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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.

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Presentation on theme: "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."— Presentation transcript:

1 Locally advance thyroid cancer Dr Sudhi Agarwal

2 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

3 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

4 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

5 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

6 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

7 TT + CCLND + left Radical neck dissection on

8 8Differentiated Thyroid Cancer Rt Sup PTG Rt RLN Rt Lobe Thy Right Superior parathyroid gland and EBSLN and recurrent laryngeal nerve identified and saved

9 9Differentiated Thyroid Cancer Thyroid Total thyroidectomy complete; left inferior parathyroid gland (circle) identified and saved

10 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 C V T

11 11Differentiated Thyroid Cancer C Tumor Tumor is adhered densly with carotid, separated completely by meticulous dissection till base of skull

12 12Differentiated Thyroid Cancer Tumor dissected out completely from base of skull Base of skull Tumor apex

13 13Differentiated Thyroid Cancer Trachea Neck following complete tumor removal Clavicle

14 14Differentiated Thyroid Cancer Central compartment following complete tumor removal

15 15Differentiated Thyroid Cancer

16 Post-operative period- uneventful Adjuvant 30 mCi of RAI required for ramnant ablation and 6 monthly follow up


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