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Locally advance thyroid cancer

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Presentation on theme: "Locally advance thyroid cancer"— 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- CECT neck- Metastatic PTC (follicular variant)
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 27-4-2012

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

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

10 Differentiated 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 T V C Differentiated Thyroid Cancer

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

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

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

14 Differentiated Thyroid Cancer
Central compartment following complete tumor removal Differentiated Thyroid Cancer

15 Differentiated 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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