Erdem Tamer, Miman Murat Cem, Oncel Semih, Mizrak Bülent
Department of Otolaryngology, Medicine Faculty of Inönü University, Malatya, Turkey.
Kulak Burun Bogaz Ihtis Derg. 2003 Jun;10(6):244-7.
Metastasis from thyroid carcinomas to the parapharyngeal space is very rare. A forty-year-old male presented with progressive dysphagia and enlargement in the right upper neck. Examination showed medial displacement of the right palatine tonsil and the lateral oropharyngeal wall. A firm, submucosal mass measuring 4 x 3 cm was palpated. Computed tomography revealed a hypodense and heterogenic parapharyngeal mass with a calcified border. The mass was totally removed by a transcervical approach. Although frozen-section diagnosis was a benign lesion, histopathologic evaluation showed metastasis of papillary thyroid carcinoma to the parapharyngeal lymph nodes. Total thyroidectomy and bilateral selective neck dissection were performed, after which the tumor turned out to be papillary microcarcinoma (0.8 x 0.8 cm) in the right upper lobe of the thyroid gland. No locoregional recurrences or distant metastasis were observed during a three-year follow-up. The differential diagnosis of parapharyngeal masses should include metastatic thyroid carcinomas, for which a lymphatic route has been suggested between the thyroid gland and the parapharyngeal lymph nodes.
甲状腺癌转移至咽旁间隙非常罕见。一名40岁男性出现进行性吞咽困难及右上颈部肿大。检查发现右侧腭扁桃体及口咽侧壁向内侧移位。触诊可及一个质地硬的黏膜下肿物，大小为4×3 cm。计算机断层扫描显示咽旁肿物呈低密度且不均匀，边界有钙化。通过经颈入路将肿物完整切除。尽管冰冻切片诊断为良性病变，但组织病理学评估显示甲状腺乳头状癌转移至咽旁淋巴结。遂行甲状腺全切除术及双侧选择性颈淋巴结清扫术，术后发现甲状腺右上叶肿瘤为乳头状微小癌（0.8×0.8 cm）。在三年随访期间未观察到局部复发或远处转移。咽旁肿物的鉴别诊断应包括转移性甲状腺癌，甲状腺与咽旁淋巴结之间可能存在淋巴转移途径。
