Metastasis Of Papillary Carcinoma Research Articles

Killing capacity analysis of tumor-infiltrating cytotoxic lymphocytes and impact on lymph node metastasis in differentiated papillary carcinoma of thyroid with the BRAF V600E mutation

BackgroundCytotoxic lymphocytes (CLs) express potent toxins, including perforin (P) and granzyme-B (G), which brings about target cell death. The purpose of this study was to evaluate the killing capacity of tumor-infiltrating CLs by means of P and G analysis, and explore the association with lymph node metastasis in papillary carcinoma of thyroid (PTC) without Hashimoto’s thyroiditis (HT).MethodsInfiltration of lymphocytes in PTC was observed in frozen sections. Both fresh tumor tissues and paracancerous tissues with lymphocyte infiltration were collected and prepared into a single cell suspension. Flow cytometry was used to detect the percentages of CD3+P+, CD3+G+, CD8+P+, and CD8+G+ T lymphocytes (TLs) and CD16-CD56+P+ and CD16-CD56+G+ natural killer (NK) cells. Finally, we investigated differential expression of P and G in NK cells and cytotoxic T lymphocytes (CTLs) in paired tumor tissues (group T, n = 44) and paracancerous tissues (group N, n = 44) from patients with PTC with the BRAF V600E mutation. Furthermore, patients were divided into two groups according to whether cervical central lymph node metastasis (CCLNM) existed: group A (with lymph node metastases, n = 27) and group B (with nonlymph node metastases, n = 17). Patients were also divided into three groups according to the total number of positive CCLNM: group B, group C (with low-level lymph node metastases, less than 5, n = 17) and group D (with high-level lymph node metastases, no less than 5, n = 10).ResultsThe percentage of CD3+P+ CTLs was significantly higher in group N than in group T (P < 0.05). The percentage of CD8+G+ CTLs was significantly higher in group T than in group N (P < 0.05). The percentages of CD3+G+, CD16-CD56+P+and CD16-CD56+G+ NK cells showed no significant difference in either group T or group N (P > 0.05). The percentages of CD3+P+ CTLs in group A and group C were significantly higher in the paracancerous tissue than in the tumor tissue (P < 0.05). The percentages of CD8+G+ CTLs in group A and group C were significantly higher in the tumor tissues than in the paracancerous tissues (P < 0.05). The percentage of CD16-CD56+G+ NK cells in group D was significantly higher in the tumor tissues than in the paracancerous tissues (P < 0.05).ConclusionsThe killing capacity of infiltrating CLs in PTC differed between tumor tissues and paracancerous tissues. In cases with CCLNM, higher expression of CD16-CD56+G+ NK cells in tumor tissues may be associated with a high risk of lymph node metastasis.

Parapharyngeal Nodal Metastasis in Papillary Thyroid Carcinoma: Catching Early.

Metastasis to parapharyngeal space in papillary carcinoma of the thyroid is rare and often missed in routine clinical and radiological investigations. Although contrast CT /MRI can be done to locate the parapharyngeal lesion, the diagnosis of metastasis mostly deepened upon aspiration cytology, which is a challenge in difficult anatomical locations. Here, we have emphasized the management dilemma of parapharyngeal metastasis in papillary carcinoma of the thyroid. A 30-year-old female presented with multiple right-side neck swelling for two months. Ultrasonography of right thyroid showed TIRAD V and left thyroid showed TIRAD II. Aspiration cytology of the right thyroid showed Bethesda III and aspiration cytology revealed thyroid follicles. Due to the diagnostic ambiguity, contrast-enhanced CT scan was advised. It revealed a hypervascular lymph node in the parapharyngeal space besides multiple right cervical lymph nodes and later changed the treatment plan. - Metastasis to parapharyngeal space in Papillary carcinoma of the thyroid is rare and often missed on routine evaluation. Contrast-enhanced CT/MRI can be added as a primary investigation in challenging cases of suspicious malignancy of the thyroid.

