Papillary thyroid carcinoma metastasis to the parapharyngeal space
Gilberto Pérez López, Marta Carrasco de la Fuente, Marta Cano Megías, Macarena Alpañes Buesa, Jesús Goméz Martín & Pilar Zurita Sepúlveda
Objective: Describe a case of a patient diagnosed with papillary thyroid carcinoma by a retropharyngeal tumor.
Methods: A 46-year-old male was referred from the otorhinolaryngology consult to our department with the post-operative diagnosis of papillary thyroid carcinoma, with 6 months history of upper airway dyspnea and dysphagia to solids. Physical examination: right side adenopathies, not painful on palpation. No goitre. Laryngoscopy: hypertrophy of right posterior pharyngeal wall, epiglottis with rotation. Glotis was permeable. Mobile vocal cords. Pyriform sinus free. Cervical and thoracic TC: right retropharyngeal and internal jugular adenopathic conglomerates. Subcentimetrical mediastinal lymph nodes. Nasopharyngeal MRI: right retropharyngeal paracentral mass rejecting adjacent structures. FNA of cervical lymph node: lymph node with metastases of papillary thyroid carcinoma.
Results: Surgical treatment is decided. Transcervical excision was performed in right parapharyngeal tumor, sacrificing laryngeal pedicle and right superior laryngeal nerve, and total thyroidectomy with cervical emptying of areas: bilateral VI, right II (A and B) and V. Tracheostomy. Pathological diagnosis: thyroid: papillary thyroid microcarcinoma (7 mm) located in the right upper pole, partially encapsulated and behind the capsule without infiltrators. Right cervical lymphadenopathy: multiple lymph node metastases of papillary carcinoma. Retropharyngeal mass: extensive infiltration of papillary carcinoma. Six weeks after surgery is given an ablative dose of I131.
Conclusions: Approximately 0.5% of all head-and-neck tumors present in the parapharyngeal space (PPS). The neoplastic processes, which may involve the PPS, include primary PPS tumors, the direct extension of tumors from regions adjacent to the PPS and regional or distant metastases to the PPS. Thyroid papillary carcinoma presenting as a pharyngeal mass is a rare clinical occurrence and has only been reported sporadically.