EP38 – Right thyroid papillary microcarcinoma with an NO neck observed on a stage II right upper lung cancer patient, develops massive ipsilateral neck nodes sixteen months after initial evaluation

      Duque, Carlos S.1,2;  Ortiz, Carlos Serna2; Otalvaro; Lina3; Munoz, Juan Fernando4 1 Hospital Pablo Tobon Uribe, Medellin, Colombia 2 Clinica Las Americas, Medellin, Colombia 3 Department of Otolaryngology, Universidad de Antioquia, School of Medicine, Medellin, Colombia 4 Department of Otolaryngology, Hospital Militar and Universidad Nueva Granada, Bogota, Colombia   Background: Thyroid micro carcinoma may be treated with a lobectomy or observed if the clinical conditions show no confounding findings within the ultrasound or in accordance with the patient situation. Purpose / case presentation: A 69 year male diagnosed with a right upper lobe lung adenocarcinoma that was removed surgically and given complementary chemotherapy. On follow up Pet Ct a right thyroid nodule was observed, ultrasound revealed a 7 mm   defined nodule with no neck nodes. On Fine Needle Aspiration (FNA) Biopsy a papillary carcinoma was diagnosed. As the lung cancer set the prognosis of the patient it was decided and agreed to follow the patient. Sixteen months after this decision the patient develops massive palpable right   neck nodes with no change in his micro carcinoma. An FNA of these nodes revealed metastatic papillary carcinoma. The patient underwent a total thyroidectomy, mediastinal and right neck dissection. Indeed he had an 7 mm right thyroid lobe microcapapillary ca. and  30  out of 31 positive neck nodes. Objectives to review the final result of the pathology as it clinically just did not fit the entire patient situation. Methods: Retrospective case review along with the pathology slides Results:  After a long process of tumor markers and slides reviewing , it was clear that the neck metastases came from a lung papillary adenocarcinoma Discussion: Sometimes the clinical scenario might miss lead treatment, the decision to continue chemotherapy for the lung cancer made a difference in this patient avoiding further thyroid cancer treatments.


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