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A case on papillary thyroid carcinoma with intraluminal tracheal extension: A Malaysian experience and literature review

Papillary thyroid carcinoma (PTC) is a common malignancy originating from the thyroid gland. In rare cases, it can invade the trachea, resulting in airway obstruction. Subsequent surgical planning may be complicated as the technique selected depends on a case-by-case basis. Here, we report a case of...

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Main Authors: Alex Zhi, Jian Ho, Abdul Wahab, Azwan Halim, Rozhan, Atikah
Format: Article
Language:English
Published: Springer Nature 2024
Subjects:
RF Otorhinolaryngology
Online Access:http://irep.iium.edu.my/117238/7/117238_A%20case%20on%20papillary%20thyroid%20carcinoma%20with%20intraluminal%20tracheal.pdf
http://irep.iium.edu.my/117238/
https://www.cureus.com/
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spelling my.iium.irep.1172382024-12-27T01:06:04Z http://irep.iium.edu.my/117238/ A case on papillary thyroid carcinoma with intraluminal tracheal extension: A Malaysian experience and literature review Alex Zhi, Jian Ho Abdul Wahab, Azwan Halim Rozhan, Atikah RF Otorhinolaryngology Papillary thyroid carcinoma (PTC) is a common malignancy originating from the thyroid gland. In rare cases, it can invade the trachea, resulting in airway obstruction. Subsequent surgical planning may be complicated as the technique selected depends on a case-by-case basis. Here, we report a case of PTC with tracheal involvement and a literature review on the latest surgical options. A 56-year-old gentleman presented with an anterior neck swelling of 3 x 3 cm for 3 months. Flexible endoscopy showed irregular mass in the subglottic region. Subsequent aspiration for cytology confirmed a diagnosis of PTC. Neck contrast enhanced computed tomography showed an ill-defined lesion in the right thyroid (3.1 x 3.8 x 2.9 cm) with a subtle irregularity of the adjacent tracheal wall suggestive of infiltration. The findings indicated a clinical staging of cT4aN0M0 (Stage III) with Shin’s staging of Stage IV. The patient underwent a total thyroidectomy and a single-stage partial cricoid-tracheal resection with anastomosis. There were no immediate post-operative complications reported. Unfortunately, the patient suffered from pulmonary embolism, which eventually resulted in his demise. A subsequent histopathology report confirmed the diagnosis of PTC. Surgical planning for such cases may be complicated. The risk of recurrent laryngeal nerve injury is increased as the site of resection is close to the nerve. Multiple intraoperative nerve monitoring systems may be required. Meticulous planning of intraoperative airway management is needed as a large intraluminal tumor may interfere with intubation. Generally, extensive tracheal invasion would require radical surgical approaches such as circumferential resection and total laryngectomy. Less extensive cases can be treated with shave excision or window resection. PTC with tracheal invasion is an uncommon condition, and surgical excision is indicated for cases with high Shin’s staging Springer Nature 2024-05-06 Article PeerReviewed application/pdf en http://irep.iium.edu.my/117238/7/117238_A%20case%20on%20papillary%20thyroid%20carcinoma%20with%20intraluminal%20tracheal.pdf Alex Zhi, Jian Ho and Abdul Wahab, Azwan Halim and Rozhan, Atikah (2024) A case on papillary thyroid carcinoma with intraluminal tracheal extension: A Malaysian experience and literature review. Cureus, 16 (6). ISSN 2168-8184 https://www.cureus.com/ 10.7759/cureus.61712
institution Universiti Islam Antarabangsa Malaysia
building IIUM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider International Islamic University Malaysia
content_source IIUM Repository (IREP)
url_provider http://irep.iium.edu.my/
language English
topic RF Otorhinolaryngology
spellingShingle RF Otorhinolaryngology
Alex Zhi, Jian Ho
Abdul Wahab, Azwan Halim
Rozhan, Atikah
A case on papillary thyroid carcinoma with intraluminal tracheal extension: A Malaysian experience and literature review
description Papillary thyroid carcinoma (PTC) is a common malignancy originating from the thyroid gland. In rare cases, it can invade the trachea, resulting in airway obstruction. Subsequent surgical planning may be complicated as the technique selected depends on a case-by-case basis. Here, we report a case of PTC with tracheal involvement and a literature review on the latest surgical options. A 56-year-old gentleman presented with an anterior neck swelling of 3 x 3 cm for 3 months. Flexible endoscopy showed irregular mass in the subglottic region. Subsequent aspiration for cytology confirmed a diagnosis of PTC. Neck contrast enhanced computed tomography showed an ill-defined lesion in the right thyroid (3.1 x 3.8 x 2.9 cm) with a subtle irregularity of the adjacent tracheal wall suggestive of infiltration. The findings indicated a clinical staging of cT4aN0M0 (Stage III) with Shin’s staging of Stage IV. The patient underwent a total thyroidectomy and a single-stage partial cricoid-tracheal resection with anastomosis. There were no immediate post-operative complications reported. Unfortunately, the patient suffered from pulmonary embolism, which eventually resulted in his demise. A subsequent histopathology report confirmed the diagnosis of PTC. Surgical planning for such cases may be complicated. The risk of recurrent laryngeal nerve injury is increased as the site of resection is close to the nerve. Multiple intraoperative nerve monitoring systems may be required. Meticulous planning of intraoperative airway management is needed as a large intraluminal tumor may interfere with intubation. Generally, extensive tracheal invasion would require radical surgical approaches such as circumferential resection and total laryngectomy. Less extensive cases can be treated with shave excision or window resection. PTC with tracheal invasion is an uncommon condition, and surgical excision is indicated for cases with high Shin’s staging
format Article
author Alex Zhi, Jian Ho
Abdul Wahab, Azwan Halim
Rozhan, Atikah
author_facet Alex Zhi, Jian Ho
Abdul Wahab, Azwan Halim
Rozhan, Atikah
author_sort Alex Zhi, Jian Ho
title A case on papillary thyroid carcinoma with intraluminal tracheal extension: A Malaysian experience and literature review
title_short A case on papillary thyroid carcinoma with intraluminal tracheal extension: A Malaysian experience and literature review
title_full A case on papillary thyroid carcinoma with intraluminal tracheal extension: A Malaysian experience and literature review
title_fullStr A case on papillary thyroid carcinoma with intraluminal tracheal extension: A Malaysian experience and literature review
title_full_unstemmed A case on papillary thyroid carcinoma with intraluminal tracheal extension: A Malaysian experience and literature review
title_sort case on papillary thyroid carcinoma with intraluminal tracheal extension: a malaysian experience and literature review
publisher Springer Nature
publishDate 2024
url http://irep.iium.edu.my/117238/7/117238_A%20case%20on%20papillary%20thyroid%20carcinoma%20with%20intraluminal%20tracheal.pdf
http://irep.iium.edu.my/117238/
https://www.cureus.com/
_version_ 1819909425298669568
score 13.23648

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