Parapharyngeal Metastasis of Papillary Carcinoma of Thyroid Gland: A Case Report and a Review of the Literature

Papillary carcinoma is the most frequently encountered differentiated thyroid carcinoma. Usually, metastasis occurs along lymphatic pathways in the central compartment and along the jugular chain. Nevertheless, lymph node metastasis in the parapharyngeal space (PS) is a rare but possible event. In fact, a lymphatic pathway has been identified that connects the upper pole of the thyroid and the PS. We describe the case of a 45-year-old man with a two-month history of a right neck mass. He underwent a complete diagnostic path that highlighted the presence of a parapharyngeal mass associated with the presence of a thyroid nodule suspected to be malignant. The patient underwent surgery (thyroidectomy and removal of the PS mass that was found to be a metastatic node of papillary thyroid carcinoma). The aim of this case is to underline the importance of detecting these kinds of lesions. Nodal metastasis in PS from thyroid cancer is a rare occurrence that is not easily detectable by a clinical examination until the metastasis reaches a considerable dimension. Computed tomography (CT) and magnetic resonance imaging (MRI) permit early identification, but unfortunately, these are not usually employed as a first-level imaging technique in patients with thyroid cancer. The treatment of choice is surgery with a transcervical approach that allows for better control of the disease and of the anatomical structures. Non-surgical treatments are usually reserved for patients with advanced disease, with satisfactory results.

Cytopathology of the distant metastasis of papillary carcinoma of thyroid.

To describe the cytomorphological features at distant metastatic sites apart from lymph nodes in papillary thyroid carcinoma (PTC). A total of eight cytology cases from seven patients reported as metastatic papillary carcinoma of thyroid were reviewed including available clinical and radiological details. The details clinical and cytological features were studied. There were a total of five males and two female patients. Two of these patients presented with lung nodules, two patients had bony lesion and lesion in kidney respectively and one patient had both bony and soft tissue lesions. Pleural fluid and bronchoalveolar lavage were received from remaining two patients. Cytology smears revealed papillary clusters and sheets of tumor cells, having round to oval nuclei with pale powdery chromatin, inconspicuous nucleoli and scant to moderate amount of cytoplasm. Nuclear features such as longitudinal nuclear grooves, intranuclear cytoplasmic inclusions were seen in all but one case. Nuclear enlargement and overlapping were variably present. The diagnosis of metastatic PTC at uncommon locations is difficult. Since many of these locations are amenable to fine needle aspiration or exfoliative cytology evaluation, clinical awareness, and identification of classic cytomorphologic features can offer quick and accurate diagnoses. In cases with occult or unknown PTC presenting with metastases, cytomorphology may help in the prompt suggestion of detecting primary tumor in the thyroid.

Femoral metastasis of papillary carcinoma of the ovary -A rare incidental finding

Epithelial ovarian cancer normally spreads transcoelomically via the peritoneal cavity and then, in more advanced stages, to the intra-abdominal lymph nodes and the liver and lung parenchyma. Bone metastasis is an extremely rare initial presentation in patients with primary carcinoma of the ovary and is associated with poor prognosis. Herein we report a rare case of femoral metastasis of papillary carcinoma of the ovary in a 49-year-old female, who presented to the orthopaedics clinic with complaints of pain and swelling around the left knee joint since 2 months. X ray and MRI of left leg showed a diffuse soft tissue swelling and osteolytic lesions in the lower femur around the condyles with focal cortical destruction. Fine needle aspiration biopsy of the lesion was suggestive of metastatic adenocarcinoma. Subsequent ultrasonography of the lower abdomen showed a hypoechoic shadow in the left ovary. Local surgical excision with left oopherectomy was performed. After histopathologic and immunohistochemical examination from both the sites, a final diagnosis of primary papillary adenocarcinoma of the ovary with femoral metastasis was given. She was treated with 6 cycles of adjuvant combination chemotherapy of Paclitaxel 150 mg/m2and Cisplatin 50 mg/m2 and a good response was seen. This case is unique in presentation of bony femoral metastasis with silent epithelial ovarian carcinoma. Keywords: Bone, Femur, Metastasis, Ovarian cancer, Immunohistochemistry.

