Metastic Papillary Thyroid Cancer for Parapharyngeal Lymph Node: A Case Report
Introduction: Thyroid cancer is the most common malignancy of the endocrine system, 4.3 men and 12.5 women per 100,000 individuals. Of these, 85% match papillary carcinoma. Metastasis of this tumor occurs mainly to the central compartment (level VI), followed by lateral compartments (II, III, and IV), and then to the final compartment (V). Metastasis into the parapharyngeal space is rare, with a few cases reported in the literature.
Objective: This study aims to report a case of metastatic papillary thyroid carcinoma into the parapharyngeal space.
Resumed Report: A 47-year-old female patient noted an increased neck mass since 3 months. A cytology study was conducted that characterized it to be Bethesda category VI. A submitted total thyroidectomy was done with neck dissection at levels II, III, and IV on the right and VI on the left. Pathology showed papillary thyroid cancer, with extrathyroid extension, it also showed involvement of 5 of 9 level VI lymph nodes and 15 of the 27 dissected lymph nodes at other levels. Submitted DTI 300 mCi after surgery, but had higher levels of thyroglobulin (54.5 ng/mL) associated with nodule of 2.2 cm right level V.
Cytology: A metastatic papillary thyroid carcinoma. Submitted shall emptying cervical level V on the right, with one lymph node affected among eight. Kept the thyroglobulin level at 300 ng/mL and was submitted to lymphadenectomy transcervical. After lymphadenectomy transcervical, the thyroglobulin levels decreased to 6.78 ng/mL.
Conclusion: Parapharyngeal neoplasm is rare, affecting only 0.5% of all the tumors of the head and neck. There are 10 cases reported of parapharyngeal involvement by metastatic papillary thyroid carcinoma in the literature. Therefore, this article reports a case of metastatic papillary thyroid carcinoma into the parapharyngeal space.