A Case of Cervical Retrotracheal Metastatic Papillary Thyroid Carcinoma Diagnosed by Endobronchial Ultrasonography with Transbronchial Needle Aspiration

Woong Jae Noh; Sung Jin Nam; Chul Ho Oak; Kang Dae Lee

doi:10.11106/ijt.2015.8.2.235

Journal List > Int J Thyroidol > v.8(2) > 1082732

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Noh, Nam, Oak, and Lee: A Case of Cervical Retrotracheal Metastatic Papillary Thyroid Carcinoma Diagnosed by Endobronchial Ultrasonography with Transbronchial Needle Aspiration

Case Report

Int J Thyroidol 2015;8(2):235-239.

Published online: 20 November 2015

DOI: https://doi.org/10.11106/ijt.2015.8.2.235

A Case of Cervical Retrotracheal Metastatic Papillary Thyroid Carcinoma Diagnosed by Endobronchial Ultrasonography with Transbronchial Needle Aspiration

Woong Jae Noh¹, Sung Jin Nam², Chul Ho Oak², Kang Dae Lee^1,

¹Department of Otorhinolaryngology-Head and Neck Surgery, Kosin University Gospel Hospital, Busan, Korea

²Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea

Correspondence: Kang Dae Lee, MD, PhD, Department of Otorhinolaryngology-Head and Neck Surgery, Kosin University Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan 49267, Korea Tel: 82-51-990-6470, Fax: 82-51-245-8539, E-mail: kdlee59@gmail.com

Received 21 October 2015 Revised 3 November 2015 Accepted 3 November 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 61-year-old woman who underwent total thyroidectomy for papillary thyroid carcinoma (PTC) five years previously referred for a cervical retrotracheal mass. The mass had intense fluorodeoxyglucose (FDG) uptake on positron emission tomography-computed tomography (PET-CT), and was thus thought to be malignant. Transcutaneous ultrasonography with fine needle aspiration (FNA) was not feasible, so we tried endobronchial ultrasonography (EBUS) with transbronchial needle aspiration (TBNA) to obtain a cytology specimen. After surgery, the mass was confirmed to be a metastatic lymph node from the previous PTC, confirming the TBNA results. Although the utility of EBUS-TBNA for evaluating mediastinal metastasis has been reported in a number of studies, few reports have addressed its utility in the cervical region. Here we report this unusual case of metastatic lymph node of PTC that recurred in the cervical retrotracheal area. It was found to exhibit esophageal muscular invasion, and was accurately diagnosed on EBUS-TBNA.

Keywords: Papillary thyroid carcinoma, EBUS-TBNA, Metastatic lymph node

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Fig. 1.

PET-CT and CT scan of retrotracheal mass. (A) PET-CT scan showed fluoro-deoxyglucose uptake in the retrotracheal mass (arrow). (B) CT scan showed well-cir-cumscribed enhancing mass (white arrow) with central low density adjacent to the eso-phagus (black arrow). The mass was compressing the trachea anteriorly.

Fig. 2.

EBUS images. (A) A large mass (star) was visua-lized protruding into the pos-terior trachea wall in endob-ronchial view (A: anterior, P: posterior). (B) In EBUS image, 1×1 cm retrotracheal mass with a hypoechogenic ap-pearance was seen.

Fig. 3.

Intraoperative view. (A) The mass (white arrow) was found to be grossly adherent to the trachea anteriorly and to the esophagus laterally. (B) The inner esophageal mucosa (black arrow) was intact after the mass was removed.

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