Цитологічні особливості багаторазово метастазуючих тиреоїдних папілярних карцином

Мета — комплексне цитологічне та імуноцитохімічне дослідження тиреоцитів пунктатів поопераційних реґіонарних метастазів папілярних тиреоїдних карцином із багаторазовим метастазуванням і порівняльний аналіз цитологічних характеристик первинних і повторних поопераційних метастазів у кожного пацієнта. Матеріал і методи. Цитоморфологічні та імуноцитохімічні дослідження з використанням моноклональних антитіл проти тиреоїдної пероксидази, тиреоглобуліну, антигену Кі‑67 проводили на матеріалі тонкоголкових аспіраційних пункційних біопсій 26 метастазів, виявлених у поопераційний період (після проведення тиреоїдектомії та радіойодтерапії), отриманих від 12 хворих на папілярний тиреоїдний рак із багаторазовим метастазуванням. Результати. За результатами дослідження фенотипових характеристик тиреоцитів пунктатів метастазів рецидивуючих папілярних карцином щитоподібної залози з повторним метастазуванням виявлено зміни цитологічних та імуноцитохімічних характеристик тиреоцитів у пунктатах повторних метастазів порівняно з такими первинних метастазів. Показано вірогідне зниження експресії тиреоїдної пероксидази та тиреоглобуліну та появу фенотипової гетерогенності популяції тиреоцитів (світлі клітини, клітини з макулами, оксифільні клітини) повторних метастазів порівняно з первинними. Висновок. У клітинах метастазів рецидивуючих папілярних карцином із повторним метастазуванням виявлено втрату ознак диференціації — вірогідне зниження експресії тиреоїдної пероксидази та тиреоглобуліну та появу фенотипової гетерогенності популяції тиреоцитів.

DIFFERENTIATED THYROID CARCINOMAS ASSOCIATED WITH CHRONIC THYROIDITIS: BIOLOGICAL AND CLINICAL PROPERTIES

To determine biological and clinical features of papillary and follicular thyroid carcinomas associated or not associated with chronic thyroiditis. The study was conducted by retrospective analysis of medical histories of 2,459patients with thyroid cancer. Tumor size, its category according to the TNM system, multi-focal properties of tumor growth, carcinoma invasiveness, as well as disease stage, rates of relapses and metastasis, and also cumulative survival rates were analyzed. The tumor size in patients with papillary or follicular carcinoma associated with thyroiditis was smaller compared to the patients without thyroiditis. In the first case, the invasion frequency into extrathyroid structure and into the capsule was also lower. Multi-focal growth of both carcinoma types was registered more frequently in the presence of thyroiditis. The frequency of papillary carcinoma metastasis to lateral cervical lymph nodes was lower in the presence of thyroiditis, the frequency being equal for metastasis into lymph nodes of the VI lymph outflow zone in both groups of patients (with and without thyroiditis). In the presence of thyroiditis, the frequency of distant papillary carcinoma metastasis was decreased, no metastases were detected in patients with follicular carcinoma. In the group of patients with papillary carcinoma there was found no relation between the presence of thyroiditis and disease stage, relapse rates, and mortality levels; however, the risk of follicular carcinoma relapse was significantly lower in patients with thyroiditis. The presence of chronic thyroiditis in papillary carcinoma patients showed a certain positive impact on the course of the disease, in particular, primary tumor growth, invasion, and metastasis. Such effect is even more expressed in the patients with follicular thyroid carcinoma.

NITRIC OXIDE SYNTHASE ACTIVITY AND ITS CONCENTRATION IN THE TISSUES OF HUMAN THYROID CARCINOMAS.

The study of the activity of the constitutive form of nitric oxide synthase (cNOS) revealed that in the papillary thyroid carcinomas it corresponded to that detected in unchanged extratumoral tissue, while the enzyme activity in follicular carcinoma was half lesser. At the same time, the activity of inducible nitric oxide synthase (іNOS) was higher in the papillary and follicular carcinomas. Such changes in the enzyme activity were associated with an increase in its level in papillary carcinomas, and with minor changes in follicular carcinomas. In medullary carcinomas the parameters under study corresponded to those in unchanged tissue, and in the papillary carcinoma metastases without changes in enzyme activity of nitric oxide formation, the level of the latter was much higher. Elevated levels of nitric oxide and іNOS activity in papillary thyroid carcinomas did not depend significantly on the aggression characteristics of the latter, being however absent in tumors of T4 category on a background of reduced cNOS activity and less expressed in tumors surrounded by the tissue in the presence of a chronic thyroiditis. Furthermore, in the papillary carcinomas of papillary or follicular structure nitric oxide level did not differ from the normal range, being slightly higher in tumors of solid or heterogeneous structure with presence of solid areas, whereas in carcinomas of papillary-follicular structure it was twice, and in tissue of solidinsular structure three times higher. іNOS hyperactivity was observed in the carcinomas of different structure, except for tumors of solid structure, in the tumor of which enzyme activity was within the normal range, and in tumor of solid-insular structure where it was significantly higher (as well as cNOS activity) compared with tumors of other structure. Nitric oxide generating system is involved in the transformation of thyroid cells and progression of tumor growth, including through apoptosis regulation, as shown by the results of an analysis of data obtained both in the present study and previously. The nature of such involvement in papillary thyroid carcinomas with different histological structure is different. Key words: nitric oxide; constitutive and inducible nitric oxide synthase; thyroid carcinoma; apoptosis.

