Lymph Node Metastases in Papillary Thyroid Microcarcinoma: Case Report

Authors

DOI:

https://doi.org/10.34635/rpc.887

Keywords:

Carcinoma, Papillary, Lymph Nodes, Lymphatic Metastasis, Thyroid Neoplasms

Abstract

Papillary thyroid carcinoma is a frequent incidental finding after thyroidectomy and is associated with a good prognosis. The authors present a clinical case of a female 54-year-old patient who underwent total thyroidectomy for a non-toxic multinodular goiter with pathological diagnosis of incidental, bifocal, classic papillary microcarcinoma, with tall cell focus, at that time classified as pT3(m); R0, AJCC/TMN 7th edition, but a pT1b (m) R0, AJCC/TMN 8th edition, at the moment. At the 28th postoperative month, a 15 mm right supraclavicular nodule was detected, whose aspiration cytology confirmed papillary carcinoma metastasis. Neck dissection was performed, confirming a single cervical lymph node metastasis in right Vb level. Despite the excellent prognosis of papillary microcarcinoma, locoregional or distant metastasis can occur, so the therapy is not consensual and must be individualized. As described in the literature, there is an increased risk of lymph node metastasis in multifocal tumors and with capsule invasion, as seen in this case.

Downloads

Download data is not yet available.

References

1. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. Jan 2016;26(1):1-133.
2. Medas F, Canu GL, Cappellacci F, et al. Predictive Factors of Lymph Node Metastasis in Patients With Papillary Microcarcinoma of the Thyroid: Retrospective Analysis on 293 Cases. Front Endocrinol (Lausanne). 2020;11:551.
3. Rodrigues F, Limbert E, Marques AP, et al. [Treatment and follow up protocol in differentiated thyroid carcinomas of follicular origin]. Acta Med Port. Jan-Feb 2005;18(1):2-16.
4. Bernet V. Approach to the patient with incidental papillary microcarcinoma. J Clin Endocrinol Metab. Aug 2010;95(8):3586-92.
5. Akın Ş, Yazgan Aksoy D, Akın S, Kılıç M, Yetişir F, Bayraktar M. Prediction of central lymph node metastasis in patientswith thyroid papillary microcarcinoma. Turk J Med Sci. Dec 19 2017;47(6):1723-1727.
6. Kaliszewski K, Zubkiewicz-Kucharska A, Kiełb P, Maksymowicz J, Krawczyk A, Krawiec O. Comparison of the prevalence of incidental and non-incidental papillary thyroid microcarcinoma during 2008-2016: a single-center experience. World J Surg Oncol. Oct 10 2018;16(1):202.
7. Cecoli F, Ceresola EM, Altrinetti V, et al. Therapeutic Strategies and Clinical Outcome in Papillary Thyroid Microcarcinoma: A Multicenter Observational Study. Eur Thyroid J. Sep 2016;5(3):180-186.
8. Bartella I, Meyer F, Frauenschläger K, et al. Incidental diagnosis of the tall-cell variant of the papillary microcarcinoma of the thyroid gland requires completion lymphadenectomy: case report. Pol Przegl Chir. Jun 30 2017;89(3):40-43.
9. Goran M, Markovic I, Buta M, et al. The influence of papillary thyroid microcarcinomas size on the occurrence of lymph node metastases. J buon. Sep-Oct 2019;24(5):2120-2126.
10. Liu QF, Bian LL, Sun MQ, et al. A rare intrahepatic subcapsular hematoma (ISH) after laparoscopic cholecystectomy: a case report and literature review. BMC Surg. Jan 7 2019;19(1):3.
11. Zhang L, Wei WJ, Ji QH, et al. Risk factors for neck nodal metastasis in papillary thyroid microcarcinoma: a study of 1066 patients. J Clin Endocrinol Metab. Apr 2012;97(4):1250-7.
12. Zhang Q, Wang Z, Meng X, Duh QY, Chen G. Predictors for central lymph node metastases in CN0 papillary thyroid microcarcinoma (mPTC): A retrospective analysis of 1304 cases. Asian J Surg. Apr 2019;42(4):571-576.
13. Zheng X, Peng C, Gao M, et al. Risk factors for cervical lymph node metastasis in papillary thyroid microcarcinoma: a study of 1,587 patients. Cancer Biol Med. Feb 2019;16(1):121-130.
14. Anastasilakis AD, Polyzos SA, Makras P, et al. Papillary thyroid microcarcinoma presenting as lymph node metastasis--a diagnostic challenge: case report and systematic review of literature. Hormones (Athens). Oct-Dec 2012;11(4):419-27.
15. Melo M, da Rocha AG, Vinagre J, Batista R, Peixoto J, Tavares C, et al. TERT promoter mutations are a major indicator of poor outcome in differentiated thyroid carcinomas. J Clin Endocrinol Metab. 2014;99(5):E754-65.

Downloads

Published

2025-03-31

Issue

Vol. 58 No. 1 (2025): Jan./Mar.

Section

Clinical Case

License

Copyright (c) 2025 Portuguese Journal of Surgery

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Para permitir ao editor a disseminação do trabalho do(s) autor(es) na sua máxima extensão, o(s) autor(es) deverá(ão) assinar uma Declaração de Cedência dos Direitos de Propriedade (Copyright). O acordo de transferência, (Transfer Agreement), transfere a propriedade do artigo do(s) autor(es) para a Sociedade Portuguesa de Cirurgia.

Se o artigo contiver extractos (incluindo ilustrações) de, ou for baseado no todo ou em parte em outros trabalhos com copyright (incluindo, para evitar dúvidas, material de fontes online ou de intranet), o(s) autor(es) tem(êm) de obter, dos proprietários dos respectivos copyrights, autorização escrita para reprodução desses extractos do(s) artigo(s) em todos os territórios e edições e em todos os meios de expressão e línguas. Todas os formulários de autorização devem ser fornecidos aos editores quando da entrega do artigo.

Most read articles by the same author(s)