The study results suggest that the incidental finding of thyroid tissue in the lymph nodes during a neck dissection in patients with head and neck carcinoma does not necessarily indicate the need for aggressive therapy.
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Affiliation(s)
- Xavier León
- Department of Otolaryngology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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21
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Sheahan P, Hafidh M, Toner M, Timon C. Unexpected findings in neck dissection for squamous cell carcinoma: Incidence and implications. Head Neck 2004; 27:28-35. [PMID: 15459919 DOI: 10.1002/hed.20110] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND During the pathologic examination of neck dissections, unexpected pathologic findings may occasionally be encountered. These pathologic findings may simulate malignant disease and/or have implications on the already complicated management of patients with head and neck cancer. METHODS We retrospectively reviewed 202 consecutive patients with a preoperative diagnosis of squamous cell carcinoma (SCC), who underwent 307 neck dissections performed by a single surgeon and examined by a single pathologist. RESULTS Ten patients had an unexpected finding. These included metastatic papillary thyroid carcinoma, leukemia, lymphoma, Warthin's tumor, and tuberculosis. Two of three patients with benign-appearing thyroid tissue within lymph nodes received no further treatment, and both remained well beyond 6 years. Four patients succumbed to SCC; none died from the incidentally discovered pathologic findings. CONCLUSIONS Unexpected pathologic findings may be present in more than 3% of neck dissections. Although this is usually indolent, with the underlying SCC remaining the main prognostic determinate, it may significantly complicate postoperative management.
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MESH Headings
- Adenolymphoma/pathology
- Adenolymphoma/therapy
- Aged
- Aged, 80 and over
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/secondary
- Carcinoma, Papillary/surgery
- Carcinoma, Squamous Cell/surgery
- Cricoid Cartilage/pathology
- Female
- Head and Neck Neoplasms/surgery
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Lymphatic Metastasis
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/therapy
- Male
- Middle Aged
- Neck Dissection
- Retrospective Studies
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/secondary
- Thyroid Neoplasms/surgery
- Thyroidectomy
- Tuberculosis, Lymph Node/drug therapy
- Tuberculosis, Lymph Node/pathology
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Affiliation(s)
- Patrick Sheahan
- Department of Otolaryngology, St. James Hospital, 17 Hampton Square, Navan Road, Dublin 7, Ireland.
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22
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Resta L, Piscitelli D, Fiore MG, Di Nicola V, Fiorella ML, Fiorella AM, Altavilla A, Marzullo A. Incidental metastases of well-differentiated thyroid carcinoma in lymph nodes of patients with squamous cell head and neck cancer: eight cases with a review of the literature. Eur Arch Otorhinolaryngol 2003; 261:473-8. [PMID: 15546174 DOI: 10.1007/s00405-003-0722-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The examination of a large series of cervical lymph nodes in patients with head and neck cancer revealed the presence of incidental metastases of occult thyroid carcinoma in eight patients, of which six cases were squamous cell carcinoma of glottic and supraglottic sites of the larynx and two cases were pyriform sinus and tongue carcinomas. Three patients had two lymph nodes and the remaining patients had one lymph node each involved. The nodal chains affected were the jugular (n=5; level IV), Kuttner (level II), supraomohyoid (level III) and supraclavicular (level VI). In four cases, a subtotal thyroidectomy or unilateral lobectomy was performed during laryngectomy (for surgical reasons) or after histologic nodal examination; a minimal focus of thyroid papillary carcinoma was detected in one patient. Three of eight patients died from recurrence of the squamous cell carcinoma; no case presented clinical evidence of thyroid malignancy. The differential diagnosis from benign thyroid heterotopia was based on the presence of minimal nuclear atypia. The choice of treatment of patients with a coexisting neoplasm characterized by poor prognosis is difficult, and contrasting opinions exist regarding the use of radical thyroidectomy and the subsequent management. As reported in the literature (66 cases), the more aggressive squamous cell carcinoma will determine the prognosis of these patients; in fact, only one of the referred cases died of cerebellar metastases of the thyroid cancer. Our results emphasize the importance of an accurate re-evaluation and follow-up of patients with incidental occult metastases for detection of a primary thyroid tumor. In the general population, this incidental nodal involvement may be related to a minimal occult thyroid carcinoma.
