Abstract
Endotracheal metastasis is a rare situation, usually associated with malignancies of breast and gastrointestinal tract, specially colon. Papillary carcinoma of thyroid commonly disseminates through lymphatic channels and tracheal involvement through vascular route is rarely reported. Here, we report a case of tracheal metastasis from papillary carcinoma of thyroid. The patient responded to external beam radiation therapy with cobalt 60 beams in a dose of 44 Gy followed by a 16 Gy boost. The patient is under followup and is presently asymptomatic. This paper adds to the repertoire of evidence in treatment of endotracheal metastasis.
Highlights
Papillary thyroid carcinoma is known for their indolent nature and erratic behavior
Pathological examination of biopsy specimen from the tracheal lesion showed papillary carcinoma of the thyroid (Figure 2) and it positively stained with cytokeratin, thyroid transcription factor-1 (TTF-1), and thyroglobulin
The patient did not consent to radical surgery which would necessitate a permanent tracheostomy. He was treated with external beam radiotherapy (EBRT) with cobalt 60 teletherapy to whole neck up to 44 Gy in 22 fractions over four and a half weeks using parallel opposed portals
Summary
Papillary thyroid carcinoma is known for their indolent nature and erratic behavior. The disease commonly spreads to lymph nodes, often present at the time of diagnosis [1]. It is a notable fact that a patient may present with symptoms of upper airway obstruction in absence of any obvious thyroid swelling or lymph node enlargement. Such a situation requires differentiation from lung carcinoma, as there are significant clinicoradiological similarities [3]. A 40-year-old man was admitted under our care with stridor for five days He was in his usual health till 5 months prior to admission, when he had an episode of hemoptysis. The patient was a smoker (25 pack years) and had contact history of tuberculosis He did not complain of cough, shortness of breath, or chest pain.
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