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Walker H, Speers J, Fabry M, Kadakia S. Metastatic oropharyngeal squamous cell carcinoma to the thyroid: A case report and review of literature. Am J Otolaryngol 2024; 45:104306. [PMID: 38669814 DOI: 10.1016/j.amjoto.2024.104306] [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: 03/23/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024]
Abstract
Oral squamous cell carcinoma (OSCC) with metastasis to the thyroid gland is exceedingly rare, with limited documentation within the literature. Between 1984 and 2023, only 40 cases of head and neck squamous cell carcinoma (SCC) with thyroid gland metastasis were described in published literature. Herein, we present a distinctive case of second primary oropharyngeal SCC with metastasis to the thyroid, detected during surveillance positron emission tomography (PET) scanning subsequent to negative margin resection and radiation therapy for SCC originating from the hard palate. The underlying mechanisms overseeing metastasis remain elusive, with hypotheses ranging from lymphatic drainage routes connecting the thyroid gland and retropharyngeal lymph nodes to hematologic dissemination. The management of metastases to the thyroid gland is multifaceted, encompassing approaches ranging from lobectomy and total thyroidectomy to palliative interventions. We present this atypical case alongside supportive pathological and radiological findings and a comprehensive review of this rare clinical entity to offer insight into its diagnosis and management.
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Affiliation(s)
- Hannah Walker
- Department of Surgery, Boonshoft School of Medicine, Wright State University, General Surgery Residency, Dayton, OH, USA.
| | - Jed Speers
- Boonshoft School of Medicine, Wright State University, Dayton, OH, USA.
| | - Milena Fabry
- Kettering Health Dayton Otolaryngology Surgery Residency, Dayton, OH, USA.
| | - Sameep Kadakia
- Department of Surgery, Director and Division Chief of Head and Neck Oncology and Reconstructive Surgery, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA.
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2
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Liu D, Nie X, Yu Q, Shang J. Risk factors for parapharyngeal and retropharyngeal metastases in papillary thyroid cancer: a matched case-control study. Eur Arch Otorhinolaryngol 2024; 281:1531-1539. [PMID: 38117306 DOI: 10.1007/s00405-023-08404-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/02/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE To analyze risk factors for parapharyngeal (PP) and retropharyngeal (RP) metastases in papillary thyroid cancer (PTC). METHODS A matched case-control study was conducted, comprising 130 age- and sex-matched cases of PTC. Among these cases, 50 had PP/RP metastases, 50 had central and/or lateral neck lymph node metastases, and 30 showed no lymph node metastases. Preoperative thyroid function test, computed tomography images, and postoperative pathological findings were collected. Associations between cases were assessed using univariate conditional logistic regression analysis, followed by multivariate conditional logistic regression analysis, and backward stepwise selection to predict risk factors for PP/RP metastases. RESULTS The study found that thyroglobulin was significantly associated with the development of PP/RP metastases [136.10(16.55-312.60) vs. 27.60(10.28-55.62) vs. 8.74(6.35-21.10) P < 0.001]. CONCLUSIONS The study concludes that thyroglobulin is a significant risk factor for PP/RP metastases in PTC. This finding emphasizes the importance of monitoring thyroglobulin levels in PTC patients to identify those at risk of developing PP/RP metastases.
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Affiliation(s)
- Daojing Liu
- Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, 310022, Zhejiang, China
- Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, Zhejiang, China
| | - Xilin Nie
- Department of Thyroid Surgery, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Science, No. 1 East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang, China
- Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, 310022, Zhejiang, China
| | - Qing Yu
- Department of Thyroid Surgery, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Science, No. 1 East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang, China
- Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, 310022, Zhejiang, China
| | - Jinbiao Shang
- Department of Thyroid Surgery, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Science, No. 1 East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang, China.
- Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, 310022, Zhejiang, China.