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Affiliation(s)
- Leonardo Resta
- Department of Pathological Anatomy and Genetics, University of Bari Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy.
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23
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Ansari-Lari MA, Westra WH. The prevalence and significance of clinically unsuspected neoplasms in cervical lymph nodes. Head Neck 2003; 25:841-7. [PMID: 12966508 DOI: 10.1002/hed.10304] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Histopathologic scrutiny of surgical pathology specimens can uncover unexpected but important pathologic processes that might not (yet) be clinically apparent. We suspect that cervical lymph nodes removed from patients with known cancers of the head and neck might occasionally harbor clinically unsuspected neoplasms. METHODS We reviewed the pathology reports of all patients who had undergone cervical lymph node dissections at our institution between 1984 and 2001 to determine the prevalence of occult metastatic thyroid cancer and other clinically unsuspected tumors. The medical records were reviewed to obtain follow-up information when histologic examination disclosed some significant finding that was unsuspected on clinical grounds. RESULTS Of the 1337 patients who underwent cervical lymphadenectomy during the 17-year period, 27 (2.0%) had at least one lymph node harboring an unanticipated finding that raised the concern of a clinically unsuspected neoplasm. Sixteen (1.2%) of these patients had conclusive histologic evidence of an unexpected neoplasm, including 6 patients (0.4%) with malignant lymphomas (low-grade B cell, n = 5; high-grade B cell, n = 1) and 10 patients (0.7%) with metastatic papillary thyroid carcinomas. An additional 11 patients (0.8%) had lymph nodes harboring "benign" thyroid inclusions or psammoma bodies. Four of these 11 patients underwent thyroidectomy, but thyroid cancer was not detected in the ipsilateral thyroid. Only one patient died as a consequence of the incidentally discovered neoplasm. CONCLUSIONS To the degree that our study population is reflective of the adult population at large, at least 1% of adults harbor malignant neoplasms in their cervical lymph nodes. Although this statistic seems alarmingly high, most of these neoplasms are indolent and do not undergo unrelenting progression to clinically overt malignancies.
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Affiliation(s)
- M Ali Ansari-Lari
- Department of Pathology, The Weinberg Building, The Johns Hopkins Medical Institutions, Room 2242, 410 N. Broadway, Baltimore, Maryland 21231, USA
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24
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Okura M, Tamaki Y, Furukawa S, Matsuya T. Bilateral multiple pulmonary metastases in a patient with double advanced cancer of the head and neck. Int J Oral Maxillofac Surg 2003; 32:430-2. [PMID: 14505631 DOI: 10.1054/ijom.2002.0339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A case of advanced gingival cancer is described. The cancer invaded into the mandible and skin of the cheek and was associated with cervical lymph node metastases, mediastinal lymph node metastases, and bilateral multiple pulmonary metastases. The patient received neoadjuvant chemoradiotherapy and local immunotherapy, followed by curative surgery for the primary and neck lesions. Histopathological examination of the primary cancer and the upper and middle cervical nodes (n = 7) indicated a diagnosis of squamous cell carcinoma. Sections of the lower cervical nodes (n = 5) revealed well-differentiated thyroid carcinoma, suggesting that the mediastinal and pulmonary lesions were of thyroid origin. After total thyroidectomy and mediastinal dissection followed by treatment with radioiodine, the multiple pulmonary nodules disappeared. There has been no evidence of recurrent tumour for 5 years.
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Affiliation(s)
- M Okura
- The First Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan.
