Retropharyngeal Lymph Node Metastases in Papillary Thyroid Carcinoma: A Case Series and Literature Review

Henrique Pina; Daniela Cavaco; Ricardo Nogueira; Valeriano Leite

doi:10.20344/amp.22908

Autores

Henrique Pina Department of Endocrinology. Hospital Beatriz Ângelo. Loures. https://orcid.org/0000-0003-2090-7390
Daniela Cavaco Department of Endocrinology. Instituto Português de Oncologia de Lisboa, Francisco Gentil, EPE. Lisbon. https://orcid.org/0000-0001-9486-9791
Ricardo Nogueira Department of Head and Neck Surgery. Instituto Português de Oncologia de Lisboa, Francisco Gentil, EPE. Lisbon. https://orcid.org/0009-0005-2035-6228
Valeriano Leite Department of Endocrinology. Instituto Português de Oncologia de Lisboa, Francisco Gentil, EPE. Lisbon. https://orcid.org/0000-0001-5479-7332

DOI:

https://doi.org/10.20344/amp.22908

Palavras-chave:

Carcinoma Papilar, Carcinoma Papilar da Tiróide/secundário, Neoplasias Faríngeas

Resumo

Introdução: A prevalência de metástases retrofaríngeas no carcinoma papilar da tiroide é baixa. O objetivo deste estudo retrospetivo foi avaliar a nossa experiência institucional na gestão destas metástases e comparar os resultados com outras séries publicadas.
Métodos: Foi realizada uma análise retrospetiva de doentes com carcinoma papilar da tiroide e metástases no espaço retrofaríngeo, seguidos no Serviço de Endocrinologia do Instituto Português de Oncologia de Lisboa Francisco Gentil. Para identificar casos publicados na literatura, foi realizada uma pesquisa bibliográfica nas bases de dados Medline e PubMed, de janeiro de 1970 a junho de 2025.
Resultados: Foram identificados 15 doentes, dos quais 12 (80,0%) eram do sexo feminino. A idade mediana na primeira cirurgia foi de 55,7 anos (amplitude 20,6 - 84,0 anos), e a mediana do tempo de seguimento foi de 9,8 anos (amplitude 0,5 - 36,3 anos). Em cinco doentes (33,3%) foram identificadas metástases retrofaríngeas durante o estadiamento inicial e em 10 (66,7%) durante o seguimento, sendo que, em oito doentes (80,0%), o diagnóstico ocorreu devido a persistência bioquímica da doença, e em dois (20,0%) após recorrência de doença nos gânglios linfáticos cervicais. Dos 15 doentes, sete (46,7%) não receberam tratamento para as metástases retrofaríngeas (grupo de vigilância), e oito (53,3%) foram tratados (grupo de tratamento). Destes, quatro (26,7%) foram submetidos a cirurgia isolada, dois (13,3%) receberam radioterapia isolada, um (6,7%) foi submetido a radiocirurgia e um (6,7%) realizou cirurgia e radioterapia.
Conclusão: A maioria dos doentes com metástases retrofaríngeas é diagnosticada após a tiroidectomia total, devido à persistência bioquímica da doença ou recorrência linfática cervical. As metástases nos gânglios linfáticos retrofaríngeos são geralmente únicas, localizadas ipsilateralmente ao tumor primário e ocorrem frequentemente em simultâneo com metástases à distância.

Downloads

Não há dados estatísticos.

Referências

Randolph GW, Duh QY, Heller KS, LiVolsi VA, Mandel SJ, Steward DL, et al. The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid. 2012;22:1144-52. DOI: https://doi.org/10.1089/thy.2012.0043

Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1-133. DOI: https://doi.org/10.1089/thy.2015.0020

Adam MA, Pura J, Goffredo P, Dinan MA, Reed SD, Scheri RP, et al. Presence and number of lymph node metastases are associated with compromised survival for patients younger than age 45 years with papillary thyroid cancer. J Clin Oncol. 2015;33:2370-5. DOI: https://doi.org/10.1200/JCO.2014.59.8391

Sandler ML, Xing MH, Levy JC, Chai RL, Khorsandi AS, Gonzalez-Velazquez C, et al. Metastatic thyroid carcinoma to the parapharyngeal and retropharyngeal spaces: systematic review with seven newly reported cases describing an uncommon presentation of a common disease. Head Neck. 2021;43:1331-44. DOI: https://doi.org/10.1002/hed.26572

Harries V, McGill M, Tuttle RM, Shaha AR, Wong RJ, Shah JP, et al. Management of retropharyngeal lymph node metastases in differentiated thyroid carcinoma. Thyroid. 2020;30:688-95. DOI: https://doi.org/10.1089/thy.2019.0359

McCormack KR, Sheline GE. Retropharyngeal spread of carcinoma of the thyroid. Cancer. 1970;26:1366-9. DOI: https://doi.org/10.1002/1097-0142(197012)26:6<1366::AID-CNCR2820260627>3.0.CO;2-V

Debnam JM, Guha-Thakurta N. Retropharyngeal and prevertebral spaces: anatomic imaging and diagnosis. Otolaryngol Clin North Am. 2012;45:1293-310. DOI: https://doi.org/10.1016/j.otc.2012.08.004

Zhao J, Zheng W, Zhong M, Daming L, Guo L. Risk factors and prognosis of retropharyngeal lymph node metastasis from papillary thyroid carcinoma. Altern Ther Health Med. 2024;30:474-9.

Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The eighth edition AJCC cancer staging manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017;67:93-9. DOI: https://doi.org/10.3322/caac.21388

Otsuki N, Morita N, Furukawa T, Teshima M, Shinomiya H, Shinomiya H, et al. Functional and oncological outcomes after retropharyngeal node dissection for papillary thyroid carcinoma. Eur Arch Otorhinolaryngol. 2019;276:1809-14. DOI: https://doi.org/10.1007/s00405-019-05420-w

Otsuki N, Nishikawa T, Iwae S, Saito M, Mohri M, Nibu K. Retropharyngeal node metastasis from papillary thyroid carcinoma. Head Neck. 2007;29:508-11. DOI: https://doi.org/10.1002/hed.20536

Hartl DM, Leboulleux S, Vélayoudom-Céphise FL, Mirghani H, Déandréis D, Schlumberger M. Management of retropharyngeal node metastases from thyroid carcinoma. World J Surg. 2015;39:1274-81. DOI: https://doi.org/10.1007/s00268-015-2947-2

Leger AF, Baillet G, Dagousset F, Vincenot MI, Izembart M, Clerc J, et al. Upper retropharyngeal node involvement in differentiated thyroid carcinoma demonstrated by 131I scintigraphy. Br J Radiol. 2000;73:1260-4. DOI: https://doi.org/10.1259/bjr.73.876.11205668

Le TD, Cohen JI. Transoral approach to removal of the retropharyngeal lymph nodes in well-differentiated thyroid cancer. Laryngoscope. 2007;117:1155-8. DOI: https://doi.org/10.1097/MLG.0b013e31805819ba

Shellenberger T, Fornage B, Ginsberg L, Clayman GL. Transoral resection of thyroid cancer metastasis to lateral retropharyngeal nodes. Head Neck. 2007;29:258-66. DOI: https://doi.org/10.1002/hed.20513

Kaplan SL, Mandel SJ, Muller R, Baloch ZW, Thaler ER, Loevner LA. The role of MR imaging in detecting nodal disease in thyroidectomy patients with rising thyroglobulin levels. AJNR Am J Neuroradiol. 2009;30:608-12. DOI: https://doi.org/10.3174/ajnr.A1405

Kainuma K, Kitoh R, Yoshimura H, Usami S. The first report of bilateral retropharyngeal lymph node metastasis from papillary thyroid carcinoma and review of the literature. Acta Otolaryngol. 2011;131:1341-8. DOI: https://doi.org/10.3109/00016489.2011.607844

Moore MW, Jantharapattana K, Williams MD, Grant DG, Selber JC, Holsinger FC. Retropharyngeal lymphadenectomy with transoral robotic surgery for papillary thyroid cancer. J Robot Surg. 2011;5:221. DOI: https://doi.org/10.1007/s11701-011-0269-4

Fornage BD, Edeiken BS, Clayman GL. Use of transoral sonography with an endocavitary transducer in diagnosis, fine-needle aspiration biopsy, and intraoperative localization of retropharyngeal masses. AJR Am J Roentgenol. 2014;202:W481-6. DOI: https://doi.org/10.2214/AJR.13.11398

Togashi T, Sugitani I, Toda K, Kawabata K, Takahashi S. Surgical management of retropharyngeal nodes metastases from papillary thyroid carcinoma. World J Surg. 2014;38:2831-7. DOI: https://doi.org/10.1007/s00268-014-2707-8

Chen S, Yang H, Su X, Yang A, Liu W. Transcervical dissection of metastatic suprahyoid retropharyngeal lymph nodes from papillary thyroid carcinoma through three anatomical barriers. Int J Oral Maxillofac Surg. 2021;50:158-62. DOI: https://doi.org/10.1016/j.ijom.2020.06.022

DiLeo MD, Baker KB, Deschler DG, Hayden RE. Metastatic papillary thyroid carcinoma presenting as a retropharyngeal mass. Am J Otolaryngol. 1998;19:404-6. DOI: https://doi.org/10.1016/S0196-0709(98)90046-1

Ma QD, Grimm K, Paz BI, Maghami E. Transoral surgical approach for retropharyngeal node involvement in i-131-negative 18-fluoro-2-deoxyglucose positron emission tomography-positive recurrent thyroid cancer. Skull Base. 2009;19:431-6. DOI: https://doi.org/10.1055/s-0029-1224772

Goepfert RP, Liu C, Ryan WR. Trans-oral robotic surgery and surgeon-performed trans-oral ultrasound for intraoperative location and excision of an isolated retropharyngeal lymph node metastasis of papillary thyroid carcinoma. Am J Otolaryngol. 2015;36:710-4. DOI: https://doi.org/10.1016/j.amjoto.2015.04.011

Fujiwara K, Fukuhara T, Koyama S, Donishi R, Kataoka H, Kitano H, et al. Ultrasound-guided transoral videolaryngoscopic surgery for retropharyngeal lymph node metastasis of papillary thyroid cancer. Case Rep Oncol. 2017;10:649-55. DOI: https://doi.org/10.1159/000478653

Kholmatov R, Emejulu O, Murad F, Aslam R, Kandil E. Locally advanced asymptomatic papillary thyroid cancer presenting with retropharyngeal lymph node metastasis symptoms. Gland Surg. 2017;6:733-7. DOI: https://doi.org/10.21037/gs.2017.06.03

Yang J, Zhang F, Qiao Y. Diagnostic accuracy of ultrasound, CT and their combination in detecting cervical lymph node metastasis in patients with papillary thyroid cancer: a systematic review and meta-analysis. BMJ Open. 2022;12:e051568. DOI: https://doi.org/10.1136/bmjopen-2021-051568