Caso Raul, Villano Anthony M, Sutton Whitney, Alexander Randi, Caragacianu Diana L
Department of Surgery, MedStar Georgetown University Hospital, Washington, DC, USA.
Department of Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA, USA.
AME Case Rep. 2019 Jan 24;3:2. doi: 10.21037/acr.2019.01.02. eCollection 2019.
Axillary lymph node involvement (ALNI) in well differentiated papillary thyroid carcinoma (WDPTC) is a rare sequela of disease presentation. We report a case of PTC with extensive cervical lymph node involvement, local extension to the skin of the neck and bilateral ALNI without evidence of distant disease. We posit that ALNI represents local extension of disease rather than distant metastasis. Therefore, in the absence of distant spread, ALNI should result in surgical intervention. This optimizes removal of all bulky disease and increases effectiveness of radioactive iodine (RAI) therapy. Future research centered on genomics should focus on ascertaining the behavior and prognosis of such cases, especially when anatomic spread is discordant with biologic behavior.
在高分化乳头状甲状腺癌（WDPTC）中，腋窝淋巴结受累（ALNI）是一种罕见的疾病表现后遗症。我们报告一例PTC病例，其伴有广泛的颈部淋巴结受累、局部侵犯至颈部皮肤以及双侧ALNI，且无远处疾病证据。我们认为ALNI代表疾病的局部侵犯而非远处转移。因此，在无远处转移的情况下，ALNI应进行手术干预。这可优化所有肿大病灶的切除，并提高放射性碘（RAI）治疗的效果。未来以基因组学为中心的研究应着重确定此类病例的行为和预后，尤其是当解剖学扩散与生物学行为不一致时。
