Parapharyngeal Metastasis Research Articles

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.

Collaborative Approach for Patient Management: Parapharyngeal Metastasis of Papillary Thyroid Carcinoma

A collaborative approach is important in the management of patients, in order to facilitate discussion, and allow cross-checking, in order to achieve the optimal outcome for patient care. Here we present a case, where a collaborative approach allowed the pre-operative identification of an unusual site of metastasis for recurrent papillary thyroid cancer, leading to the change of treatment plan.

A rare case of syncronous solitary para-pharyngeal metastasis of clear cell carcinoma in a patient with small renal mass.

Unusual metastatic sites of renal cell carcinoma (RCC) are not infrequent. We report a rare case of solitary pharyngeal metastasis as first presentation of RCC. A 74 years-old man was referred to our hospital due to rapidly progressive dyspnoea and dysphagia. Physical examination showed a large right para-pharyngeal mass. Imaging findings showed a 5.5 cm mass, suspicious for malignancy, which extended to right para and retro-pharyngeal spaces with compression of the major right cervical vessels, C2-C3 vertebral bodies osteolysis, dural sac compression and dislocation. Futhermore, a small (2.6 × 2 cm) mass located at the upper pole of the right kidney was shown. Patient underwent partial trans-oral removal of the mass. Pathological examination and immunochemistry resulting strongly suggestive for metastatic RCC. Considering the metastatic stage of the tumour and the rapidly progressive clinical worsening with poor performance status, we offered the patient a palliative treatment with tyrosine kinase and cytoreductive radiotherapy on vertebral bodies. The patient developed a rapidly progressive multifocal metastatic disease and died 4 months after the presentation. We think that our case is noteworthy for some aspects. Firstly, pharyngeal localizations of RCC are very rare and this is the first case of solitary pharyngeal metastasis. Secondly, this metastatic lesion was really particular because it was synchronous and twice as big than the primary tumour. Thirdly, this case is consistent with previous evidence that synchronous compared with metachronous metastasis RCC is associated with adverse effect on outcome and response to targeted treatment.

A Rare Case of Rectal Gastrointestinal Stromal Tumor Associated with Parapharyngeal Metastasis

Background: Gastrointestinal stromal tumors are the most frequent mesenchymal tumors and represent 1- 3% of all digestive neoplasms. Their incidence is 0.68 per 10,000 people. GISTs originate from the interstitial cells of Cajal, which are known as the gastrointestinal pacemaker, and carry mutations in the KIT gene in 95% of those affected. GISTs occur mainly in the middle-aged and rarely under the age of 40. The main age of presentation is 64 years old. The most common site of metastasis is the liver (65%), and exceptionally the bone (3%). Discussion: Rectal GISTs represent 5 to 15% of all GISTs. They are usually asymptomatic and discovered incidentally. Surgical resection with curative intent is the standard treatment for localized GISTs. Complete excision of the tumor is the most significant factor related to the outcome and can be accomplished in 40- 60% of cases. For borderline or unresectable lesions, neoadjuvant treatment with anti-tyrosine kinase (imatinib) should be considered. Imatinib is considered to be a relatively safe treatment and is generally well-tolerated by patients. Overall, the five-year survival rate is 90% for low-grade GIST, but the prognosis is worse for high-grade tumors (< 20%). Bone metastasis is a rare site of GIST metastases and usually presents itself during disease relapse. We present a rare case of a patient with an oligometastatic with pelvic bone lesion rectal GIST who developed parapharyngeal metastasis infiltrating C3 with airway compromise. Unfortunately, the patient passed away after massive tracheal bleeding. Conclusion: Bone metastasis from GIST is uncommon. The development of dyspnea and hoarseness should prompt the diagnosis of potential life-threatening complications such as parapharyngeal metastasis.

Cardiac metastasis from medullary thyroid carcinoma: insights from multimodal molecular imaging and magnetic resonance imaging.

Myocardial metastases are relatively uncommon and are frequently diagnosed postmortem especially in patients with aggressive cancers and systemic dissemination. The imaging phenotype of myocardial metastases of neuroendocrine medullary thyroid carcinoma (MTC) is not exhaustively detailed. Herein, we illustrate the results of cardiac morphofunctional imaging in a 49-year-old woman with sporadic MTC addressed to our institution after total thyroidectomy and multiple neck metastatic lymphadenectomy for dysphagia and increasing serum calcitonin (4840 ng/mL) and carcinoembryonic antigen (35 ng/mL) values. 6-L-18F-fluorodihydroxyphenylalanine (18F-FDOPA) positron emission tomography/computed tomography (PET/CT) established a voluminous and symptomatic left para-pharyngeal nodal metastasis and revealed additional cervical and mediastinal hypermetabolic lymphadenopathies (Panel A...

副咽頭（頭蓋底）転移に対する手術の適応と限界

副咽頭（頭蓋底）転移に対する手術の適応と限界

Localization and identification of parapharyngeal metastases from differentiated thyroid carcinoma by 131I‐SPECT/CT

Parapharyngeal metastasis is a rare event in differentiated thyroid carcinoma (DTC). The (131) I-single photon emission CT (SPECT)/CT allows better localization and definition for metastases in DTC. The aim of this study was to assess the value of (131) I-SPECT/CT for the diagnosis of parapharyngeal metastasis in patients with DTC. Consecutive patients with DTC (n = 561) treated with (131) I for the ablation of remnant or treatment of metastases were enrolled. A (131) I-SPECT/CT was performed when there were abnormal findings indicative of parapharyngeal metastasis on (131) I-whole-body scan (WBS). A total of 15 lesions were found to be parapharyngeal metastasis in 14 of 561 patients with DTC after the use of (131) I-SPECT/CT. The incidence rate of parapharyngeal metastasis was about 2.5% in DTC. Of the 15 lesions, only 5 lesions were CT-positive. The remaining 10 lesions were either ignored or indeterminate by the CT alone. The (131) I-SPECT/CT can identify parapharyngeal metastasis at an early stage. Parapharyngeal metastasis in DTC is relatively frequent after the use of (131) I-SPECT/CT.