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3
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Tzelnick S, Tsai J, Hosni A, Goldstein DP, de Almeida JR, Yao CMKL. A Comparison of Transoral Versus Transcervical Surgical Approaches to Retropharyngeal Lymphadenectomy: A Scoping Review. J Otolaryngol Head Neck Surg 2024; 53:19160216241265092. [PMID: 39077912 PMCID: PMC11289808 DOI: 10.1177/19160216241265092] [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: 01/21/2024] [Accepted: 04/21/2024] [Indexed: 07/31/2024] Open
Abstract
IMPORTANCE A gap in knowledge exists concerning the functional outcomes and complications when comparing various surgical approaches for retropharyngeal lymph node (RPLN) metastases. OBJECTIVE To explore perioperative outcomes, functional outcomes, and complications associated in the treatment of RPLN metastases. DESIGN The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) protocol was used to conduct a scoping review of the PubMed and Scopus databases. REVIEW METHODS We systematically searched 2 databases from inception to January 2023 for articles examining the treatment approaches and postoperative outcomes in the retropharyngeal space. We included English records about surgical approaches, complications, functional outcomes for patients >18 years old with retropharyngeal lymphadenopathy. RESULTS One-hundred ninety-nine articles were identified, of which 17 were included in the analysis. Three studies assessed RPLN dissection in the postradiation setting. We identified limited knowledge about functional outcomes and complications following surgery for retropharyngeal lymphadenopathy. Overall, acute postoperative dysphagia was documented in 35/170 patients (20.5%). However, the assessment of dysphagia was limited, and not described in the majority of studies. The overall rate of postoperative neuropathy and hematoma were 4.1% and 4.7%, respectively. No postoperative hematomas were documented in the transcervical approach. CONCLUSION Our findings underscore the need for further research on postoperative outcomes following RPLN dissection. We recommend further studies focusing on objective swallow assessments and long-term outcomes of either surgical approaches.
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Affiliation(s)
- Sharon Tzelnick
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology—Head and Neck Surgery, Princess Margaret Cancer Center—University Health Network, Toronto, ON, Canada
| | - Jillian Tsai
- Department of Radiation Oncology, Princess Margaret Cancer Center—University Health Network, Toronto, ON, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Center—University Health Network, Toronto, ON, Canada
| | - David P. Goldstein
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology—Head and Neck Surgery, Princess Margaret Cancer Center—University Health Network, Toronto, ON, Canada
| | - John R. de Almeida
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology—Head and Neck Surgery, Princess Margaret Cancer Center—University Health Network, Toronto, ON, Canada
| | - Christopher M. K. L. Yao
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology—Head and Neck Surgery, Princess Margaret Cancer Center—University Health Network, Toronto, ON, Canada
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4
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Campagnoli M, Masnaghetti D, Rosa MS, Paganelli E, Garzaro M, Aluffi Valletti P. Parapharyngeal Metastasis of Papillary Carcinoma of Thyroid Gland: A Case Report and a Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13081426. [PMID: 37189526 DOI: 10.3390/diagnostics13081426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
Papillary carcinoma is the most frequently encountered differentiated thyroid carcinoma. Usually, metastasis occurs along lymphatic pathways in the central compartment and along the jugular chain. Nevertheless, lymph node metastasis in the parapharyngeal space (PS) is a rare but possible event. In fact, a lymphatic pathway has been identified that connects the upper pole of the thyroid and the PS. We describe the case of a 45-year-old man with a two-month history of a right neck mass. He underwent a complete diagnostic path that highlighted the presence of a parapharyngeal mass associated with the presence of a thyroid nodule suspected to be malignant. The patient underwent surgery (thyroidectomy and removal of the PS mass that was found to be a metastatic node of papillary thyroid carcinoma). The aim of this case is to underline the importance of detecting these kinds of lesions. Nodal metastasis in PS from thyroid cancer is a rare occurrence that is not easily detectable by a clinical examination until the metastasis reaches a considerable dimension. Computed tomography (CT) and magnetic resonance imaging (MRI) permit early identification, but unfortunately, these are not usually employed as a first-level imaging technique in patients with thyroid cancer. The treatment of choice is surgery with a transcervical approach that allows for better control of the disease and of the anatomical structures. Non-surgical treatments are usually reserved for patients with advanced disease, with satisfactory results.
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Affiliation(s)
| | | | - Maria Silvia Rosa
- ENT Department, University of Piemonte Orientale, 28100 Novara, Italy
| | - Edoardo Paganelli
- ENT Department, Michele e Pietro Ferrero Hospital, 12060 Verduno, Italy
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5
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Mechera R, Maréchal-Ross I, Sidhu SB, Campbell P, Sywak MS. A Nod to the Nodes: An Overview of the Role of Central Neck Dissection in the Management of Papillary Thyroid Carcinoma. Surg Oncol Clin N Am 2023; 32:383-398. [PMID: 36925192 DOI: 10.1016/j.soc.2022.10.012] [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: 03/15/2023]
Abstract
Lymph node metastasis in thyroid cancer is common and associated with an increased risk of locoregional recurrence (LRR). Although therapeutic central neck dissection is well established, prophylactic central node dissection (pCND) for microscopic occult nodal involvement is controversial and recommendations are based on low-level evidence. The potential benefits of pCND such as reducing LRR and re-operation, refining staging, and improving surveillance are enthusiastically debated and the decision to perform pCND must be weighed up against the increased risks of complications.
