Cummings Amy L, Goldfarb Melanie
Division of Breast/Soft Tissue and Endocrine Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Los Angeles, California.
Endocr Pract. 2014 Mar;20(3):e34-7. doi: 10.4158/EP13339.CR.
Axillary lymph nodes (ALNs) are a rare manifestation of thyroid carcinoma; only 16 cases are in the published literature. This study adds two additional patients, one involving differentiated papillary thyroid carcinoma (PTC) and one case involving medullary thyroid carcinoma (MTC). The limited information on this topic in the literature is also reviewed.
In case 1, a 56-year-old female diagnosed in 2004 with stage IV PTC (lung and rib metastases) underwent total thyroidectomy (TTx) and received radioiodine and antineoplastics for progression in the lung, liver, and chest wall (2008-2011). In 2012, screening mammography detected multiple axillary masses corresponding to ALNs on magnetic resonance imaging. After fine-needle aspiration biopsy demonstrated metastatic PTC, the patient underwent right ALN dissection and is currently with stable disease. In case 2, a 59-year-old male diagnosed in 2011 with stage III MTC underwent TTx and bilateral modified lymph node (LN) dissection for cervical LN metastases. Three months later, a positron emission tomography scan revealed hypermetabolic ALNs confirmed by excisional biopsy as metastatic MTC. A completion left ALN dissection and supraclavicular LN excision was performed and the patient is currently with stable disease.
Sixteen reports of ALN metastases from thyroid cancer exist in the literature: 11 PTC, 2 mucoepidermoid carcinoma variants, and 1 each of follicular thyroid carcinoma, MTC, and poorly differentiated mucin-producing adenocarcinoma. This study reports the second case of MTC metastatic to ALNs.
Thyroid cancer ALN metastases are rare representations of distant metastatic disease. Complete surgical resection remains the standard of care for all MTC metastases and for DTC patients with local symptoms or otherwise stable disease that can tolerate the operation.
腋窝淋巴结（ALN）是甲状腺癌的一种罕见表现；已发表的文献中仅有16例。本研究新增了两例患者，一例为分化型乳头状甲状腺癌（PTC），另一例为髓样甲状腺癌（MTC）。同时还对文献中关于该主题的有限信息进行了综述。
病例1，一名56岁女性，2004年被诊断为IV期PTC（肺和肋骨转移），接受了全甲状腺切除术（TTx），并因肺、肝和胸壁进展接受了放射性碘和抗肿瘤药物治疗（2008 - 2011年）。2012年，乳腺筛查钼靶检查发现多个腋窝肿块，磁共振成像显示为ALN。细针穿刺活检显示为转移性PTC后，患者接受了右侧ALN清扫术，目前病情稳定。病例2，一名59岁男性，2011年被诊断为III期MTC，因颈部淋巴结转移接受了TTx和双侧改良淋巴结清扫术。三个月后，正电子发射断层扫描显示代谢活跃的ALN，切除活检证实为转移性MTC。进行了左侧ALN清扫术和锁骨上淋巴结切除术，患者目前病情稳定。
文献中有16篇关于甲状腺癌ALN转移的报道：11例PTC，2例黏液表皮样癌变异型，滤泡状甲状腺癌、MTC和低分化黏液腺癌各1例。本研究报告了第二例MTC转移至ALN的病例。
甲状腺癌ALN转移是远处转移疾病的罕见表现。对于所有MTC转移以及有局部症状或病情稳定可耐受手术的DTC患者，完整的手术切除仍然是治疗的标准。
