Endocrine Abstracts

Introduction: Papillary and follicular thyroid carcinoma are the most frequent endocrine malignancy. Lymphatic metastases at the time of diagnosis are common in differentiated thyroid cancer (DTC). In these patients, most authors recommend a thyroidectomy with neck dissection. However, neck dissection can lead to numerous post-operative complications. Thus, careful pre-operative evaluation of cervical lymph node metastasis may be crucial, so that patients do not undergo unnecessary neck dissection for other benign conditions The aim of the study is to determinate the clinical, histological and therapeutic aspects of the coexistence of differentiated thyroid cancer and tuberculous cervical lymphadenopathy.

Materials and Methods: We report three cases of association between differentiated thyroid cancer with tuberculous cervical lymphadenopathy collected in ENT department of Fattouma Bourguiba Hospital of Monastir over a period of 10 years.

Results: Our study investigated three women aged 47, 49 and 56 years old respectively. The first patient had a history of hypertension, diabetes mellitus and hysterectomy for endometrial stromal sarcoma while the second patient didn’t have any past medical history. The third case was admitted in the Rheumatology Department for bone pain and worsening of the general state. A bone biopsy was performed during that hospitalization showing follicular thyroid carcinoma metastasis. In all cases, ultrasonography showed thyroid nodules associated to suspicious jugular node. All of patients underwent a total thyroidectomy, associated to central and lateral lymph node dissection. The histology disclosed a papillary carcinoma in two cases and follicular carcinoma in the third one. In all cases, thyroid carcinoma was associated to tuberculosis in the lateral cervical lymph node. In all cases, surgical treatment was followed by radioactive iodine therapy and antituberculosis medication. Follow-up has been negative for any recurrence or distant metastasis during the past 24 months.

Conclusion: Cervical lymphadenitis is the most common clinical presentation of extrapulmonary tuberculosis. The coincident of (DTC) and tuberculous lymphadenitis are not rare. The large lymph nodes with central necrosis recognized at uncommon site of metastasis from DTC might remind us of such coexistence. Preoperative diagnosis for tuberculous infection is important to avoid unnecessary surgical complications and secondary infections.