Metastatic spread of occult papillary carcinoma of the thyroid to the parapharyngeal space: a case report

Year 2003, Volume: 10 Issue: 6, 244 - 247, 24.12.2003

Tamer Erdem Murat Cem Miman Semih Öncel Bülent Mızrak

Abstract

Metastasis from thyroid carcinomas to the parapharyngeal space is very rare. A forty-year-old male presented with Pro­ gressive dysphagia and enlargement in the right upper neck.Examination showed medial displacement of the right palatine tonsil and the lateral oropharyngeal wall. A firm, submucosal mass measuring 4x3 cm was palpated. Computed tomogra- phy revealed a hypodense and heterogenic parapharyngeal mass with a calcified border. The mass was totally removed by a transcervical approach. Although frozen-section diagnosis was a benign lesion, histopathologic evaluation showed metas­ tasis of papillary thyroid carcinoma to the parapharyngeal lymph nodes. Total thyroidectomy and bilateral selective neck dissection were performed, after which the tumor turned out to be papillary microcarcinoma 0.8x0.8 cm in the right upper lobe of the thyroid gland. No locoregional recurrences or dis- tant metastasis were observed during a three-year follow-up.The differential diagnosis of parapharyngeal masses should include metastatic thyroid carcinomas, for which a lymphatic route has been suggested betvveen the thyroid gland and the parapharyngeal lymph nodes.

Keywords

Carcinoma, papillary/secondary/diagnosis, lymphatic Sys­tem, pharyngeal neoplasms/secondary/diagnosis/radiography, thy­roid neoplasms

Gizli tiroit papiller karsinomundan parafarenjeal alana metastatik yayılım: Olgu sunumu

Abstract

Tiroit karsinomlarından parafaranjeal alana yayılım çok nadirdir. İlerleyici yutma zorluğu ve boyun sağ üst kıs- mında flifllik flikayeti ile baflvuran 40 yaflında erkek has- tada, sağ tonsili ve orofarenjeal duvarı mediale iten 4x3 cm boyutlarında submulozal kitle palpe edildi. Bilgisayar- lı tomografide, sağ parafarenjeal bofllukta, 5x4x2.5 cm boyutlarında, hipodens, etrafı kalsifiye kitle saptandı. Kit- le transservikal yolla tümüyle çıkarıldı. Frozen-section in- celemesinde benign lezyon tanısı konmasına rağmen, çıkarılan örneğin histopatolojik değerlendirmesinde pa- piller tiroid karsinom metastazı belirlendi. Hastaya total tiroidektomi ve iki taraflı selektif boyun diseksiyonu uygu- landı. Ameliyat sonrası değerlendirmede tiroit bezinin sağ üst kutbunda 0.8x0.8 cm boyutlarında papiller mikro- karsinom saptandı. Hastanın üç yıllık izlemi sırasında lo- korejyonel ya da uzak metastazla karflılaflılmadı.Parafa- renjeal kitlelerin ayırıcı tanısına metastatik tiroit karsi- nomları da alınmalıdır. Tiroit bezi ile parafarenjeal lenf nodları arasında olduğu bildirilen lenfatik yol bu metas- tazların nedeni olabilir.

Keywords

Karsinom, papiller/sekonder/tanı, lenfatiksistem, farenjeal neoplazmlar/sekonder/tanı/radyografi, tiroit neoplazmları

References

• Lawson VG, LeLiever WC, Makerewich LA, Rabuzzi DD, Bell RD. Unusual parapharyngeal lesions. J Otolaryngol 1979;8:241-9.
• Shoss SM, Donovan DT, Alford BR. Tumors of the para- pharyngeal space. Arch Otolaryngol 1985;111 : 7 5 3 - 7 .
• Batsakis JG, Sneige N. Parapharyngeal and retropha- ryngeal space diseases. Ann Otol Rhinol Laryngol 1989;98(4 Pt 1):320-1.
• Ferrario F, Roselli R, Macchi A. Occult thyroid carcino- ma presenting as a parapharyngeal mass. J Laryngol Otol 1995;109:1204-6.
• Work WP, Hybels RL. A study of tumors of the para- pharyngeal space. Laryngoscope 1974;84:1748-55.
• Robbins KT, Woodson GE. Thyroid carcinoma present- ing as a parapharyngeal mass. Head Neck Surg 1985; 7:434-6.
• Lau WF, Lam KH, Wei W. Parapharyngeal space tumours. Aust N Z J Surg 1986;56:835-42.
• Pearlman SJ, Lawson W, Biller HF. Occult medullary carcinoma of the thyroid presenting as neck and para- pharyngeal metastases. Otolaryngol Head Neck Surg 1988;99:509-12.
• Carrau RL, Myers EN, Johnson JT. Management of tumors arising in the parapharyngeal space. Laryngoscope 1990;100:583-9.
• Sirotnak JJ, Loree TR, Penetrante R. Papillary carcino- ma of the thyroid metastatic to the parapharyngeal space. Ear Nose Throat J 1997;76:342-4.
• Saydam L, Kalcioglu T, Demirkiran A, Gurer M. Occult papillary thyroid carcinoma presenting as a parapharyngeal metastasis. Am J Otolaryngol 1999; 20:166-8.
• Som PM, Biller HF, Lawson W. Tumors of the para- pharyngeal space: preoperative evaluation, diagnosis and surgical approaches. Ann Otol Rhinol Laryngol Suppl 1981;90(1 Pt 4):3-15.
• Maran AG, Mackenzie IJ, Murray JA. The parapharyn- geal space. J Laryngol Otol 1984;98:371-80.