Combined treatment of the highly differentiated cancer of thyroid gland: recombinant human thyrotropin-alpha is in the focus

Aim . An assessment of the effectiveness of treatment and also the detection of advantages of prescription of the recombinant human thyrotropin-alpha (rhTTH) in postoperative period in patients with the highly differentiated cancer of thyroid gland (HDCTG) comparing with traditional method of preparation (cancellation of the thyroid hormones) to the treatment using radioactive iodine. Methods . There was carried out an analysis of the treatment of 100 patients with HDCTG: the control group – 56 patients (standard tactics), the main group – 44 patients (the use of rhTTH). There was carried out the scanning of all the body in 48 hours after administration of 150 MBc 131 I, was detected the concentration of thyroglobulin and antibodies to it, the level of thyrotropic hormone, was carried out the ultrasound of neck and also questioning about the life quality. Results . The comparative analysis of the data of studied groups demonstrated the reliably less number of isotope accumulation nidi in persons whose preparation was carried out with the help of rhTTH, that is the absence of visible catch in 25 % of cases in patients from the category of low risk (in 5,7 times higher than in analogous cohort of the control group– 4,4 %) and in 7,1 % – in patients from the high risk group. The number of cases of the minimal visible catch 2,0 ng/ml was detected in 3,1 % of cases in the main group whereas in the control one – 13,1 %; within 1,0–2,0 ng/ml was detected reliably less often in the main group: 8,3 % in the low risk patients and 12,5 % – in the high risk ones comparing with the control group (28,6 % and 31,7 % respectively). The effective decrease of thyroglobulin level in 6–8 months after radioiodine therapy was detected in 22 (91,7 %) patients of the main low risk group and in 27 (84,4 %) – ones of the high risk that is reliably higher than in the control group (60,0 % and 53,7 % respectively, Р<0,01). In the main group was not observed any clinical relapse of disease or persistence of pathological tumor process, in the control group on the contrary – 2 clinical relapses (4,9 %) and 4 cases (9,7 %) of persistence of disease. In the main group nobody needed the repeated operation during 6 months after radioiodine therapy because of absence of the regional metastases of papillary carcinoma. The negative assessment of health was observed in 10,7 % of cases in the control group and was not fixed in the main one. The positive assessment of health was observed in 63,6 % of patient who took recombinant TTH comparing with the control group – 21,4 %. Conclusions . The research demonstrated that combined treatment of the group of patients with HDCTG with the use of rhTTH is reliably more effective comparing with the group of patients who were prepared to treatment with the radioactive iodine using traditional method. The received results ground by the new proofs the advantages of the use of recombinant human thyrotropin-alpha

リンパ節転移を伴う甲状腺癌を疑ったIgG4関連甲状腺炎（準確診群）の1切除例

We present a case of probably IgG4-related thyroiditis with lymphadenopathy. The patient was a 70-year-old Japanese female who was undergoing hemodialysis and had undergone a right hemi-thyroidectomy in 1989 due to carcinoma. In December 2010, an ultrasonography study revealed a hypoechoic small lesion in thyroid gland. When the patient was admitted to our hospital in November 2013, the lesion and regional lymph nodes had enlarged and we suspected that they were metastatic thyroid cancer. We performed a residual total thyroidectomy and regional lymph node dissection in August 2014. At that time, lymphoplasmacytic infiltration and fibrosis were observed histopathologically in thyroid tissue. Immunohistochemical studies revealed infiltrated lymphocytes and plasma cells were markedly IgG-positive, and the ratio of IgG4-positive to IgG-positive cells was over 40%. We therefore diagnosed the patient with IgG4-related thyroiditis. The cervical lymph nodes were metastases of papillary carcinoma from 25 years earlier. The patient remains well without any recurrences 33 months after the surgery.