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Affiliation(s)
- Robert Mechera
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, St. Leonards, New South Wales 2065, Australia; Clarunis, University Hospital Basel, Spitalstrasse 21, Basel 4031, Switzerland; Endocrine and Breast Surgery, St. George Hospital, Gray Street, Kogarah, New South Wales 2217, Australia.
| | - Isabella Maréchal-Ross
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, St. Leonards, New South Wales 2065, Australia
| | - Stan B Sidhu
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, St. Leonards, New South Wales 2065, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales 2006, Australia
| | - Peter Campbell
- Endocrine and Breast Surgery, St. George Hospital, Gray Street, Kogarah, New South Wales 2217, Australia
| | - Mark S Sywak
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, St. Leonards, New South Wales 2065, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales 2006, Australia
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6
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López F, Al Ghuzlan A, Zafereo M, Vander Poorten V, Robbins KT, Hamoir M, Nixon IJ, Tufano RP, Randolph G, Pace-Asciak P, Angelos P, Coca-Pelaz A, Khafif A, Ronen O, Rodrigo JP, Sanabria Á, Palme CE, Mäkitie AA, Kowalski LP, Rinaldo A, Ferlito A. Neck Surgery for Non-Well Differentiated Thyroid Malignancies: Variations in Strategy According to Histopathology. Cancers (Basel) 2023; 15:cancers15041255. [PMID: 36831604 PMCID: PMC9954150 DOI: 10.3390/cancers15041255] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/04/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Lymph node metastases in non-well differentiated thyroid cancer (non-WDTC) are common, both in the central compartment (levels VI and VII) and in the lateral neck (Levels II to V). Nodal metastases negatively affect prognosis and should be treated to maximize locoregional control while minimizing morbidity. In non-WDTC, the rate of nodal involvement is variable and depends on the histology of the tumor. For medullary thyroid carcinomas, poorly differentiated thyroid carcinomas, and anaplastic thyroid carcinomas, the high frequency of lymph node metastases makes central compartment dissection generally necessary. In mucoepidermoid carcinomas, malignant peripheral nerve sheath tumors, sarcomas, and malignant thyroid teratomas or thyroblastomas, central compartment dissection is less often necessary, as clinical lymphnode involvement is less common. We aim to summarize the medical literature and the opinions of several experts from different parts of the world on the current philosophy for managing the neck in less common types of thyroid cancer.
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Affiliation(s)
- Fernando López
- Head and Neck Surgery, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, University of Oviedo, CIBERONC, 330011 Oviedo, Spain
- Correspondence: ; Tel.: +34-985108000
| | - Abir Al Ghuzlan
- Department of Biology and Pathology, Gustave Roussy Cancer Campus, University Paris-Saclay, 91190 Villejuif, France
| | - Mark Zafereo
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Vincent Vander Poorten
- Otorhinolaryngology Head and Neck Surgery and Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, 3000 Leuven, Belgium
- European Reference Network for Rare Adult Solid Cancers (EURACAN), 69008 Lyon, France
| | - K. Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL 62702, USA
| | - Marc Hamoir
- Department of Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, 1200 Brussels, Belgium
| | - Iain J. Nixon
- Department of Otorhinolaryngology Head and Neck Surgery, NHS Lothian, Edinburgh EH1 3EG, UK
| | - Ralph P. Tufano
- FPG Thyroid and Parathyroid Center, Division of Head and Neck Endocrine Surgery, The Sarasota Memorial Health Care System, Sarasota, FL 34239, USA
| | - Gregory Randolph
- Division of Otolaryngology-Endocrine Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, MA 02138, USA
| | - Pia Pace-Asciak
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON M5S, Canada
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL 60637, USA
| | - Andrés Coca-Pelaz
- Head and Neck Surgery, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, University of Oviedo, CIBERONC, 330011 Oviedo, Spain
| | - Avi Khafif
- A.R.M. Center of Otolaryngology-Head and Neck Surgery, Assuta Medical Center, Affiliated with Ben-Gurion University of the Negev, Tel Aviv 8410501, Israel
| | - Ohad Ronen
- Department of Otolaryngology—Head and Neck Surgery, Galilee Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Safed 5290002, Israel
| | - Juan Pablo Rodrigo
- Head and Neck Surgery, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, University of Oviedo, CIBERONC, 330011 Oviedo, Spain
| | - Álvaro Sanabria
