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Abstract
We report a case of axillary lymph node metastasis (LNM) as a recurrence of papillary thyroid carcinoma (PTC) in a 68-year-old male. The patient initially presented in 2009 with a 3.4×5.4 cm sized neck swelling and left cervical lymphadenopathy. He underwent total thyroidectomy and central compartment neck dissection (CCND) with left modified radical neck dissection (MRND). The pathological report confirmed PTC with metastasis of neck lymph node. On a regular follow up of positron emission tomography (PET), LNM was found on the right supraclavicular area and on the left axillary area. It was 17 months after the initial thyroid cancer had been diagnosed. The right MRND and left axillary lymph node dissections were performed in April of 2012. Pathological result confirmed metastatic PTC of left axillary lymph nodes. After recovery from the surgery, the patient got radioactive iodine therapy with I-131 180 mCi.
References
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Fig. 1.
Neck CT showing large mass in left lower neck carotid space, metastatic lymphadenopathy and left thyroid nodule.
Fig. 2.
I– 123 5 mCi whole body scan showing normal functioning thyroid tissue in both thyroid gland and cold nodule in left thyroid lobe.
Fig. 3.
151 mCi therapeutic whole body scan at 48 hours showing two intense accumulation of the I–131 in the mid thyroid bed and remnant pyramidal lobe, with a focal much less I–131 uptake in the left upper thyroid bed or neck lymph node.
Fig. 5.
PET showing hypermetabolic metastatic lymph nodes in right suprclavicular (A) and left axillary area (B).
Fig. 7.
The tumor shows papillary growths with numerous branches (H&E stain, x10) (A). The papillae of the tumor are lined by single layer or pseudostratified tall columnar cells with elongated nuclei (H&E stain, x200) (B).
Fig. 8.
The therapeutic whole body scan reveals well uptake of residual thyroid tissue in both thyroid bed.
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