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Rare Case of Lymph Node Metastasis of Papillary Thyroid Cancer to the Tongue

By: Susan Reckling
Posted: Thursday, September 17, 2020

According to Hiroki Bukawa, MD, DDS, PhD, of the Faculty of Medicine, University of Tsukuba, Japan, and colleagues, “it is important to consider the possibility of malignant metastases when a distinctly different histologic appearance is observed for cervical lymph nodes.” Published in the journal of Oral and Maxillofacial Surgery, a rare case study illustrates the presentation of occult thyroid cancer incidentally identified during postoperative pathologic diagnosis of head and neck cancer.

“Preoperative thyroid lesions detected using FDG-PET/CT with focal FDG uptake and high standardized uptake value have a high risk of thyroid malignancy,” the authors commented. “Therefore, it is better to use ultrasonography, as in this case, before oral cancer surgery because of the improved examination for diagnosing thyroid tumors.”

A 42-year-old woman presented with a 10 x 6 x 4 mm mass in the left region of her tongue. Although there was no swelling or tenderness, there were painful ulceration and induration. Contrast-enhanced CT and MRI demonstrated mild lymphadenopathy. On 18F-fluorodeoxyglucose (FDG)-PET/CT, a 7-mm lymph node with FDG uptake of maximal standardized uptake value of 8.08 and a standardized uptake value peak of 3.41 in the left upper internal jugular cervical region. A low-absorbing nodule in both lobes of the thyroid gland was found to be stage I squamous cell carcinoma of the tongue (T1N0M0). She underwent partial glossectomy with supraomohyoid neck dissection.

“Immunohistochemical examination showed that the tumor cells were positive for TTF-1 and thyroglobulin and were considered metastases of papillary thyroid cancer,” the authors reported. The patient underwent total thyroidectomy and left modified radical neck dissection. At the 9-month follow-up, there was no evidence of distant metastasis or tumor recurrence.

Disclosure: The study authors reported no conflicts of interest.

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