- Department of Surgery, Universidad de Antioquia, CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín 050021, Colombia
| | - Carsten E. Palme
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O’Brien Lifehouse, Sydney, NSW 2050, Australia
- Faculty of Medicine and Health Sciences, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW 2050, Australia
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland
| | - Luiz P. Kowalski
- Department of Head and Neck Surgery, University of Sao Paulo Medical School, Sao Paulo 01246-903, Brazil
- Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center, Sao Paulo 01509-001, Brazil
| | | | - Alfio Ferlito
- Coordinator of International Head and Neck Scientific Group, 35125 Padua, Italy
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Ning Y, Qin S, Zeng D, Zhou Y, Ma L, Jiang M, Wang S. Papillary Thyroid Carcinoma with Extensive Cervical Lymph Node Metastasis and Initial Retropharyngeal Lymph Node Metastasis: A Case Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2022:1455613221138214. [PMID: 36330830 DOI: 10.1177/01455613221138214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
Papillary thyroid carcinoma (PTC) is prone to regional lymph node metastasis, which is more common in central lymph nodes and lateral cervical lymph nodes, and retropharyngeal lymph node metastasis (RLNM) is extremely rare. A male with PTC presented with extensive cervical lymph node metastasis and the initial RLNM. After full evaluation by preoperative imaging examination, the patient underwent total thyroidectomy + left central lymph node dissection + left neck lymph node dissection (II III IV V) + left retropharyngeal tumor resection, and the postoperative recovery was good without recurrence long-term complications, and no local recurrence and metastasis were found during one-year follow-up.
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Affiliation(s)
- Yudong Ning
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science andand Technology of China, Chengdu, China
| | - Sheng Qin
- Department of pathology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Dingfen Zeng
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science andand Technology of China, Chengdu, China
| | - Yuqiu Zhou
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science andand Technology of China, Chengdu, China
| | - Linjie Ma
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science andand Technology of China, Chengdu, China
| | - Man Jiang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science andand Technology of China, Chengdu, China
| | - Shaoxin Wang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science andand Technology of China, Chengdu, China
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8
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Russo E, Accorona R, Costantino A, Ferreli F, Malvezzi L, Pellini R, Colombo G, Wang CC, Spriano G, Mercante G, De Virgilio A. Different surgical approaches in retropharyngeal lymph nodes dissection in head and neck cancer: A systematic review. Auris Nasus Larynx 2022; 50:327-336. [PMID: 36184298 DOI: 10.1016/j.anl.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/21/2022] [Accepted: 09/01/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To perform a systematic review of studies analyzing different surgical approaches in the treatment of retropharyngeal lymph node (RPLN) metastases. METHODS The study was performed according to the PRISMA guidelines. RESULTS Twenty-one studies were included in the review, for a total of 481 patients (median age: 55.8 years; male: n = 279/393, 70.1%). The success rate by type of approach was 100% (n = 233/233), 93.5% (n = 29/31), 95.7% (n = 67/70), 100% (n = 14/14), 100% (n = 82/82), and 100% (n = 51/51) in the transcervical, endoscopic-assisted transcervical, TORS, transoral, maxillary swing and transmandibular cohorts, respectively. The complication rate by type of approach was 11.2% (n = 26/233), 48.4% (n = 15/31), 48.6% (n = 34/70), 14.3% (n = 2/14), 6.1% (n = 5/82) in the transcervical, endoscopic-assisted transcervical, TORS, transoral and maxillary swing cohorts, respectively. Oncological outcomes were reported by 17 studies (n = 404/481; 84%). Overall, after a median follow-up of 28 months (n = 339/481; IQR 23-40.5), no evidence of disease (NED) was found in 238 patients (58.9%), recurrence at the RPLNs in 14 (3.5%), local recurrence in 22 (5.4%), regional recurrence in 23 (5.7%), locoregional recurrence in 16 (4%), distant metastases in 42 (10.4%), death from disease in 36 (8.9%), death from other cause in 23 (5.7%), and death from unspecified cause in 26 (6.4%). CONCLUSIONS Further prospective randomized controlled trials are needed to provide direct comparison between different approaches for RPLNs dissection.
