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Kim JK, Kim MJ, Choi SH, Choi SM, Choi HR, Lee CR, Kang SW, Lee J, Jeong JJ, Nam KH, Chung WY. Cystic Lateral Lymph Node Metastases From Papillary Thyroid Cancer Patients. Laryngoscope 2020; 130:E976-E981. [PMID: 32275332 DOI: 10.1002/lary.28631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/09/2020] [Accepted: 02/22/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES/HYPOTHESIS Papillary thyroid carcinoma (PTC) tends to metastasize rather early to local lymph nodes (LNs). Incidences of cystic LN metastases is relatively rare compared with that of solid LN metastases. Few studies have attempted to assess the characteristics in these patients. This study aimed to compare the clinicopathologic characteristics and surgical outcomes between patients with cystic LN metastases and those with solid LN metastases. STUDY DESIGN Retrospective cohort study. METHODS We retrospectively reviewed the data of 1,028 patients with N1b PTC who underwent bilateral total thyroidectomy with central compartment neck dissection and modified radical neck dissection between January 2005 and September 2011. Of these, 136 (13.2%) had cystic LN metastases and 892 (86.8%) had solid LN metastases. Clinicopathologic characteristics and surgical outcomes were compared between these two patient groups. RESULTS The proportion of patients with thyroid tumor multifocality was relatively higher in the cystic node cohort (19.9% vs. 12.7%, P = .048). The number of total metastatic LNs and positive lateral LNs was slightly higher in the cystic node cohort (11.3 ± 8.9 vs. 9.7 ± 7.5, P = .029 and 6.9 ± 6.3 vs. 5.5 ± 4.6, P = .018, respectively). The proportion of patients with recurrence was higher in the cystic node cohort (14.0% vs. 3.0%, P < .001). Multivariate analysis indicated that cystic nodes were a significant risk factor for recurrence (hazard ratio: 5.265, 95% confidence interval: 2.898-9.563). CONCLUSIONS This study demonstrates that cystic lateral LN metastases are associated with aggressive tumor behavior in PTC patients. and that their presence is a significant independent prognostic factor for disease-free survival. LEVEL OF EVIDENCE 2b Laryngoscope, 2020.
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Affiliation(s)
- Jin Kyong Kim
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Jhi Kim
- Department of Surgery, Samsung Medical Center, Seoul, South Korea
| | - Sun Hyung Choi
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Soon Min Choi
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Ryeon Choi
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Cho Rok Lee
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang-Wook Kang
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Jandee Lee
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong Ju Jeong
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Kee-Hyun Nam
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Woong Youn Chung
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
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Riju J, Thomas S. Submental nodal metastasis in papillary carcinoma of the thyroid. Indian J Cancer 2019; 56:356-358. [PMID: 31607708 DOI: 10.4103/ijc.ijc_279_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Papillary carcinoma of thyroid (PCT) commonly shows metastasis to central and lateral cervical compartment neck nodes. Submental nodes are rarely involved by PCT. Thus, its management is not clear. We report two young men who presented with submental nodal metastasis from PCT. Both underwent total thyroidectomy with central compartment neck dissection and modified radical neck dissection (MRND). Probable factors which might influence submental nodal metastasis are analyzed. We conclude that physicians should be aware of the possibility of submental nodal metastasis from PCT. A selective approach for neck dissection can be an alternative to MRND, reducing the morbidity in management of such cases.
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Affiliation(s)
- Jeyashanth Riju
- Department of Head and Neck Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Shaji Thomas
- Department of Head and Neck Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
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Saadi R, LaRusso S, Vijay K, Goldenberg D. Elastography as a potential modality for screening cervical lymph nodes in patients with papillary thyroid cancer: A review of literature. EAR, NOSE & THROAT JOURNAL 2018; 97:31-39. [PMID: 29493721 DOI: 10.1177/0145561318097001-224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Papillary thyroid cancer often presents with cervical lymph node involvement and has a high incidence of recurrence, which requires routine follow-up with ultrasound imaging. Elastography is a novel ultrasound technique that has been demonstrated to be effective clinically in detecting tissue pathology in areas such as the liver and breast. Preliminary data suggest that it may be effective in screening tissues in the neck for malignancy, specifically cervical lymph nodes. However, diagnostic criteria and elastographic techniques vary significantly among the studies we have reviewed, which all tend to focus on populations of patients with many different types of primary malignancies. Further research is required on the feasibility of creating standardized and reproducible clinical criteria in a specific patient population. To study the clinical utility of elastography in cervical lymph nodes, patients with diagnosed papillary thyroid carcinoma may serve as an ideal population because of their need for ultrasound surveillance and the propensity of papillary thyroid cancer to metastasize to and recur in cervical lymph nodes. We will review the limitations, techniques, and reported clinical utility of elastography on cervical lymph nodes and its potential as a screening modality for papillary thyroid cancer.
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Affiliation(s)
- Robert Saadi
- Division of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, 500 University Dr., H091, Hershey, PA 17033-0850, USA
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Minkara A, Dhanda-Patil R, Patil Y. Syncope caused by a pleomorphic adenoma: Case report and literature review. EAR, NOSE & THROAT JOURNAL 2018; 97:E23-E26. [PMID: 29493727 DOI: 10.1177/0145561318097001-206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Pleomorphic adenomas are considered the most common salivary gland tumors, although they rarely occur in the parapharyngeal space. To the best of our knowledge, this is the first case report of a parapharyngeal parotid pleomorphic adenoma causing syncope. A 57-year-old man was admitted for left-sided blurred vision, left-sided weakness, dysarthria, lightheadedness, and syncope. Upon his admission, an electrocardiogram showed sinus bradycardia, and computed tomography of the neck with contrast showed a large parapharyngeal mass involving the prestyloid compartment, leading to compression of blood flow through the internal carotid artery. The mass was biopsied via intraoral fine-needle aspiration, which revealed cytology consistent with pleomorphic adenoma. The mass was resected via a transcervical approach, and a total parotidectomy was performed. The patient's hypotensive and bradycardic episodes disappeared after surgery. Surgical pathology showed a benign pleomorphic adenoma with a hemorrhagic and necrotic center and without capsular invasion or malignant transformation.
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Affiliation(s)
- Anas Minkara
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, PO Box 670528, 231 Albert Sabin Way, Cincinnati, OH 45267-0528, USA
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