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25
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Moore BA, Duncan IM, Burkey BB, Day T. Incidental metastatic papillary thyroid carcinoma in microvascular reconstruction. Laryngoscope 2002; 112:2170-7. [PMID: 12461335 DOI: 10.1097/00005537-200212000-00008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS Occult papillary thyroid carcinoma has a reported prevalence of 1% to 35% based on autopsy studies. Cervical lymphatic metastases from papillary thyroid carcinoma have been associated with a higher likelihood of recurrence with a questionable impact on survival. Without clinically evident disease in the thyroid or cervical nodes, management of these patients presents a treatment dilemma. We propose an individualized treatment plan for patients in whom metastatic papillary thyroid carcinoma is incidentally detected during neck exploration for other purposes. STUDY DESIGN Retrospective review and discussion of the literature. METHODS The clinical course of two patients with incidentally discovered metastatic papillary thyroid carcinoma to the cervical lymph nodes is described. Both patients had previously received head and neck irradiation in childhood and required free flap reconstruction of extensive skull base defects following extirpation of meningiomas. RESULTS Neck dissection specimens from levels I and II obtained during exposure of recipient vessels for microvascular tissue transfer revealed papillary thyroid carcinoma in both cases. The patients subsequently underwent total thyroidectomy, neck dissection, and postoperative radioactive iodine ablation of residual thyroid tissue. After 1 year of follow-up, both patients were without evidence of recurrent disease. CONCLUSIONS An individualized approach is justified to treat metastatic papillary thyroid carcinoma incidentally discovered during other procedures. The case reports underscore the importance of pathological analysis of surgical specimens obtained during head and neck reconstruction.
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Affiliation(s)
- Brian A Moore
- Vanderbilt Bill Wilkerson Center for Otolaryngology and Communication Sciences, Nashville, Tennessee, USA.
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26
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Coskun H, Erisen L, Tolunay S, Basut O, Onart S, Tezel I. Incidental association of thyroid carcinoma and squamous cell carcinoma of head and neck. Am J Otolaryngol 2002; 23:228-32. [PMID: 12105788 DOI: 10.1053/ajot.2002.124541] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE This study was carried out to address the dilemma of managing incidentally associated squamous cell carcinoma of the head and neck and thyroid carcinoma. MATERIALS AND METHODS The patient group consists of 229 consecutive cases of squamous cell carcinoma of the head and neck and who were treated surgically at the Uludag University School of Medicine Department of Otolaryngology over a four-year period between 1997 and 2000. RESULTS Among these patients, 3 had additional thyroid papillary carcinoma metastases (1.3%, 3/229) within the surgical specimens of the surgical procedures performed for squamous cell carcinoma of the head and neck. Complementary thyroidectomy was recommended but could not be performed in one of three cases because of the patient's refusal, and the primary focus of thyroid carcinoma could be found in only one of these two cases who had undergone complementary thyroidectomy. All three patients received postoperative radioactive iodine and thyroid hormone suppression, and all are free of disease after 49, 46, and 19 months of follow-up, respectively. CONCLUSIONS Management of thyroid carcinoma found incidentally during treatment of squamous cell carcinoma of the head and neck is still debatable, and all patients must be evaluated individually with regard to its benefit. Our limited experience suggests that total thyroidectomy may not be regarded as mandatory in managing these patients.
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Affiliation(s)
- Hakan Coskun
- Department of Otolaryngology-Head and Neck Surgery, Uludag University School of Medicine, Gorukle, Bursa, Turkey
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27
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Fliegelman LJ, Genden EM, Brandwein M, Mechanick J, Urken ML. Significance and management of thyroid lesions in lymph nodes as an incidental finding during neck dissection. Head Neck 2001; 23:885-91. [PMID: 11592236 DOI: 10.1002/hed.1128] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidental discovery of thyroid lesions in lymph nodes during a lymph node dissection performed for a separate primary head and neck tumor is an unusual clinical entity. Its discovery has led to controversy regarding its significance and management. METHODS We identified five patients over the years 1991-1999 with this finding. All five patients were subsequently treated with a total thyroidectomy and a level VI lymph node dissection. RESULTS Pathological examination revealed three papillary carcinomas and level VI lymph node metastases in the two patients who had carcinoma in their thyroid glands. All five patients are presently free of their primary and thyroid disease on follow-up examinations. CONCLUSIONS These patients should be addressed with additional work-up and surgery if metastatic thyroid cancer is documented in the lymph node. We offer a diagnostic algorithm that may aid in further work-up and treatment in these unusual cases.