Cervical Ectopic Thymic Tissue with Parathyroid Elements Mimicking Papillary Carcinoma Metastasis

Cervical Ectopic Thymic Tissue with Parathyroid Elements Mimicking Papillary Carcinoma Metastasis

Concordance study between one-step nucleic acid amplification and morphologic techniques to detect lymph node metastasis in papillary carcinoma of the thyroid

Tumor resection in papillary thyroid carcinoma (PTC) is often accompanied by lymph node (LN) removal of the central and lateral cervical compartments. One-step nucleic acid amplification (OSNA) is a polymerase chain reaction-based technique that quantifies cytokeratin 19 (CK19) messenger RNA copies. Our aim is to assess the value of OSNA in detection of LN metastases in PTC, in comparison with imprints and microscopic analysis of formalin-fixed, paraffin-embedded (FFPE) tissue. A total of 387 LNs from 37 patients were studied. From each half LN, 2 imprints were taken and analyzed with hematoxylin and eosin (H&E) and CK19 immunostaining. One half of the LN was submitted to OSNA and one half to FFPE processing and H&E and CK19 staining. For concordance analysis, every single LN was considered as a case. A group of 11 cases with discordant results between OSNA and H&E/CK19 FFPE sections were subjected to additional FFPE serial sectioning and H&E and CK19 staining. We found a high degree of concordance between the assays used, with sensitivities ranging from 0.81 to 0.95, and specificities ranging from 0.87 and 0.98. OSNA allowed upstaging of patients from pN0 to pN1, in comparison with standard pathologic analysis. Identification of a metastatic LN with more than 15000 CK19 messenger RNA copies predicted the presence of a second LN with macrometastasis (<5000 copies). In summary, the study shows that OSNA application in sentinel or suspicious LN may be helpful in assessing nodal status in PTC patients.

Frequency and pattern of central lymph node metastasis in papillary carcinoma of the thyroid isthmus.

The purpose of this study was to evaluate the frequency and pattern of central lymph node metastasis in isthmic papillary thyroid carcinoma (PTC). We compared the clinical and pathological data of 45 patients with a single isthmic PTC and 149 patients with a single PTC located in the unilateral thyroid lobe, all of whom underwent total thyroidectomy and bilateral central neck dissection. The rates of clinical, pathologic, and occult central lymph node metastasis were higher in the isthmus group than the non-isthmus group. Central lymph node metastasis in the pretracheal and bilateral paratracheal lymph nodes was more frequent in the isthmic PTC group than in the non-isthmus group. On multivariate analysis, isthmic location of the tumor was an independent risk factor for central lymph node metastasis. Complete bilateral central neck dissection should be considered for isthmic PTC because of the high rate of bilateral central lymph node metastasis, especially to pretracheal and bilateral paratracheal lymph nodes. © 2015 Wiley Periodicals, Inc. Head Neck 38: E412-E416, 2016.

Fine Needle Aspiration Biopsy of Thyroid Nodules: Diagnostic Value, Technical Aspects, Analysis of Results

