Case of Papillary Thyroid Carcinoma with Subclinical Lateral Lymph Node Metastasis Presenting as Recurrence
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Lateral neck metastasis is an independent risk factor of the loco-regional recurrence in papillarythyroid carcinoma (PTC). Ultrasonography (US) and computed tomography are frequentlyperformed to diagnose the lymph node (LN) metastasis. However, some metastatic LNs canremain after initial treatment and can present as regional recurrences. A 19-year-old womanwas diagnosed as having 1.99 cm PTC. No abnormal LNs was detected on preoperative CTand US. She underwent operation and radioactive iodine (RAI) therapy: seven months afterRAI therapy, thyroglobulin level was elevated. However, no metastatic LNs were detected onneck CT, US and positron emission tomography-CT. Neck exploration was performed andmetastatic PTC was diagnosed in bilateral level III and IV. A radiologist retrospectively reviewedthe neck CTs taken before the first surgery and the second surgery. There was no significantdifference in the LN appearances of two CTs. On both CT scans, all LNs were verysmall, homogenously enhanced, without calcification or cystic changes.
Abstract
Lateral neck metastasis is an independent risk factor of the loco-regional recurrence in papillarythyroid carcinoma (PTC). Ultrasonography (US) and computed tomography are frequentlyperformed to diagnose the lymph node (LN) metastasis. However, some metastatic LNs canremain after initial treatment and can present as regional recurrences. A 19-year-old womanwas diagnosed as having 1.99 cm PTC. No abnormal LNs was detected on preoperative CTand US. She underwent operation and radioactive iodine (RAI) therapy: seven months afterRAI therapy, thyroglobulin level was elevated. However, no metastatic LNs were detected onneck CT, US and positron emission tomography-CT. Neck exploration was performed andmetastatic PTC was diagnosed in bilateral level III and IV. A radiologist retrospectively reviewedthe neck CTs taken before the first surgery and the second surgery. There was no significantdifference in the LN appearances of two CTs. On both CT scans, all LNs were verysmall, homogenously enhanced, without calcification or cystic changes.
참고문헌 (15)
- Hay ID, "Papillary thyroid carcinoma", Endocrinol Metab Clin North Am, 19(3), pp.545~576 (1990)[DOI]
- Kupferman ME, "Patterns of lateral neck metastasis in papillary thyroid carcinoma", Arch Otolaryngol Head Neck Surg, 130(7), pp.857~860 (2004)[DOI]
- Wada N, "Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection", Ann Surg, 237(3), pp.399~407 (2003)
- Patron V, "Pattern of lateral neck metastases in N0 papillary thyroid carcinoma", BMC Cancer, 11, pp.8~ (2011)[DOI]
- Suh YJ, "Factors affecting the locoregional recurrence of conventional papillary thyroid carcinoma after surgery: a retrospective analysis of 3381 patients", Ann Surg Oncol, 22(11), pp.3543~3549 (2015)[DOI]
- Ito Y, "Prognostic values of clinical lymph node metastasis and macroscopic extrathyroid extension in papillary thyroid carcinoma", Endocr J, 61(8), pp.745~750 (2014)[DOI]
- Verburg FA, "Life expectancy is reduced in differentiated thyroid cancer patients <TEX>${\geq}$<", TEX> 45 years old with extensive local tumor invasion, lateral lymph node, or distant metastases at diagnosis and normal in all other DTC patients, 2013, pp.98(1), 172~180
- Kim E, "Preoperative diagnosis of cervical metastatic lymph nodes in papillary thyroid carcinoma: comparison of ultrasound, computed tomography, and combined ultrasound with computed tomography", Thyroid, 18(4), pp.411~418 (2008)[DOI]
- -fluoro-2-deoxy-D-glucose-positron emission tomography, "computed tomography, ultrasonography, and enhanced computed tomography alone in the preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma", World J Surg, 34(11), pp.2564~2569 (2010)[DOI]
- Wu LM, "The accuracy of ultrasonography in the preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma: a metaanalysis", Eur J Radiol, 81(8), pp.1798~1805 (2012)[DOI]
- Lee DW, "Roles of ultrasonography and computed tomography in the surgical management of cervical lymph node metastases in papillary thyroid carcinoma", Eur J Surg Oncol, 39(2), pp.191~196 (2013)[DOI]
- Rosario PW, "Ultrasonographic differentiation between metastatic and benign lymph nodes in patients with papillary thyroid carcinoma", J Ultrasound Med, 24(10), pp.1385~1389 (2005)[DOI]
- Ahn JE, "Diagnostic accuracy of CT and ultrasonography for evaluating metastatic cervical lymph nodes in patients with thyroid cancer", World J Surg, 32(7), pp.1552~1558 (2008)[DOI]
- Jeong HS, "Integrated 18F-FDG PET", CT for the initial evaluation of cervical node level of patients with papillary thyroid carcinoma: comparison with ultrasound and contrast-enhanced CT, 2006, pp.65(3), 402~407
- Som PM, "The varied presentations of papillary thyroid carcinoma cervical nodal disease: CT and MR findings", AJNR Am J Neuroradiol, 15(6), pp.1123~1128 (1994)