Zusammenfassung
Das papilläre Schilddrüsenkarzinom metastasiert üblicherweise in die regionalen Lymphknoten sowie in Lunge und Knochen. Wir berichten über eine Patientin mit einem papillären Schilddrüsenkarzinom, das in axilläre Lymphknoten metastasierte. Die Patientin war 62 Jahre alt – bei der Erstoperation zeigte der Tumor bereits eine Ausbreitung außerhalb der Kapsel. Sechs Jahre nach dieser Operation wurden Metastasen in den axillären Lymphknoten mittels Positronen-Emissions-Tomographie gefunden. Unserem Wissen nach wurde ein solcher Fall erst einmal in der Literatur beschrieben. Beide Fälle weisen darauf hin, dass das papilläre Schilddrüsenkarzinom in Ausnahmefällen auch in die axillären Lymphknoten metastasieren kann. Hypothetische Erklärungen für dieses Phänomen beinhalten sowohl eine hämatogene Aussaat als auch die Möglichkeit einer retrograden Ausbreitung entlang der regionalen Lymphknoten-Kanäle. Wir empfehlen daher bei Verdacht auf Rezidiv beziehungsweise Metastasierung eines Schilddrüsenkarzinoms auch eine genaue Untersuchung der Axilla. Außerdem sollte bei der Differentialdiagnose eines palpablen Tumors in der Axilla nach Ausschluss von Brustkrebs die Schilddrüse miteinbezogen werden.
Summary
Papillary thyroid cancer usually metastasizes to regional lymph nodes and to distant sites such as lungs and bones. We report a case of axillary lymph node metastasis as a result of recurrence of papillary carcinoma in a 62-year-old woman with papillary thyroid cancer extending locally beyond the thyroid capsule. Six years after initial surgical treatment, a lymph node metastasis in the left axillary region was diagnosed with positron tomography. To our knowledge, only one previous case of confirmed axillary metastasis of thyroid cancer has ever been reported. These two cases provide some evidence that thyroid carcinoma may exceptionally spread to axillary lymph nodes. Hypotheses that may account for such unusual localization include hematogenous dissemination or retrograde dissemination to regional lymphatic channels. Thus, when recurrence of thyroid carcinoma is considered, careful clinical examination of the axilla is recommended. Furthermore, thyroid carcinoma must be considered in the differential diagnosis of an axillary mass, especially when breast cancer is ruled out.
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Ers, V., Galant, C., Malaise, J. et al. Axillary lymph node metastasis in recurrence of papillary thyroid carcinoma: a case report. Wien Klin Wochenschr 118, 124–127 (2006). https://doi.org/10.1007/s00508-006-0533-1
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DOI: https://doi.org/10.1007/s00508-006-0533-1