The goal of the study was to determine diagnostic value of fine needle aspiration biopsy (FNAB) in detection of malignant thyroid tumors based on retrospective analyses of 40696 FNAB of patients with thyroid nodules. Results. Comparison of the results of FNAB with postoperative histological examination data from 3004 patients revealed that the rate of false positive cytopathological results was 1.2% and the rate of false negative results was 1.8%. The sensitivity reached 99.67%. The specificity of FNAB when taking into account follicular lesions dropped to 16.29%, while leaving follicular lesions - 94.29%. Cytological results of 49609 FNAB of patients with thyroid nodules according to Bethesda system were arranged as follows: noninformative results - 8%, benign nodules - 81.9% (colloid nodules - 71.6%, autoimmune thyroiditis - 10.2%, subacute thyroiditis and others - 0.02%), follicular lesions - 7.2% (follicular neoplasm - 7.1%, follicular lesion of indeterminate value - 0.1%), suspicious for malignancy - 0.02%, malignant tumor - 3%, among the latter papillary carcinoma - 93%. Malignant tumors, according to postoperative histological examination, were detected among the group with cytological diagnosis “follicular neoplasm” in 16.3% of cases. After performing FNAB of regional lymph nodes with suspicious ultrasound signs the metastases of papillary carcinoma were revealed in 24.6% of cases. Application of FNAB in clinical practice at our Center to all patients with thyroid nodules of 1 cm in size and larger resulted in increment of thyroid operations for oncological indications from 12.5% in 2004 to 53% in 2012. Conclusion. FNAB under ultrasound control is the most informative differential method for thyroid diseases, permitting to reveal primary and metastatic thyroid lesions. FNAB allow to evade nonobligatory diagnostic operations in many patients.

PP120: Synchronous appearance of metastasis of squamous-cell laryngeal carcinoma and papillary carcinoma of thyroid gland in the one neck lymphonode

Purpose In less than hundred cases were published until now synchronous appearance of squamous-cell and papillary carcinoma metastases within neck lymphonodes. In this presentation metastases of these cancers were detected within only one lymphonode. Material and methods At 72 years old man with subglottic laryngeal carcinoma and colloid thyroid nodule were performed total laryngectomy and thyroidectomy with bilateral selective neck dissection. Histologically was diagnosed laryngeal squamous-cell carcinoma (T4N0M0) and colloid thyroid gland goiter. After eight months one lymphonode on the neck left side was extirpated. Microscopical in one part of lymphonode it was found atypical squamous epithelium with extensive keratinization which corresponded to squamous-cell carcinoma and in the other part tissue composed of loose and edematous villi, partly fibrovascular stroma with atypical epithelial cells, such as ground-glass nuclei with visible notches corresponding to thyroid papillary carcinoma. The patient died 19 months after the first surgery. Results Head and neck squamous-cell carcinomas commonly occurring synchronously with well-differentiated thyroid cancer with the incidence of 5–12%. We have shown that it is possible synchronous occurrence of different metastatic cells within a single lymphonode. Most commonly affected are men ages between 50 and 60 years, exposed to risky behavior. In the symptomatology usually dominate symptoms related to advanced squamous-cell carcinoma of the head and neck, while thyroid gland cancers symptoms are usually subclinical. The co-occurrence of two different cancers metastases in lymphonodes is negative prognostic sign. Five-year survival of these patients was 41% usually determined by complications of the laryngeal cancer. Conclusions To consider the possibility of simultaneous occurrence of cancers of the larynx and thyroid gland is advisable during diagnostic evaluation of patients with laryngeal cancer to make thyroid gland evaluation in order to avoid repeated surgery.

Skull metastasis in papillary carcinoma of thyroid: A case report

Papillary thyroid carcinoma with metastasis to the skull is extremely rare. We report a case of unsuspected papillary thyroid carcinoma with skull metastasis. A 48-year-old female patient presenting with painless, pulsatile, progressively increasing swelling in the occipitoparietal region of the scalp approached for an X-ray of the skull. Ultrasound of palpable swelling in the neck revealed a heteroechoic lesion with increased vascularity. Foci of calcification were seen involving both lobes of the thyroid. Ultrasound of scalp showed a destructive mass in the skull with increased vascularity. Biopsy of thyroid lesions revealed branching papillae having a dense fibrovascular core covered by cuboidal epithelial cells with nuclei having a clear ground glass appearance. This case illustrates how isolated extensive skull metastasis can be found in papillary carcinoma patients without causing significant morbidity. Therefore, in the clinical course of thyroid papillary carcinoma, skull metastasis should be considered, and the patients should be meticulously investigated and followed up.