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Affiliation(s)
- L J Fliegelman
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai School of Medicine, Box 1189, One Gustave L. Levy Place, New York, New York 10029, USA
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28
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Abstract
BACKGROUND AND OBJECTIVES Radioactive iodine (RAI) therapy remains a primary treatment modality for metastatic thyroid carcinoma, but poor tumor uptake of the agent can limit its usefulness. While offering effective palliation, radiation therapy is not curative, and chemotherapy is even less useful. Surgical resection occasionally remains the only hope of offering a long-term cure in the case of isolated metastases. METHODS We describe 3 cases of thyroid cancer metastatic to the pelvic girdle that were unresponsive to RAI and other nonoperative therapies, which presented over a 15-year time period. The pelvic disease was the only site of active disease in all cases, and all 3 patients were suffering considerable pain. All 3 patients underwent internal hemipelvectomy with reconstruction in 2 cases using a pelvic bone allograft. RESULTS All 3 experienced symptomatic relief and early mobilization. While the infection rate was 100%, these all responded completely to operative debridement, irrigation, and antibiotics. One patient, found postoperatively to have a positive surgical margin, developed a local recurrence at 4 months and died. A second patient developed a local recurrence at 11 months and died. The third patient underwent a revision of her hip arthroplasty because of acetabular loosening after a fall 21 months postoperatively. She is alive, disease-free, and ambulatory with the aid of a cane 32 months after the original procedure. CONCLUSIONS We propose this surgical procedure in selected patients with metastatic pelvic thyroid cancer. It provides symptomatic relief with a chance for prolonged disease-free survival some patients.
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Affiliation(s)
- M J Boyle
- Department of Surgery, Division of Surgical Oncology, University of Miami School of Medicine, Miami, Florida, USA.
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29
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Coleman SC, Smith JC, Burkey BB, Day TA, Page RN, Netterville JL. Long-standing lateral neck mass as the initial manifestation of well-differentiated thyroid carcinoma. Laryngoscope 2000; 110:204-9. [PMID: 10680917 DOI: 10.1097/00005537-200002010-00004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyze the presentation, evaluation, and treatment of a subset of patients with well-differentiated thyroid carcinoma who present with a lateral neck mass and no palpable disease in the thyroid gland. STUDY DESIGN A retrospective review of all patients undergoing thyroidectomy for malignancy. METHODS A database of all thyroidectomies performed for malignancy by the Vanderbilt University Department of Otolaryngology-Head and Neck Surgery from 1992 to 1997 was created. Patients who presented with an isolated neck mass without evidence of palpable disease in the thyroid were selected for the study population. RESULTS There were 60 cases of thyroid malignancy, with 14 cases (23.3%) that presented as isolated lateral neck mass. The characteristics of this group (compared with the population of all thyroid malignancies) include younger age at presentation (37.7 +/- 15.2 y vs. 49.8 +/- 15.6 y; Student t test: P = .019) and long-standing presence of symptoms (27.4 +/- 39.6 mo vs. 3.6 +/- 3.9 mo; P = .023). These patients generally presented from a referring facility after having an excisional biopsy, which was 100% accurate. Fine-needle aspiration is becoming more useful and was 66.7% accurate. Histological examination revealed cancer in the thyroid gland in all patients, 11 cases of papillary carcinoma, 2 follicular carcinomas, and one medullary carcinoma The mean size of the primary focus was 10.9 +/- 8.7 mm, with 29% demonstrating bilateral disease and 14% demonstrating multifocal disease in the ipsilateral gland. The neck specimens revealed an average of 5.3 +/- 3.2 metastatic nodes in levels II-IV and 3.9 +/- 4.6 metastatic nodes in the paratracheal region. CONCLUSION Based on this patient population, the long-standing lateral neck mass in the young patient should raise the physician's index of suspicion for thyroid carcinoma Fine-needle aspiration should be used in conjunction with judicious excisional biopsy. The bilateral and multifocal nature of otherwise occult primary disease argues for total thyroidectomy in this setting.
