Endocrine Abstracts

Introduction: Cases of spinal ganglionic chains invasion due to a thyroid carcinoma are exceptional. We are reporting the observation of a patient with thyroid papillary carcinoma, with insular component, revealed by retro-spinal lymphadenopathy.

Observation: Our patient is 55-year-old with no particular pathological history, consulting due to the development of a posterior cervical swelling gradually increasing in volume. A cervical ultrasound was performed, showing the appearance of several retro-spinal lymphadenopathies associated with a nodular goiter. An excisional biopsy of the largest lymphadenopathy found lymph node metastasis of a necrotized and moderately differentiated carcinoma, originating from the thyroid gland, with images of vascular emboli. The patient underwent total thyroidectomy with the excision of the cervical lymph node, including right lateral and cervical, jugulo-carotidian superior and inferior, and retro-spinal. Anatomopathological examination of the operative specimen found a right thyroid carcinoma with an unencapsulated insular component of 2 cm, capsular intrusion and lymph node metastasis. The patient finally benefited from a radioactive iodine treatment at 100 mCi. Three years after the surgery, the evolution was marked by the reappearance of multiple hypodense and necrotic bilateral cervical adenopathies, whose cytological study suspected a malignancy. Lymph node excision was the treatment of choice.

Conclusion: The discovery of spinal adenopathy should not rule out the diagnosis of a lymph node metastasis of a thyroid carcinoma even if it is not the preferred drainage region of these tumors.