HIGH-GRADE NON INVASIVE PAPILLARY UROTHELIAL CARCINOMA (HG-TCC) OF THE URINARY BLADDER: CLINICAL OUTCOME IN A SINGLE ACADEMIC CENTER COHORT

A parapharyngeal metastasis from primary thyroid carcinoma is rare and a search of relevant publications disclosed only seven previous reported cases. We describe a 46-year-old man who presented with a left parapharyngeal mass that was subsequently diagnosed by peroral fine-needle aspiration as a metastasis originating from a papillary carcinoma of the thyroid gland. Metastatic thyroid cancer should be considered in the differential diagnosis of a parapharyngeal mass. Fine-needle aspiration cytology is a simple, speedy, and cost-effective method of diagnosis of parapharyngeal masses.

Parapharyngeal metastasis from papillary thyroid carcinoma: a case diagnosed by thyroglobulin measurement in peroral fine-needle aspiration of a cystic metastatic lymph node

We report a case of a parapharyngeal cystic metastatic lymph node arising from papillary thyroid carcinoma (PTC). Parapharyngeal metastases arising from PTC are rare and correct diagnosis of the parapharyngeal mass before surgery is difficult. In this case, the diagnosis of a parapharyngeal mass was made pre-operatively by thyroglobulin measurement in peroral fine-needle aspiration with negative cytology.

Parapharyngeal metastases from thyroid cancer

Aim. To emphasise the pattern of lymphatic dissemination in the parapharyngeal space from thyroid cancer. Patients and method. Among 696 patients treated for thyroid cancer between 1986 and 2001, parapharyngeal metastasis was diagnosed in three patients, previously treated for papillary thyroid carcinoma. Results. All three patients have been treated by surgical resection through lateral cervical approach. Two of them were controlled regionally whereas the remaining one had a submucosal pharyngeal metastasis locally resected 27 months after parapharyngeal resection. Conclusions. Parapharyngeal metastasis is rare, but should be a recognized pattern of lymphatic dissemination from thyroid carcinoma to avoid unnecessary radioiodine and because surgical resection is efficacious with acceptable morbidity.

Parapharyngeal metastasis from papillary microcarcinoma of thyroid: report of a case diagnosed by peroral fine needle aspiration

A parapharyngeal metastasis from primary thyroid carcinoma is rare and a search of relevant publications disclosed only seven previous reported cases. We describe a 46-year-old man who presented with a left parapharyngeal mass that was subsequently diagnosed by peroral fine-needle aspiration as a metastasis originating from a papillary carcinoma of the thyroid gland. Metastatic thyroid cancer should be considered in the differential diagnosis of a parapharyngeal mass. Fine-needle aspiration cytology is a simple, speedy, and cost-effective method of diagnosis of parapharyngeal masses.

Occult papillary thyroid carcinoma presenting as a parapharyngeal metastasis

The neoplastic involvement of the parapharyngeal space is a rare condition that represents only 0.5% of all head and neck tumors.1-3 The benign salivary gland tumors and tumors of neural tissue origin constitute the great majority of these cases. 3-6 To encounter a metastatic thyroid cancer in the parapharyngeal space is an extremely unusual occurrence. The literature review showed only six cases published previously.7-*2 In this article, we report a patient presenting with a left parapharyngeal mass. The pathological examination showed a metastatic thyroid papillary cancer. Besides the unusual localization of the lesion, this case also confirms the anatomic study of Rouviere13 showing the existence of lymphatic channels between the thyroid lymphatics and the parapharyngeal space.

Successful Surgical Treatment of a Solitary Parapharyngeal Metastasis from Thyroid Cancer, Using the Mandibular Swing-Transcervical Approach: Report of a Case

Successful Surgical Treatment of a Solitary Parapharyngeal Metastasis from Thyroid Cancer, Using the Mandibular Swing-Transcervical Approach: Report of a Case

Diagnostic dilemma involving calcification in the parapharyngeal space: Metastatic thyroid carcinoma masquerading as a deep lobe parotid mass

As the parapharyngeal space is difficult to examine clinically, the radiographic distinction between deep lobe parotid masses and extraparotid tumors is essential in determining the surgical approach. We describe the case of a 53-year-old woman who presented with facial pain consequent to metastatic papillary thyroid carcinoma of the parapharyngeal space. A highly unusual pattern of calcification was present in the mass as observed by panoramic radiography and computed tomography. Parapharyngeal metastasis as the presenting feature of occult thyroid carcinoma has only been described four times previously in the medical literature.

Papillary Carcinoma of the Thyroid Metastatic to the Parapharyngeal Space

The parapharyngeal space is a complex anatomic area which can give rise to a variety of both primary and metastatic neoplasms. Squamous cell carcinoma can also present as a parapharyngeal space mass, either by direct extension or by metastases. Occult thyroid carcinoma presenting as a parapharyngeal space mass is a rare clinical occurrence which has been only sporadically reported in the medical literature. We present a case of occult papillary thyroid cancer with parapharyngeal space metastasis in the form of an isolated tumor, as well as a review of the literature on similar presentations. This rare situation has been previously described only once in the medical literature. Metastatic thyroid cancer should be considered in the differential diagnosis of a parapharyngeal space mass.