J Korean Thyroid Assoc.  2014 Nov;7(2):194-200. 10.11106/cet.2014.7.2.194.

Axillary Lymph Node Metastasis of Papillary Thyroid Carcinoma: A Case Report

• Koo EJ
• Lee MR

• KMID: 2095134
• DOI: http://doi.org/10.11106/cet.2014.7.2.194

Abstract

We report a case of axillary lymph node metastasis (LNM) as a recurrence of papillary thyroid carcinoma (PTC) in a 68-year-old male. The patient initially presented in 2009 with a 3.4x5.4 cm sized neck swelling and left cervical lymphadenopathy. He underwent total thyroidectomy and central compartment neck dissection (CCND) with left modified radical neck dissection (MRND). The pathological report confirmed PTC with metastasis of neck lymph node. On a regular follow up of positron emission tomography (PET), LNM was found on the right supraclavicular area and on the left axillary area. It was 17 months after the initial thyroid cancer had been diagnosed. The right MRND and left axillary lymph node dissections were performed in April of 2012. Pathological result confirmed metastatic PTC of left axillary lymph nodes. After recovery from the surgery, the patient got radioactive iodine therapy with I-131 180 mCi.

Keyword

Axillary lymph nodes metastasis; Papillary thyroid carcinoma

MeSH Terms

Aged
Follow-Up Studies
Humans
Iodine
Lymph Node Excision
Lymph Nodes*
Lymphatic Diseases
Male
Neck
Neck Dissection
Neoplasm Metastasis*
Positron-Emission Tomography
Recurrence
Thyroid Neoplasms*
Thyroidectomy
Iodine

Figure

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  Fig. 1. Neck CT showing large mass in left lower neck carotid space, metastatic lymphadenopathy and left thyroid nodule.

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  Fig. 2. I– 123 5 mCi whole body scan showing normal functioning thyroid tissue in both thyroid gland and cold nodule in left thyroid lobe.

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  Fig. 3. 151 mCi therapeutic whole body scan at 48 hours showing two intense accumulation of the I–131 in the mid thyroid bed and remnant pyramidal lobe, with a focal much less I–131 uptake in the left upper thyroid bed or neck lymph node.

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  Fig. 4. Diagnostic I–131 scan showing no longer iodine uptake in the thyroid bed.

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  Fig. 5. PET showing hypermetabolic metastatic lymph nodes in right suprclavicular (A) and left axillary area (B).

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  Fig. 6. Intraoperative finding of axillary lymph node dissection.

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  Fig. 7. The tumor shows papillary growths with numerous branches (H&E stain, x10) (A). The papillae of the tumor are lined by single layer or pseudostratified tall columnar cells with elongated nuclei (H&E stain, x200) (B).

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  Fig. 8. The therapeutic whole body scan reveals well uptake of residual thyroid tissue in both thyroid bed.

Reference

References

1. Ers V, Galant C, Malaise J, Rahier J, Daumerie C. Axillary lymph node metastasis in recurrence of papillary thyroid carcinoma: a case report. Wien Klin Wochenschr. 2006; 118(3-4):124–124.

2. Jaffer S, Goldfarb AB, Gold JE, Szporn A, Bleiweiss IJ. Contralateral axillary lymph node metastasis as the first evidence of locally recurrent breast carcinoma. Cancer. 1995; 75(12):2875–8.

3. Banzo J, Ubieto MA, Gonzalez C, Razola P, Tardin L, Andres A. et al. [Papillary thyroid carcinoma synchronous with breast cancer: an incidental finding in an (18)F-FDG PET-CT study carried out in a search for occult breast cancer]. Rev Esp Med Nucl Imagen Mol. 2012; 31(4):213–5.

4. Cummings AL, Goldfarb M. Thyroid carcinoma metastases to axillary lymph nodes: report of two rare cases of papillary and medullary thyroid carcinoma and literature review. Endocr Pract. 2014; 20(3):e34–7.

5. Koike K, Fujii T, Yanaga H, Nakagawa S, Yokoyama G, Yahara T. et al. Axillary lymph node recurrence of papillary thyroid microcarcinoma: report of a case. Surg Today. 2004; 34(5):440–3.

6. Nakayama H, Wada N, Masudo Y, Rino Y. Axillary lymph node metastasis from papillary thyroid carcinoma: report of a case. Surg Today. 2007; 37(4):311–5.

7. Krishnamurthy A, Vaidhyanathan A. Axillary lymph node metastasis in papillary thyroid carcinoma: report of a case and review of the literature. J Cancer Res Ther. 2011; 7(2):220–2.

8. Chiofalo MG, Losito NS, Fulciniti F, Setola SV, Tommaselli A, Marone U. et al. Axillary node metastasis from differentiated thyroid carcinoma with Hurthle and signet ring cell differentiation. A case of disseminated thyroid cancer with peculiar histologic findings. BMC Cancer. 2012; 12:55.

9. Kepenekci I, Demirkan A, Cakmak A, Tug T, Ekinci C. Axillary lymph node metastasis as a late manifestation of papillary thyroid carcinoma. Thyroid. 2009; 19(4):417–9.

10. Wada N, Duh QY, Sugino K, Iwasaki H, Kameyama K, Mimura T. et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg. 2003; 237(3):399–407.

11. Elboga U, Kalender E, Yilmaz M, Celen YZ, Aktolun C. Axillary lymph node metastasis of papillary thyroid carcinoma detected by FDG PET/CT in a thyroglobulin-positive patient with negative whole-body 131I scan. Clin Nucl Med. 2012; 37(11):1120–2.

12. Rouvière H. Anatomie des lymphatiques de L'homme. Paris: Masson;1932.

13. Mazzaferri EL, Young RL. Papillary thyroid carcinoma: a 10 year follow-up report of the impact of therapy in 576 patients. Am J Med. 1981; 70(3):511–8.