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Chirurgia 2020 October;33(5):273-7

DOI: 10.23736/S0394-9508.19.05045-9


language: English

A case of thyroid carcinoma with cervical and mediastinal lymph node metastases that required mediastinal lymph node dissection via median sternotomy

Junzo SHIMIZU 1 , Makio MORIYA 1, Tadashi KAMESUI 1, Susumu MIYAMOTO 2, Toshiro NAGAYOSHI 3, Akitaka NONOMURA 4, Yoshihiko ARANO 5

1 Department of Chest Surgery, Hokuriku Central Hospital, Oyabe, Japan; 2 Department of Internal Medicine, Hokuriku Central Hospital, Oyabe, Japan; 3 Department of Radiology, Hokuriku Central Hospital, Oyabe, Japan; 4 Department of Pathology, Hokuriku Central Hospital, Oyabe, Japan; 5 Department of Surgery, KKR Hokuriku Hospital, Kanazawa, Japan

A 61-year-old woman presented to our hospital with a chief complaint of induration over the right thyroid lobe, which was suspected thyroid carcinoma. Neck computed tomography revealed a calcified lobulated mass measuring appropriately 2 cm in diameter in the right thyroid lobe along with multiple swollen lymph nodes (LNs) in an area covering both the lateral cervical regions and superior mediastinum. A biopsy from a right cervical LN led to a diagnosis of LN metastasis from papillary thyroid carcinoma. Total thyroidectomy and bilateral cervical and superior mediastinal LN dissection were performed via collar incision of the neck and median sternotomy. Although the recurrent laryngeal nerve coursed in a metastatic right paratracheal LN (III), the nerve was preserved as much as possible. Pathological examination revealed many intrathyroidal metastatic lesions in both the thyroid lobes, besides the primary focus (measuring 18x13 mm) in the right thyroid lobe. Of 34 dissected LNs, 18 harbored metastatic cancer cells. LN metastasis was detected in two superiors mediastinal LNs (XI). Immediately after surgery, Thyradin S (100mg/day) was administered, and thyroid hormone levels were maintained within the normal range. Although the patient has a slight voice hoarseness, it does not interfere with her daily life. The patient is now doing well at 17 months after surgery. In differentiated thyroid carcinoma with mediastinal LN metastasis, swollen LNs affect the respiratory tract and esophagus, affecting the quality of life. Thus, a combination of total thyroidectomy and mediastinal LN dissection is the first choice of treatment. When lung metastasis or regional LN recurrence is detected in the clinical course, oral radioactive iodine therapy should be administered. Furthermore, in patients with therapy-resistant lesions, tyrosine kinase inhibitors should be considered.

KEY WORDS: Thyroid cancer, papillary; Lymph node excision; Sternotomy

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