Endocrine Abstracts

JOINT1983

Introduction: Later ocervical lymphadenopathies revealing a papillary microcarcinoma of the thyroid are rare (7 to 13% of cases). The parapharyngeal location of these metastatic lymphnodes is exceptional. We report a case of cystic lymph node metastasis of parapharyngeal location which revealed a papillary microcarcinoma of the thyroid.

Observation: A 40-year-old patient with no particular pathological history was admitted for management of an isolated right laterocervical swelling that had been developing for 4 months. The physical examination revealed two high and medium jugulocarotid swellings of 2 and 3 cm respectively, firm, mobile and painless. The rest of the lymph node areas as well as the thyroid lodge were free. On indirect laryngoscopy, the vocal cords were mobile. The cavum was free on nasal endoscopy. Cervical ultrasound showed two right jugulocarotid cystic adenopathies of 45 and 38 mm, the site of microcalcifications with a homogeneous thyroid gland. Cervical CT scan was suggestive of a cystic lymphangioma with the presence of a right parapharyngeal unilocular cystic formation. A complement by cervical MRI revealed right cervical cystic adenopathies, one of which is located in the right parapharyngeal space. A lymph node cytopuncture concluded with the diagnosis of lymph node metastasis of a papillary thyroid carcinoma. The repeated cervical ultrasound showed thyroid micronodules. The patient underwent functional right dissection with extemporaneous histological examination which confirmed the diagnosis of cystic metastasis of papillary thyroid carcinoma. A total thyroidectomy with bilateral recurrent mediastinal dissection was performed. An excision of the parapharyngeal component by the intraoral route after unilateral tonsillectomy was performed. The definitive histology concluded that there was a multifocal and bilateral papillary microcarcinoma of the thyroid (tumor foci between 1 and 5 mm) with central, lateral and parapharyngeal lymph node metastases. Iratherapy was indicated. The evolution was favorable after a 3-year follow-up.

Conclusion: Lymph node dissemination is often reported to the central compartment of the neck followed by the lateral region. Metastasis to the parapharyngeal space seem to be straight forward due to the close anatomical localisation, but a few cases of parapharyngeal involvement have appeared in the literature