Thyroid carcinomas incidentally found in the cervical lymph nodes ...
Thyroid carcinomas incidentally found in the cervical lymph nodes ... Thyroid carcinomas incidentally found in the cervical lymph nodes ...
observation periods.In 13 patients, their thyroid status was not noted.The levels and number of lymph nodes with occult thyroid carcinoma are insufficientlydescribed in literatures (the description of the levels and number are limited to a fewliteratures) 4,5,7,10 (Table 4). In the 16 cases with a sufficient description, occult thyroid carcinomawas observed in 42 lymph nodes (mean number = 2.5 lymph nodes/case). Among the levels, levelIII was most commonly involved (19 lymph nodes), followed by level IV (14 lymph nodes) andlevel II (9 lymph nodes).Three cases revealed an involvement of level II with no carcinoma atother levels of lymph nodes. 4,7,10DiscussionCervical lymph nodes are frequently involved in both inflammatory and neoplastic diseases.In malignant tumors, the involved lymph nodes become usually enlarged to be detected clinically,but asymptomatic metastasis to the cervical lymph nodes (occult metastasis) is occasionally foundin the lymph nodes that are dissected in treatment of head and neck carcinomas.However,incidental thyroid carcinoma is very rare in the cervical lymph nodes. Cervical occult thyroidcarcinoma is generally regarded as a metastatic lesion from the thyroid gland.However, it isquestionable whether all occult thyroid carcinomas found in the cervical lymph nodes aremetastasized from the thyroid carcinomas.The existence of heterotopic thyroid tissues andsalivary gland tissues in the cervical and parotid lymph nodes is well known and a possibility of theformation of thyroid and salivary carcinomas arising from these ectopic tissues has been8
eported 16-20 although Maceri DR et al. 13 and Attie JN et al. 12 have reported the existence of thyroidgland carcinoma in patients with thyroid carcinoma in the cervical lymph nodes.As a matter of course, an occult metastatic thyroid carcinoma requires for primarycarcinoma(s) in the thyroid gland. We reviewed the incidental thyroid carcinomas formed in thecervical lymph nodes and added the frequency of the existence of primary occult carcinomas in thethyroid glands (Table 3).Of the 75 patients associated with thyroid carcinoma that wasincidentally found in the cervical lymph nodes, 48 patients underwent thyroidectomy and 26patients revealed either foci of thyroid papillary or follicular carcinoma but no carcinoma was foundin the thyroid glands in the remaining 22 patients. No occurrence of thyroid carcinoma had beenascertained in the clinical follow-up of the patients who did not undergo thyroidectomy.Thisresult appears to indicate that nearly two-fifths of the patients with incidental thyroid carcinoma inthe cervical lymph nodes were free from carcinoma of their thyroid glands. Coskun H, et al. 5reported 3 cases of the incidental association of thyroid gland carcinoma with SCC of head andneck, and they developed an opinion that incidental thyroid carcinomas in the cervical lymph nodeswere metastatic, additionally quoting the report of Attie JN et al. that 12 the histological examinationof clinically normal thyroids in patients with occult metastatic thyroid carcinoma revealed thyroidcancer in all patients who underwent thyroidectomy. Pacheco-Ojeda L et al. 8 also reported 6suspicious cases of occult metastasis and they ascertained the existence of thyroid gland carcinomasin 5 of these cases.In addition, some autopsy reports showed occult thyroid glandcarcinomas, 14,15) which indicated a high percentage of occult carcinomas. However, as we have9
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eported 16-20 although Maceri DR et al. 13 and Attie JN et al. 12 have reported <strong>the</strong> existence of thyroidgland carc<strong>in</strong>oma <strong>in</strong> patients with thyroid carc<strong>in</strong>oma <strong>in</strong> <strong>the</strong> <strong>cervical</strong> <strong>lymph</strong> <strong>nodes</strong>.As a matter of course, an occult metastatic thyroid carc<strong>in</strong>oma requires for primarycarc<strong>in</strong>oma(s) <strong>in</strong> <strong>the</strong> thyroid gland. We reviewed <strong>the</strong> <strong>in</strong>cidental thyroid <strong>carc<strong>in</strong>omas</strong> formed <strong>in</strong> <strong>the</strong><strong>cervical</strong> <strong>lymph</strong> <strong>nodes</strong> and added <strong>the</strong> frequency of <strong>the</strong> existence of primary occult <strong>carc<strong>in</strong>omas</strong> <strong>in</strong> <strong>the</strong>thyroid glands (Table 3).Of <strong>the</strong> 75 patients associated with thyroid carc<strong>in</strong>oma that was<strong><strong>in</strong>cidentally</strong> <strong>found</strong> <strong>in</strong> <strong>the</strong> <strong>cervical</strong> <strong>lymph</strong> <strong>nodes</strong>, 48 patients underwent thyroidectomy and 26patients revealed ei<strong>the</strong>r foci of thyroid papillary or follicular carc<strong>in</strong>oma but no carc<strong>in</strong>oma was <strong>found</strong><strong>in</strong> <strong>the</strong> thyroid glands <strong>in</strong> <strong>the</strong> rema<strong>in</strong><strong>in</strong>g 22 patients. No occurrence of thyroid carc<strong>in</strong>oma had beenascerta<strong>in</strong>ed <strong>in</strong> <strong>the</strong> cl<strong>in</strong>ical follow-up of <strong>the</strong> patients who did not undergo thyroidectomy.Thisresult appears to <strong>in</strong>dicate that nearly two-fifths of <strong>the</strong> patients with <strong>in</strong>cidental thyroid carc<strong>in</strong>oma <strong>in</strong><strong>the</strong> <strong>cervical</strong> <strong>lymph</strong> <strong>nodes</strong> were free from carc<strong>in</strong>oma of <strong>the</strong>ir thyroid glands. Coskun H, et al. 5reported 3 cases of <strong>the</strong> <strong>in</strong>cidental association of thyroid gland carc<strong>in</strong>oma with SCC of head andneck, and <strong>the</strong>y developed an op<strong>in</strong>ion that <strong>in</strong>cidental thyroid <strong>carc<strong>in</strong>omas</strong> <strong>in</strong> <strong>the</strong> <strong>cervical</strong> <strong>lymph</strong> <strong>nodes</strong>were metastatic, additionally quot<strong>in</strong>g <strong>the</strong> report of Attie JN et al. that 12 <strong>the</strong> histological exam<strong>in</strong>ationof cl<strong>in</strong>ically normal thyroids <strong>in</strong> patients with occult metastatic thyroid carc<strong>in</strong>oma revealed thyroidcancer <strong>in</strong> all patients who underwent thyroidectomy. Pacheco-Ojeda L et al. 8 also reported 6suspicious cases of occult metastasis and <strong>the</strong>y ascerta<strong>in</strong>ed <strong>the</strong> existence of thyroid gland <strong>carc<strong>in</strong>omas</strong><strong>in</strong> 5 of <strong>the</strong>se cases.In addition, some autopsy reports showed occult thyroid gland<strong>carc<strong>in</strong>omas</strong>, 14,15) which <strong>in</strong>dicated a high percentage of occult <strong>carc<strong>in</strong>omas</strong>. However, as we have9
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