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Affiliation(s)
- S C Coleman
- Department of Otolaryngology, Vanderbilt Bill Wilkerson Center for Otolaryngology and Communication Sciences, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2559, USA
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30
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Pitman KT, Johnson JT, Myers EN. Papillary thyroid carcinoma associated with squamous cell carcinoma of the head and neck: significance and treatment. Am J Otolaryngol 1996; 17:190-6. [PMID: 8827279 DOI: 10.1016/s0196-0709(96)90059-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Several studies in the recent literature would suggest that PTC found incidentally in the cervical lymphatics may be significant. By age alone, most of our head and neck cancer patients will fall into an intermediate risk group. There are also data to suggest that cervical metastasis from PTC may portend higher recurrence and mortality and that occult PTC may be a biologically significant situation. Many patients with cancer of the head and neck either have a good prognosis or don't follow the rules of their predicted prognosis, and for these patients living with the knowledge of an untreated thyroid, cancer may be an unnecessary concern. Other factors to be considered are that early PTC is probably curable disease and that there is real risk of transformation to higher grade or anaplastic cancer. Finally, there is no way to accurately predict the behavior of PTC. The decision to treat these cancers is ultimately made by the patient and the physician, and if there is a treatment with low morbidity that will alleviate concern of PTC recurrence, then this may outweigh the risk of treatment. Situations may exist when treating incidental PTC could be deferred. These include: a dismal prognosis for the head and neck primary when quality time outside of the hospital is the goal of the patient and the physician; or if the head and neck primary tumor requires external beam radiation therapy, because this may be adequate therapy for occult PTC. In summary, the scenario of PTC found incidentally in the neck treated for a head and neck SCC is unusual. Each patient will have a unique clinical situation based on the site and stage of the SCC, the age of the patient, and the treatment required for the SCC. Treatment options include total thyroidectomy, thyroid lobectomy, the administration of I131, and/or the use of external beam radiation, which must be weighed against the option of close clinical follow-up. In general, we recommend total thyroidectomy for PTC found incidentally in the cervical LNs for the reasons that have emerged from a recent review of the medical literature. We report 7 patients with synchronous head nad neck SCC and PTC who have all received surgical treatment for PTC (Table 1). In addition, we advocate postoperative radioiodine scanning with radioablation of metastatic or persistent PTC, or remnant ablation if uptake is greater than 2%. Our goal as head and neck surgeons should be to avoid inadequate therapy for incidental PTC.
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Affiliation(s)
- K T Pitman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, PA, USA
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Hefer T, Joachims HZ, Hashmonai M, Ben-Arieh Y, Brown J. Highly aggressive behaviour of occult papillary thyroid carcinoma. J Laryngol Otol 1995; 109:1109-12. [PMID: 8551134 DOI: 10.1017/s0022215100132165] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Occult papillary thyroid carcinoma is generally associated with an excellent prognosis. Distant metastasis of this tumour is extremely rare. A case of occult papillary thyroid carcinoma with metastases to the lungs, cervical lymph nodes, skeleton, and the brain is reported. The tumour expressed itself in extremely aggressive clinical behaviour and responded only partially to aggressive therapy. The controversial methods of treatment for occult papillary thyroid carcinoma are also discussed.
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Affiliation(s)
- T Hefer
- Department of Otorhinolaryngology, Rambam Medical Centre, Haifa, Israel
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32
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Falk SA. Metastatic thyroid cancer. Head Neck 1993; 15:357-8. [PMID: 8360060 DOI: 10.1002/hed.2880150415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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