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Affiliation(s)
- Elena Russo
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy.
| | - Remo Accorona
- Department of Otorhinolaryngology-Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Andrea Costantino
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Fabio Ferreli
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Luca Malvezzi
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Raul Pellini
- Department of Otolaryngology-Head & Neck Surgery, Regina Elena National Cancer Institute, via Elio Chianesi 53, Rome, Italy
| | - Giovanni Colombo
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Chen-Chi Wang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Speech Language Pathology & Audiology, Chung Shan Medical University, Taichung, Taiwan; Department of Otolaryngology-Head & Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Giuseppe Spriano
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Giuseppe Mercante
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Armando De Virgilio
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
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9
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Garas G, Roland NJ, Lancaster J, Zammit M, Manon VA, Davies K, Jones TM, De M, Holsinger FC, Prestwich RJD, Fleming JC. Novel Strategies for Managing Retropharyngeal Lymph Node Metastases in Head and Neck and Thyroid Cancer with Transoral Robotic Surgery (TORS). Ann Surg Oncol 2022; 29:7881-7890. [PMID: 35842533 DOI: 10.1245/s10434-022-12208-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/01/2022] [Indexed: 12/18/2022]
Abstract
Retropharyngeal metastases are encountered in a variety of head and neck malignancies, imposing significant surgical challenges owing to their distinct location and proximity to neurovascular structures. Radiotherapy is the recommended treatment in most cases owing to its oncological efficacy. However, retropharyngeal irradiation affects the superior pharyngeal constrictor muscles and parotid glands, with the potential for long-term dysphagia and xerostomia. A younger oropharyngeal and thyroid cancer patient demographic is trending, fueling interest in treatment de-escalation strategies. Consequently, reducing radiotoxicity and its long-term effects is of special relevance in modern head and neck oncology practice. Through its unique ability to safely extirpate these traditionally difficult-to-access retropharyngeal lymph nodes via a natural orifice, TransOral Robotic Surgery (TORS) can considerably lower the surgical morbidity of retropharyngeal lymph node dissection (RPLND), compared with current existing approaches. This review summarizes the latest developments in the field, exposing current research gaps and discusses specific clinical settings where TORS could enable treatment de-escalation. In early-stage node-negative oropharyngeal cancer, single-modality surgical treatment with TORS RPLND may improve risk stratification of metastasis and recurrence in this region. TORS RPLND is also a potentially viable treatment option in salvage of an isolated retropharyngeal node recurrence or in the primary setting of a thyroid malignancy with a single positive retropharyngeal node. In time, TORS RPLND may provide an alternative de-escalation strategy in these three scenarios. However, with the reported morbidities, further prospective trials with long-term follow-up data are required to prove oncological safety and functional benefits over existing strategies.
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Affiliation(s)
- George Garas
- Head and Neck Unit, Department of Otorhinolaryngology and Head and Neck Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, UK.
| | - Nick J Roland
- Liverpool Head and Neck Centre, Department of Otorhinolaryngology and Head & Neck Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Jeffrey Lancaster
- Liverpool Head and Neck Centre, Department of Otorhinolaryngology and Head & Neck Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Matthew Zammit
- Liverpool Head and Neck Centre, Department of Otorhinolaryngology and Head & Neck Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Victoria A Manon
- Department of Oral and Maxillofacial Surgery, The University of Texas at Houston, Houston, TX, USA
| | - Katharine Davies
- Liverpool Head and Neck Centre, Department of Otorhinolaryngology and Head & Neck Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Terry M Jones
- Liverpool Head and Neck Centre, Department of Otorhinolaryngology and Head & Neck Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Mriganka De
- Head and Neck Unit, Department of Otorhinolaryngology and Head and Neck Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, UK
| | - Floyd C Holsinger
- Department of Otorhinolaryngology and Head and Neck Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - Robin J D Prestwich
- Department of Clinical Oncology, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jason C Fleming
- Liverpool Head and Neck Centre, Department of Otorhinolaryngology and Head & Neck Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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10
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Riley K, Anzai Y. Imaging of Treated Thyroid and Parathyroid Disease. Neuroimaging Clin N Am 2021; 32:145-157. [PMID: 34809835 DOI: 10.1016/j.nic.2021.08.014] [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: 10/19/2022]
Abstract
The thyroid and parathyroid glands are endocrine structures located in the visceral space of the infrahyoid neck. Imaging plays a critical role in the evaluation of patients with thyroid cancer, both in the pre and posttreatment setting. Disorders of thyroid function, that is, hyperthyroidism and hypothyroidism, are also fairly common, although imaging utilization is less frequent with these conditions. Parathyroid dysfunction results in disordered calcium metabolism. Imaging is frequently applied in the preoperative assessment of these patients undergoing parathyroidectomy; however, routine imaging in the postoperative setting is uncommon. Parathyroid carcinoma is rare; however, imaging may be used in the pre and posttreatment setting.
