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Early papillary thyroid cancer with an unusually high lymphatic spread
Introduction Papillary thyroid cancer is a form of differentiated thyroid cancer. Metastatic spread occurs usually late and in most cases only to the central compartment lymph nodes in the neck. Through the case of a 39-year-old female patient will be shown that high rates of lymphatic spread can occur even at an early tumour stage.
Patient and Methods Following patient history, physical examination and diagnostic hemithyroidectomy on the right side alio loco, a completion total thyroidectomy on the left side and a CND Levels VI-VII on the right side were performed. In the subsequently performed nuclear medicine examination, a lateral lymphatic spread was detected in several nodes, so that a SND levels IIA-III-IV-VB was added to the treatment regime.
Results Surgical procedures: 1. First, a diagnostic right hemithyroidectomy was perfomed by our general surgical colleagues. A thyroid nodule measuring 38mm x 14mm x 10mm was found intraoperatively. Histopathology showed papillary thyroid cancer with a single lymph node metastasis.
2. Second, a completion total thyroidectomy on the left side with a CND Levels VI-VII on the right side were performed by head and neck surgeons. Several dark-coloured lymph nodes were found in the central compartment. Histopathology confirmed tumour spread in 10 of the 11 harvested central lymph nodes. During the workup for high-dose radioiodine therapy, several suspect lymph nodes were displayed in the lateral neck levels, which resulted in a lateral SND Levels IIA-III-IV-VB subsequently.
Conclusion Even in small papillary thyroid carcinoma with clinically normal cervical lymph nodes, a high rate of lymphatic spread can occur in the central compartments as well as in the lateral cervical lymph nodes.
10 June 2020 (online)
© Georg Thieme Verlag KG
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