Endocrine Abstracts

Introduction: The tuberculous lymphadenitis is the most common form of extra-pulmonary tuberculosis. The association with thyroid cancer is rare and can mislead the physician with the lymphadenopathy being considered as metastatic. In an endemic region for tuberculosis such as Tunisia, an adequate preoperative evaluation is crucial to distinguish these two entities and provide the patient with the appropriate treatment.

Material and methods: 2 cases of a lymph node tuberculosis associated with a papillary thyroid carcinoma treated in our ENT department.

Patient 1: Is about a 37-year-old patient with no significant pathological history who consulted for left cervical lymphadenopathy that has been evolving for 2 months with a recent weight loss of 5 kg. The clinical examination objectified a lymphadenopathy of the III left territory and a right thyroid nodule. The patient underwent right lobo-isthmectomy with an extemporaneous examination identifying a papillary thyroid carcinoma, hence a thyroid totalization with a central lymph nodes dissection. An additional functional left lymph node dissection identified a lymph node tuberculosis. The definitive pathological examination concluded to a 1.5 cm papillary carcinoma of the right lobe of the thyroid with no lymph node metastasis in the central lymph nodes dissection, and tuberculous lymphadenitis in the left functional lymph node dissection. The patient is currently in complete remission after postoperative radiation therapy and anti-tuberculosis treatment. The current follow-goes up to six years with no metastasis.

Patient 2: Is about a 62-year-old diabetic patient who consulted for a right thyroid nodule. During his right lobo-isthmectomy, the extemporaneous examination identified a papillary carcinoma, hence the totalization of the thyroid with a central lymph nodes dissection. The definitive pathological examination concluded to a papillary carcinoma with no lymph node metastasis but rather a lymph node tuberculosis in the central lymph node dissection. The patient received anti tuberculosis treatment for 6 months and a radioactive iodine treatment and is now doing well. The current follow-up goes up to four years.

Conclusion : In the presence of metastatic cervical lymphadenopathy, and even in the presence of suggestive signs such as necrosis and calcifications, in patients in which a papillary thyroid carcinoma is suspected, a tuberculous lymphadenopathy should be considered as a differential diagnosis and should be carefully researched preoperatively in order to limit surgical complications.