Locally advance thyroid cancer Dr Sudhi Agarwal. R; 35/F c/o left upper cervical swelling x 5 years...
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Transcript of Locally advance thyroid cancer Dr Sudhi Agarwal. R; 35/F c/o left upper cervical swelling x 5 years...
Locally advance thyroid cancer
Dr Sudhi Agarwal
• R; 35/F• c/o left upper cervical
swelling x 5 years• Painless, gradually
progressive • No other complaints• Consulted a local
surgeon due to recent rapid increase in size of swelling
• u/w biopsy 2 months back (records not available)
• Post op developed discharging sinuses at the operated site (A) and drain site (B)
• H/P- Metastatic PTC• Referred by the surgeon
to “higher centre for further management”
A
B
• Patient consulted in SMC• o/e- hard, partially fixed conglomerate mass
of left cervical LNs involving levels 2,3,4 and 5• Upper limit – not reachable completely• Left carotid displaced medially with relatively
slightly feeble pulsations• Thyroid gland – not palpable• Right subcm cervical LNs
Work up
• Blocks review-– Metastatic PTC (follicular variant)
• CECT neck-– Conglomerate mass of lymph nodes (levels 2,3,4,5)
extending from base of skull to clavicle, involving carotid sheath
– 1.5 cm left IJV thrombus– Carotids pushed medially– Right subcm LNs +– Hypodense lesion in left lobe of thyroid
• USG thyroid with doppler– Left IJV thrombus +– Carotids- displaced with normal flow
• IDL-– Bilateral vocal cords mobile
• TFT– WNL
• Other fitness work-up- NAD
• Diagnosis– Papillary thyroid cancer with left cervical lymph nodes
metastasis with left IJV thrombosis
TT + CCLND + left Radical neck dissection on 27-4-2012
8Differentiated Thyroid Cancer
Rt Sup PTG
Rt RLN
Rt Lobe Thy
Right Superior parathyroid gland and EBSLN and recurrent laryngeal nerve identified and saved
9Differentiated Thyroid Cancer
Thyroid
Total thyroidectomy complete; left inferior parathyroid gland (circle) identified and saved
10Differentiated Thyroid Cancer
Left radical neck dissection; conglomerate mass of lymph nodes involving skin and carotid sheath; IJV ligated and divided at base of neck (circle); carotid (C) and vagus (V) identified and saved
CV
T
11Differentiated Thyroid Cancer
CTumor
Tumor is adhered densly with carotid, separated completely by meticulous dissection till base of skull
12Differentiated Thyroid Cancer
Tumor dissected out completely from base of skull
Base of skull
Tumor apex
13Differentiated Thyroid Cancer
Trachea
Neck following complete tumor removal
Clavicle
14Differentiated Thyroid Cancer
Central compartment following complete tumor removal
15Differentiated Thyroid Cancer
• Post-operative period- uneventful• Adjuvant 30 mCi of RAI required for ramnant
ablation and 6 monthly follow up