%0 Journal Article
%T Synchronous lateral lymph node metastases from papillary and follicular thyroid carcinoma: case report and review of the literature.
%A Stenman A
%A Kjellman M
%A Zedenius J
%A Juhlin CC
%A Stenman A
%A Kjellman M
%A Zedenius J
%A Juhlin CC
%A Stenman A
%A Kjellman M
%A Zedenius J
%A Juhlin CC
%J Thyroid Res
%V 15
%N 1
%D Feb 2022 4
%M 35120551
暂无%R 10.1186/s13044-022-00120-w
%X <B>BACKGROUND: </B>Follicular thyroid carcinomas (FTCs) rarely metastasize to regional lymph nodes, and descriptions of synchronous lateral lymph node metastases of FTC and papillary thyroid carcinoma (PTC) are lacking.<BR><B>METHODS: </B>We describe a 43-year-old female with a preoperative cytology indicating a right-sided PTC with lateral lymph node metastases. She underwent a total thyroidectomy and central and lateral lymph node dissection, and histopathology confirmed a multifocal tall cell variant PTC together with a 12 mm minimally invasive FTC in the ipsilateral lobe. While the central compartment demonstrated metastatic PTC, the lateral compartment contained PTC metastases alongside a 15 mm large follicular-patterned mass in a separate lymph node. As the cells lacked PTC associated nuclear changes, the possibility of a lateral lymph node metastasis of FTC was considered, with the possibility of ectopic thyroid tissue as a differential diagnosis. By utilizing next-generation sequencing, a Q61R NRAS mutation was pinpointed, thus proving the tissue as tumorous. The patient underwent radioiodine treatment and is currently monitored following a negative whole-body scan.<BR><B>CONCLUSIONS: </B>This is probably the first case report of a patient with co-existing lateral lymph node PTC and FTC metastases. Consulting previous publications, there is currently a gap of knowledge in terms of how patients with regional FTC metastases should be followed-up and treated, especially when co-occurring with spread high-risk PTC subtypes. Moreover, what guides a seemingly indolent FTC to spread via the lymphatic system remains to be defined from a molecular standpoint.