EYES2024 ESE Young Endocrinologists and Scientists (EYES) 2024 Thyroid (12 abstracts)
The largest case of exophytic lymph node papillary thyroid cancer metastasis: a multidisciplinary approach from diagnosis to treatment
Valentino Marino Picciola 1 , Aldo Carnevale 2 , Lucrezia Rossi 1 , Anna Crociara 4 , Stefania Bruni 4 , Serena Chirico 1 , Federica Bianco 1 , Paolo Carcoforo 3 , Paola Franceschetti 4 , Maria Rosaria Ambrosio 1 & Maria Chiara Zatelli 1
1Department of Medical Sciences, Section of Endocrinology, Geriatrics and Internal Medicine, University of Ferrara, Ferrara, Italy; 2Department of Translational Medicine, Section of Radiology, University of Ferrara, Ferrara, Italy; 3Department of Morphology, Surgery and Experimental Medicine, Section of General Surgery, University of Ferrara, Ferrara, Italy; 4Department of Specialty Medicines, Unit of Endocrinology and Metabolic Diseases, University Hospital of Ferrara, Ferrara, Italy
Introduction: Papillary Thyroid Carcinoma (PTC), the most frequent thyroid cancer, has excellent prognosis. Risk factors for lymph node metastatic spread are capsular invasion and size >1 cm. The COVID-19 pandemic caused significant delays in thyroid cancer diagnosis due to social isolation with consequent reduced medical referral. The lack of patient examination and of ultrasonography (US) led to inadequate thyroid nodule and cancer recurrence evaluation. We hereby present, to the best of our knowledge, the largest case of exophytic lymph node PTC metastasis.
Case presentation: A 82 years old female patient living alone, come to our attention in July 2023 for a bulky exophytic, purplish, hard, warm, asymptomatic lateral neck mass. In October 2018 she was submitted to right hemithyroidectomy, isthmectomy and sentinel lymph node radioguided exeresis due to a BRAF positive PTC (T3N1Mx). Completion thyroidectomy was not performed due to right recurrent laryngeal nerve injury with right vocal cord palsy. In March 2019, US showed a 5 × 10 × 14 mm lateral neck mass consistent with recurrent disease. The patient refused completion surgery because of concomitant herpes zoster; later COVID-19 pandemic hampered any medical procedure. Contrast-enhanced CT in July 2023 showed an exophytic mass deeply attached to neck muscles next to the left submandibular gland, measuring 60 × 52 × 66 mm. Thyroglobulin, anti-thyroglobulin antibodies, TSH, FT4 were in the normal range. In September 2023, radical and demanding surgical exeresis of the mass was performed without complications. Histological diagnosis was consistent with PTC lymph node metastasis. The patient has been disease-free so far.
Conclusion: COVID-19 pandemic, in the presence of risk factors, allowed the development of a bulky PTC lymph node metastasis. Despite the advanced age and the problematic surgical management, a multidisciplinary approach allowed an excellent outcome. This case underlines the importance of seeking for solutions also in very difficult situations.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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