Endocrine Abstracts

Introduction: Vagal paragangliomas are rare tumors that developed from paraganglionnar tissue. They are relatively easy to diagnose. They have benefited from advances in diagnostic imaging, particularly angiography and magnetic resonance imaging (MRI). We aim to study the particularities of clinical findings in a vagal paraganglioma miming a lymph node metastases in patient with a history of papillary thyroid carcinoma.

Case report: We report the case of a 66-year-old woman treated for lymph node tuberculosis eight years ago, with a discovery on a cervical ultrasound monitoring of an infracentimetric left thyroid nodule staged EU-TIRADS 4 with lymph node metastases. The patient underwent a total thyroidectomy with bilateral mediastinal lymphadenectomy for multifocal papillary carcinoma associated with lymph node metastases in recurrent chains. The patient was treated by complementary iratherapy with no fixation on technetium scintigraphy. However, thyroglobulin remained at high levels. A cervico-thoracic computed tomography was performed concluding to a vascularized sized 18x30 mm in relation to the left carotid glomus, suggesting lymph node metastases in the context. The patient underwent left functional lymphadenectomy. Per-operatively, we observed a high bleeding lesion closed to the vagal nerve. The extemporaneous examination confirmed the diagnosis of a vagal paraganglioma. Definitive pathology did not show any lymph node metastases. The postoperative period was marked by the occurrence of a recurrent left paralysis with a good course after speech therapy. There were no recurrence of paraganglioma and thyroid carcinoma after six years of fellow-up.

Discussion/Conclusion: Paragangliomas are usually benign tumors. They are rare and slow in evolution. Management is well codified included imaging for the diagnosis of the tumor and its extensions, surgery as standard treatment and radiotherapy is an alternative in non-operable cases. Nevertheless is not usually the rule, as in our case we misdiagnosed the paraganglioma on the CT scan, as it highly mimed a lymph node metastasis.

Disclosure of interest: none declared

Keywords: paraganglioma, thyroid cancer, lymph node, metastasis, surgery