The Efficacy of Lateral Neck Sentinel Lymph Node Biopsy in Papillary Thyroid Carcinoma

Although occult lymph node metastasis to the lateral neck compartment is common in papillary thyroid carcinoma, the incidence and patterns of lateral neck node metastasis in papillary carcinoma are not known. We hypothesized that sentinel lymph node biopsy (SLNB) with radioisotope in the detection of occult lateral neck node metastasis would be useful in characterizing metastasis in papillary carcinoma. Ninety-four patients with papillary thyroid carcinoma were included from June 2009 to March 2010 for lateral neck SLNB. Preoperative lymphoscintigraphy was obtained after intratumoral injection of a (99m)Tc-tin colloid under ultrasound guidance. Total thyroidectomy or lobectomy preceded SLN detection to avoid radioactivity interference with the primary tumor, after which SLNB was performed in the lateral neck nodes. In the cases where metastasis was detected in SLNs upon frozen biopsy, an immediate modified radical neck node dissection was performed. A total of 174 SLNs were identified in 60 patients (63.8%). The identification rate of the SLNs with isotope increased with time. Sentinel lymph node metastasis was found in 19 patients (31.7%). This clinically occult metastasis was only related to the total number of metastatic LNs in the central compartment. Patient age, gender, tumor size, location, extent of tumor invasion, multiplicity, and presence of thyroiditis were not related to metastasis in the lateral compartment. Detection of lateral neck SLNs upon biopsy with radioisotope was also feasible in level II and contralateral neck. Sentinel lymph node biopsy is a useful method for evaluating the occult lateral neck lymph node status in patients with papillary thyroid carcinoma, especially in the cases of central neck node metastasis.

Cervical Thymic Cyst Presenting as a Possible Cystic Nodal Metastasis of Papillary Carcinoma in a 53-Year-Old Man

Cervical thymic cysts are rare embryonic remnants that develop along the course of thymic migration in the neck. They usually occur during infancy and childhood, and they are extremely rare in adults. We report a case of cervical thymic cyst in a 53-year-old man. The patient presented with a small mass of the thyroid gland and a cystic mass at the left level II area of the neck. On histopathology, the thyroid mass was identified as a papillary carcinoma and the left-sided neck mass was diagnosed as a cervical thymic cyst lined with nonkeratinizing, flattened squamous epithelium. The cyst wall contained atrophic thymic tissue composed of lymphoid cells, epithelial cords, and Hassall corpuscles. Although it is rare, cervical thymic cyst should be considered in the differential diagnosis of a lateral cystic neck mass in an adult.

An unusual case of thyroid papillary carcinoma with solitary cerebral metastasis presenting with neurological symptoms

Papillary carcinoma of the thyroid is well known for metastasis to regional lymph nodes resulting in early detection and overall favorable prognosis. Solitary metastasis of papillary carcinoma of the thyroid in the cerebrum is extremely rare with only a few cases reported in the literature. Here, we report an unusual case of a 40-year-old female patient who presented with neurological symptoms and a radiological diagnosis of meningioma was made. Subsequent histopathology from the resected brain tumor revealed a solitary cerebral metastasis from papillary carcinoma of the thyroid. There was no involvement of regional lymph nodes and the radiological findings were indicative of a primary brain tumor.

Papillary Thyroid Carcinoma Presenting with a Right Preauricular and Intracranial mass

Objective: To describe a case of a papillary thyroid carcinoma presenting with a pre-auricular and an intracranial mass and review the literature on the metastatic nature and invasiveness of papillary thyroid carcinoma. Method: Design: Case Report Setting: Tertiary Private Hospital Patient: One &nbsp; Results: &nbsp;A 46-year-old female with a 12-year anterior neck mass and a two-year right pre-auricular pleomorphic adenoma on fine needle aspiration biopsy was found to have an intracranial mass on CT-scan. Total thyroidectomy and section biopsy of the preauricular mass yielded a final histopathologic report of follicular variant of papillary carcinoma, thyroid gland; and metastatic papillary thyroid carcinoma, follicular type, pre-auricular mass. The condition of the patient precluded neurosurgical intervention and RAI therapy, and she underwent 23 sessions of external radiotherapy using 46Gy with significant diminution in size of the intracranial metastasis. Conclusion: Papillary thyroid malignancy may be an indolent tumor but is capable of distant metastasis. We should be alerted by host and tumor factors which can be predictors of a more radical papillary malignant disease. Keywords: papillary thyroid carcinoma; papillary thyroid carcinoma metastasis; infratemporal metastasis; brain metastasis of papillary carcinoma.