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Affiliation(s)
- Kalen Riley
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N. University Boulevard, Room 0663, Indianapolis, IN 46202, USA.
| | - Yoshimi Anzai
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, 30 North 1900 East #1A071, Salt Lake City, UT 84132, USA. https://twitter.com/@yoshimianzai
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11
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Zhang Y, Wang K, Liu J, Xu S, Sun Y, Xu M, Wang X. Surgical management of parapharyngeal lymph node metastases from thyroid carcinoma with transcervical approach. Surgery 2021; 171:1233-1239. [PMID: 34711428 DOI: 10.1016/j.surg.2021.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 08/07/2021] [Accepted: 08/30/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Parapharyngeal lymph node metastasis is very rare in patients with thyroid carcinoma. In this study, we elucidated on the clinical features, diagnosis, surgical treatment, and outcomes for patients with parapharyngeal lymph node metastases from thyroid carcinoma. METHODS Patients with thyroid carcinoma who had been subjected to surgery through the transcervical approach at our institution between April 1999 and January 2019 were retrospectively enrolled in this study. RESULTS Parapharyngeal lymph node metastases were successfully resected through the transcervical approach in all the 97 patients. There were 32 treatment-naïve patients, while 65 patients had a history of treatment before parapharyngeal lymph node metastases. All 97 cases of parapharyngeal lymph node metastases were detected by enhanced CT scans. Lateral neck lymph nodes metastases were confirmed in 96 patients. Unexpected postoperative neurological side effects were reported in 11 (11%) patients, including dysphagia in 5 (5%) patients, Horner's syndrome in 2 (2%) patients, glossal deviation in 3 (3%) patients, and asymmetrical mouth in 1 (1%) patient. During the follow-up period, 6 of the 97 patients exhibited parapharyngeal lymph node recurrence (recurrence rate 6.2%). The incidence of distant metastases was 44.3% (43 out of 97). The 5- and 10-year disease-specific survival was 93.4% and 88.9%, respectively. CONCLUSION Parapharyngeal lymph node metastases should be considered in patients with widespread cervical lymph node metastases. Enhanced CT scan is one of the best methods for diagnosing such metastases. Surgical resection through the transcervical approach is an effective and safe option for patients with parapharyngeal lymph node metastases from thyroid carcinoma. Moreover, parapharyngeal lymph node metastasis is associated with distant metastases that may lead to poor prognosis.
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Affiliation(s)
- Ye Zhang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. https://twitter.com/yezhang1220
| | - Kai Wang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Liu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Siyuan Xu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Sun
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Xu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaolei Wang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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12
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Chasen NN, Wang JR, Gan Q, Ahmed S. Imaging of Cervical Lymph Nodes in Thyroid Cancer: Ultrasound and Computed Tomography. Neuroimaging Clin N Am 2021; 31:313-326. [PMID: 34243866 DOI: 10.1016/j.nic.2021.04.002] [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: 10/20/2022]
Abstract
Sonographic evaluation of cervical lymph nodes in patients with thyroid malignancy is important both for preoperative staging and for post-treatment surveillance, and contrast-enhanced computed tomography plays a complementary role. Knowledge of anatomy and surgical approaches, combined with an understanding of the various imaging features that distinguish malignant from benign lymph nodes, allows for accurate staging, thereby enabling complete surgical initial resection.
