Cervical metastasis of occult papillary thyroid carcinoma associated with epidermoid carcinoma of the larynx

Department of Otorhinolaryngology, Hospital Universitario Virgen de las Nieves, Granada, Spain.
ORL (Impact Factor: 0.88). 01/1999; 61(4):224-6. DOI: 10.1159/000027676
Source: PubMed


An occult, laterocervical papillary thyroid carcinoma tissue was found in a functional neck dissection for larynx cancer. The patient was a 76-year-old man with a history of smoking and alcohol ingestion who presented with a supraglottic carcinoma of the larynx located at the laryngeal surface of the epiglottis, left aryepiglottic fold, band and left ventricle with extension to the left vocal cord. Light microscopy showed a lymph node with a fibrous stroma with lymphoid follicles that presented a total substitution of the parenchyma by a papillary thyroid carcinoma. Although examination of the thyroid gland by seriated sections did not reveal any neoplasm, we argue that the papillary thyroid tissue is metastatic.

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    • "Although there are several reports of synchronous association between squamous cell carcinoma of the upper aero digestive tract and lymph node metastasis from occult PCT [7,8], extra nodal metastasis to the larynx and hypopharynx is not reported. We believe this to be the first report of extra nodal metastasis of papillary carcinoma thyroid to larynx and hypopharynx. "
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    ABSTRACT: Background Although direct infiltration of papillary carcinoma of thyroid to larynx, trachea and esophagus is well recognized, lymphatic and vascular metastases to larynx and hypopharynx have rarely been reported. Case report A case of loco-regionally advanced papillary carcinoma of thyroid metastasizing to the hypopharynx and aryepiglottic fold is presented Conclusions Papillary thyroid carcinoma (PCT) is known for their indolent nature and erratic behavior. PCT commonly spreads through lymphatics and vascular spread is rare. However, when occurs it is usually to bone, brain, lungs and soft tissue. Therapeutic decisions in advanced thyroid malignancies are usually difficult especially when there is extra-nodal spread of the tumor. A judicious combination of surgical clearance combined with radioablation is the key to the management of such tumors
    World Journal of Surgical Oncology 07/2003; 1(1):7. DOI:10.1186/1477-7819-1-7 · 1.41 Impact Factor
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    ABSTRACT: This study was carried out to address the dilemma of managing incidentally associated squamous cell carcinoma of the head and neck and thyroid carcinoma. 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. 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. 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.
    American Journal of Otolaryngology 07/2002; 23(4):228-32. DOI:10.1053/ajot.2002.124541 · 0.98 Impact Factor
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    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.
    Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 11/2004; 261(9):473-8. DOI:10.1007/s00405-003-0722-8 · 1.55 Impact Factor
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