Dzodic Radan, Oruci Merima, Buta Marko, Markovic Ivan, Djurisic Igor, Pupic Gordana, Lukic Silvana
Department of Surgery, School of Medicine, University of Belgrade, Belgrade, Serbia.
Institute for Oncology and Radiology of Serbia, Belgrade, Serbia.
VideoEndocrinology. 2014 Jun 30;1(2). doi: 10.1089/ve.2014.0011. eCollection 2014.
Here, we present a 9-year-old male boy admitted at the Institute for Oncology and Radiology of Serbia due to enlarged lymph node in the left lateral neck region and palpable tumor in the upper pole of the left thyroid lobe. Clinically and sonographically, there were no metastases in the right jugulo-carotid chain, but the lymph nodes in the central pretracheal neck compartment and left jugulo-carotid chain were metastatic. Chest X ray, abdominal ultrasound, and laryngoscopy findings were normal. After injection of 2 mL of methylene blue dye in the normal right lobe, we accessed the right lateral neck region and the colored sentinel lymph node was removed, which was proven to be metastatic on frozen section analysis. Then, we explored entire thyroid gland and there were no nodules in the right lobe. The left lobe was explored and tumor was verified, which was in close contact to the infrahyoid muscles. We performed left loboisthmectomy by shaving off left lobe from trachea. Three foci of papillary carcinoma were found in the upper pole of left lobe 11 mm, just below 6 mm, and in isthmic region focus of 6 mm. We proceeded with the removal of the right lobe and central lymph nodes, including Delphian, which was metastatic, pretracheal, right paratracheal, and the lymph nodes behind the right recurrent laryngeal nerve down to the aortic arch. Upper mediastinal lymph nodes were removed. In the central neck region and upper mediastinal compartment, 15 lymph nodes were removed and 11 were metastatic. Right modified radical neck dissection from region two to four was performed. Twenty-one lymph nodes were examined, 5 were metastatic, including the sentinel lymph node. Left modified radical neck dissection, from level IIB to V, was performed on two incisions, which enabled reaching left level II and common carotid artery bifurcation. Left lateral lymph nodes were removed in one piece, berry picking must be avoided. Of 21 removed lymph nodes, 5 were metastatic in the left lateral region. A total of 57 lymph nodes were removed and 21 were metastatic. We showed the necessity and usefulness of sentinel lymph node biopsy of contralateral neck region by injecting vital dye in the normal right lobe. We confirmed the presence of metastases in a patient with clinically and sonographically negative lymph nodes. All authors declare no conflict of interest. Runtime of video: 10 mins.
在此，我们介绍一名9岁男性患儿，因左侧颈部外侧淋巴结肿大及左侧甲状腺叶上极可触及肿物，入住塞尔维亚肿瘤与放射研究所。临床及超声检查显示，右侧颈内静脉-颈动脉链无转移，但气管前颈部中央区及左侧颈内静脉-颈动脉链的淋巴结有转移。胸部X线、腹部超声及喉镜检查结果均正常。在正常右侧叶注射2毫升亚甲蓝染料后，我们进入右侧颈部区域，切除了染色的前哨淋巴结，经冰冻切片分析证实其为转移性。然后，我们探查了整个甲状腺，右侧叶无结节。探查左侧叶并证实有肿瘤，该肿瘤与舌骨下肌群紧密相连。我们通过从气管上刮除左侧叶进行了左侧叶甲状腺峡部切除术。在左侧叶上极发现3个乳头状癌病灶，分别为11毫米、恰好在其下方6毫米处，以及峡部区域6毫米的病灶。我们继续切除右侧叶及中央区淋巴结，包括有转移的Delphian淋巴结、气管前淋巴结、右侧气管旁淋巴结以及右侧喉返神经后方直至主动脉弓的淋巴结。切除上纵隔淋巴结。在颈部中央区及上纵隔区，共切除15个淋巴结，其中11个有转移。进行了右侧改良根治性颈清扫术，范围从二区至四区。检查了21个淋巴结，其中5个有转移，包括前哨淋巴结。通过两个切口进行了左侧改良根治性颈清扫术，范围从IIB级至V级，这样能够到达左侧II级及颈总动脉分叉处。将左侧外侧淋巴结整块切除，必须避免“浆果采摘式”切除。在切除的21个左侧外侧淋巴结中，有5个有转移。总共切除57个淋巴结，其中21个有转移。我们通过在正常右侧叶注射活性染料，展示了对侧颈部区域前哨淋巴结活检的必要性和实用性。我们证实了一名临床及超声检查显示淋巴结阴性的患者存在转移。所有作者均声明无利益冲突。视频时长：10分钟。