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Affiliation(s)
- Noah Nathan Chasen
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1482, Houston, TX 77030-4009, USA
| | - Jennifer Rui Wang
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1445, Houston, TX 77030-4009, USA
| | - Qiong Gan
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 0085, Houston, TX 77030-4009, USA
| | - Salmaan Ahmed
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1482, Houston, TX 77030-4009, USA.
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13
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Sandler ML, Xing MH, Levy JC, Chai RL, Khorsandi AS, Gonzalez-Velazquez C, Urken ML. Metastatic thyroid carcinoma to the parapharyngeal and retropharyngeal spaces: Systematic review with seven newly reported cases describing an uncommon presentation of a common disease. Head Neck 2020; 43:1331-1344. [PMID: 33295689 DOI: 10.1002/hed.26572] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 11/09/2020] [Accepted: 11/20/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Metastatic thyroid carcinoma to retropharyngeal and parapharyngeal (RP/PP) lymph nodes is rare. Literature suggests previous lateral neck dissection (LND) may alter patterns of lymphatic drainage in the neck, predisposing to these less common sites of spread. METHODS PRISMA-guided systematic search for all published cases detailing RP/PP metastases of well-differentiated thyroid carcinoma from 1970 to 2019. RESULTS Seventy articles were identified and 44 were included, along with seven cases treated at our institution, totaling 239 cases. Cases represented both retropharyngeal (60.7%) and parapharyngeal (39.3%) metastases identified in the initial (27.6%) and recurrent (72.4%) setting. CONCLUSION RP/PP metastases generally present in the recurrent setting. RP/PP metastases often represent high-risk disease, and surgical treatment is recommended.
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Affiliation(s)
- Mykayla L Sandler
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - Monica H Xing
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - Juliana C Levy
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - Raymond L Chai
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Azita S Khorsandi
- Department of Radiology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Camilo Gonzalez-Velazquez
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA.,Division of Endocrinology, Internal Medicine Department, Dr. Jose E. González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Mark L Urken
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
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14
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Asimakopoulos P, Shaha AR, Nixon IJ, Shah JP, Randolph GW, Angelos P, Zafereo ME, Kowalski LP, Hartl DM, Olsen KD, Rodrigo JP, Vander Poorten V, Mäkitie AA, Sanabria A, Suárez C, Quer M, Civantos FJ, Robbins KT, Guntinas-Lichius O, Hamoir M, Rinaldo A, Ferlito A. Management of the Neck in Well-Differentiated Thyroid Cancer. Curr Oncol Rep 2020; 23:1. [PMID: 33190176 DOI: 10.1007/s11912-020-00997-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW In this narrative review, we discuss the indications for elective and therapeutic neck dissections and the postoperative surveillance and treatment options for recurrent nodal disease in patients with well-differentiated thyroid cancer. RECENT FINDINGS Increased availability of advanced imaging modalities has led to an increased detection rate of previously occult nodal disease in thyroid cancer. Nodal metastases are more common in young patients, large primary tumors, specific genotypes, and certain histological types. While clinically evident nodal disease in the lateral neck compartments has a significant oncological impact, particularly in the older age group, microscopic metastases to the central or the lateral neck in well-differentiated thyroid cancer do not significantly affect outcome. As patients with clinically evident nodal disease are associated with worse outcomes, they should be treated surgically in order to reduce rates of regional recurrence and improve survival. The benefit of elective neck dissection remains unverified as the impact of microscopic disease on outcomes is not significant.
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Affiliation(s)
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Iain J Nixon
- Department of Otorhinolaryngology Head and Neck Surgery, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Jatin P Shah
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA
| | - Mark E Zafereo
- Head and Neck Endocrine Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Luiz P Kowalski
- Department of Otorhinolaryngology-Head and Neck Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil.,Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Dana M Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.,Laboratoire de Phonétique et de Phonologie, Paris, France
| | - Kerry D Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, Oviedo, Spain.,University of Oviedo-IUOPA, Oviedo, Spain.,Head and Neck Cancer Unit, CIBERONC, Madrid, Spain
| | - Vincent Vander Poorten
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, Leuven, Belgium
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación, Medellín, Colombia.,CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, University of Oviedo, Oviedo, Spain
| | - Miquel Quer
- Department of Otolaryngology-Head and Neck Surgery, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Surgery Department, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Francisco J Civantos
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - K Thomas Robbins
- Department of Otolaryngology Head and Neck Surgery, Southern Illinois University Medical School, Springfield, IL, USA
| | | | - Marc Hamoir
- Department of Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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