Korean J Otorhinolaryngol-Head Neck Surg.  2012 Sep;55(9):571-577. 10.3342/kjorl-hns.2012.55.9.571.

Evaluation of Lymph Nodes in Patients with Concurrent Papillary Thyroid Carcinoma and Cervical Tuberculous Lymphadenitis

• Chung EW
• Chang YS
• Lee J
• Choi SY
• Lee NJ
• So YK
• Jeong HS

• KMID: 2141143
• DOI: http://doi.org/10.3342/kjorl-hns.2012.55.9.571

Abstract

BACKGROUND AND OBJECTIVES
To determine the diagnostic clues to differentiate tuberculous lymph node infection from nodal metastasis in patients with both papillary thyroid carcinoma and cervical tuberculous lymphadenitis.
SUBJECTS AND METHOD
We retrospectively reviewed 11 patients suffering concurrently from papillary thyroid carcinomas with cervical tuberculous lymphadenitis. Nine of the 11 patients underwent preoperative neck ultrasonography (US) and seven CT scans. Using the surgical pathology as the reference standards, the results of the preoperative diagnostic tools were re-evaluated according to lymph node level-based analysis. US and CT features were also compared between metastatic nodes and tuberculous lymphadenitis.
RESULTS
Preoperative CT could localize the involved lymph node levels and differentiate tuberculous infection from metastasis of thyroid carcinoma in only two of seven patients. The site of the involved lymph nodes, the presence of pulmonary tuberculosis, and the tumor volume of the thyroid carcinoma were the clues to diagnose the lymph node status. However, in five of seven cases, CT could not differentiate tuberculosis from metastasis in the lymph nodes. The morphological characteristics of lymph nodes seen on CT and US did not differ between tuberculous infection and metastasis of papillary thyroid carcinomas.
CONCLUSION
Pre-operative CT or US does not provide differential information about lymph node status between tuberculous infection and metastasis in patients with concurrent papillary thyroid carcinomas and cervical tuberculous lymphadenitis. Rather, clinical characteristics such as the site of the involved lymph nodes, the primary tumor burden, and the associated clinical features can help the physician differentiate between them.

Keyword

Lymph nodes; Lymphatic metastasis; Thyroid carcinoma; Tuberculous lymphadenitis

MeSH Terms

Carcinoma
Humans
Lymph Nodes
Lymphatic Metastasis
Neck
Neoplasm Metastasis
Pathology, Surgical
Retrospective Studies
Stress, Psychological
Thyroid Gland
Thyroid Neoplasms
Tuberculosis
Tuberculosis, Lymph Node
Tuberculosis, Pulmonary
Tumor Burden
Carcinoma
Thyroid Neoplasms