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...
![Page 1: 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.](https://reader035.fdocuments.in/reader035/viewer/2022070307/551b46135503465c7e8b5431/html5/thumbnails/1.jpg)
Locally advance thyroid cancer
Dr Sudhi Agarwal
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• 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
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• 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
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• 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
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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
![Page 6: 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.](https://reader035.fdocuments.in/reader035/viewer/2022070307/551b46135503465c7e8b5431/html5/thumbnails/6.jpg)
• 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
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TT + CCLND + left Radical neck dissection on 27-4-2012
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8Differentiated Thyroid Cancer
Rt Sup PTG
Rt RLN
Rt Lobe Thy
Right Superior parathyroid gland and EBSLN and recurrent laryngeal nerve identified and saved
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9Differentiated Thyroid Cancer
Thyroid
Total thyroidectomy complete; left inferior parathyroid gland (circle) identified and saved
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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
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11Differentiated Thyroid Cancer
CTumor
Tumor is adhered densly with carotid, separated completely by meticulous dissection till base of skull
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12Differentiated Thyroid Cancer
Tumor dissected out completely from base of skull
Base of skull
Tumor apex
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13Differentiated Thyroid Cancer
Trachea
Neck following complete tumor removal
Clavicle
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14Differentiated Thyroid Cancer
Central compartment following complete tumor removal
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15Differentiated Thyroid Cancer
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• Post-operative period- uneventful• Adjuvant 30 mCi of RAI required for ramnant
ablation and 6 monthly follow up