Cover Image

Papillary Thyroid Microcarcinoma Presenting as Horner’s Syndrome: A Novel Clinical Presentation

Ammara Ashraf, Asad Azim, Khwaja Muhammad Azim, Talat Waseem

Abstract


Background: There is considerable worldwide rising incidence of slow growing Papillary Thyroid Microcarcinoma (PTMC) due to increasing availability of modern imaging tools. Cervical lymph node metastasis still remains the most frequent site of its metastasis. Here we present a rare case of PMC resulting in Horner’s syndrome, which to our knowledge is the first case in the history of known medical literature.

Case Report: A 32 years old male presented with right posterior triangle cervical lymphadenopathy, drooping of right eyelid and anhydrosis for last 3 years. Biopsy of the swelling revealed metastatic papillary thyroid carcinoma. US neck and computerized tomography showed a mass in the right suprclavicular region closely adherent to the common carotid and the stellate ganglion area without any significant pathology within thyroid and the lung. The patient underwent total thyroidectomy with type II block neck dissection. The specimen revealed microscopic foci of papillary thyroid carcinoma involving right lobe, largest focus measuring 0.2cm. Cervical lymph nodes of level II were negative for cancer metastasis however level III, IV and V were positive for metastasis. Patient underwent I131 radio-ablation postoperatively and is disease free since operation.

Conclusion: Here we demonstrate a novel presentation of the PTMC inform of Horner’s syndrome and give brief review of literature regarding presentation of PTMC.

Keywords


Horner’s syndrome; Papillary Thyroid Microcarcinoma; lymphadenopathy; Thyroid cancer.

Full Text:

PDF

References


Arem MD, FACE, Ridha et al. Thyroid microcarcinoma: prevalence, prognosis, and management. Endocrine Practice. 1999, 5:148-156

Ezzat S et al. Thyroid incidentalomas: prevalence by palpation and ultrasonography. Archives of internal medicine. 1994, 154:1838-1840

Yamashita H et al. Thyroid cancer associated with adenomatous goiter: an analysis of the incidence and clinical factors. Surgery Today. 1997, 27:495-499

Rego-Iraeta A et al. Time trends for thyroid cancer in northwestern Spain: true rise in the incidence of micro and larger forms of papillary thyroid carcinoma. Thyroid. 2009, 19:333-340

Sakorafas GH et al. Microscopic papillary thyroid cancer as an incidental finding in patients treated surgically for presumably benign thyroid disease. Journal of Postgraduate Medicine. 53.1 (2007):23

Pelizzo MR et al. Papillary thyroid microcarcinoma (PTMC): prognostic factors, management and outcome in 403 patients. European Journal of Surgical Oncology (EJSO). 2006, 32:1144-1148

Fink A et al. Occult micropapillary carcinoma associated with benign follicular thyroid disease and unrelated thyroid neoplasms. Modern Pathology. 1996, 9:816-820

Ito Y et al. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid. 2003, 13:381-387

Chow SM et al. Papillary microcarcinoma of the thyroid—prognostic significance of lymph node metastasis and multifocality. Cancer. 2003, 98:31-40

Ito Y et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World journal of surgery. 2006, 30:91-99

Baudin E, et al. Microcarcinoma of the thyroid gland. Cancer. 1998, 83:553-559

Ito Y, Miyauchi A. A therapeutic strategy for incidentally detected papillary microcarcinoma of the thyroid. Nature Clinical Practice Endocrinology & Metabolism. 2007, 3:240-248

Hay, Ian D et al. Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic scoring system. Surgery. 1987, 102:1088-1095

Cooper DS et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association (ATA) guidelines taskforce on thyroid nodules and differentiated thyroid cancer. Thyroid. 2009, 19:1167-1214

Roti E et al. Clinical and histological characteristics of papillary thyroid microcarcinoma: results of a retrospective study in 243 patients. The Journal of Clinical Endocrinology & Metabolism. 2006, 91:2171-2178

Wada N et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Annals of Surgery. 2003, 237:399

Sugitani I and Fujimoto Y. Symptomatic versus asymptomatic papillary thyroid microcarcinoma: a retrospective analysis of surgical outcome and prognostic factors. Endocrine Journal. 1999, 46:209-216.

Leuchter I et al. Horner’s syndrome and thyroid neoplasms. ORL. 2002, 64:49-52


Refbacks

  • There are currently no refbacks.


AJCC-REP (ISSN 2572-5742)Copyright © 2012-2020. All rights reserved. Published by Ivy Union Publishing, 3204 Valley Rush Dr, Apex, North Carolina 27502, United States