Int J Thyroidol.  2015 Nov;8(2):235-239. 10.11106/ijt.2015.8.2.235.

A Case of Cervical Retrotracheal Metastatic Papillary Thyroid Carcinoma Diagnosed by Endobronchial Ultrasonography with Transbronchial Needle Aspiration

• Noh WJ
• Nam SJ
• Oak CH
• Lee KD

• KMID: 2171243
• DOI: http://doi.org/10.11106/ijt.2015.8.2.235

Abstract

A 61-year-old woman who underwent total thyroidectomy for papillary thyroid carcinoma (PTC) five years previously referred for a cervical retrotracheal mass. The mass had intense fluorodeoxyglucose (FDG) uptake on positron emission tomography-computed tomography (PET-CT), and was thus thought to be malignant. Transcutaneous ultrasonography with fine needle aspiration (FNA) was not feasible, so we tried endobronchial ultrasonography (EBUS) with transbronchial needle aspiration (TBNA) to obtain a cytology specimen. After surgery, the mass was confirmed to be a metastatic lymph node from the previous PTC, confirming the TBNA results. Although the utility of EBUS-TBNA for evaluating mediastinal metastasis has been reported in a number of studies, few reports have addressed its utility in the cervical region. Here we report this unusual case of metastatic lymph node of PTC that recurred in the cervical retrotracheal area. It was found to exhibit esophageal muscular invasion, and was accurately diagnosed on EBUS-TBNA.

Keyword

Papillary thyroid carcinoma; EBUS-TBNA; Metastatic lymph node

MeSH Terms

Biopsy, Fine-Needle
Electrons
Female
Humans
Lymph Nodes
Middle Aged
Needles*
Neoplasm Metastasis
Thyroid Gland*
Thyroid Neoplasms*
Thyroidectomy
Ultrasonography*

Figure

• 

  Fig. 1. PET-CT and CT scan of retrotracheal mass. (A) PET-CT scan showed fluoro-deoxyglucose uptake in the retrotracheal mass (arrow). (B) CT scan showed well-cir-cumscribed enhancing mass (white arrow) with central low density adjacent to the eso-phagus (black arrow). The mass was compressing the trachea anteriorly.

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  Fig. 2. EBUS images. (A) A large mass (star) was visua-lized protruding into the pos-terior trachea wall in endob-ronchial view (A: anterior, P: posterior). (B) In EBUS image, 1×1 cm retrotracheal mass with a hypoechogenic ap-pearance was seen.

• 

  Fig. 3. Intraoperative view. (A) The mass (white arrow) was found to be grossly adherent to the trachea anteriorly and to the esophagus laterally. (B) The inner esophageal mucosa (black arrow) was intact after the mass was removed.

Reference

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