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REPORT OF A CASE AND REVIEW OF THE LITERATURE: AXILLARY LYMPH NODES METASTASIS IN PAPILLARY THYROID CANCER PATIENT

Introduction: thyroid cancer (ТС) is the most common endocrine malignancy. Typical and frequent type of TC is papillary carcinoma (PC). Metastases of papillary TC have more often cervical location in II-VI neck lymph nodes groups. Axillary metastasis is not a common finding in the classic type of PC. Adequate Surgery and radioiodine therapy, if necessary, provide the excellent prognosis for most papillary TC patients. Case presentation. 87-year-old woman was presented in our Center with metastatic axillary lymphadenopathy. She had a history of thyroidectomy with central neck dissection 31 years ago for papillary TC. Earlier she underwent right and left lateral neck dissection and 131-I therapy (3 times: after 6 months - 86 mCi, after 12 months- 92 mCi, after 24 months - 98 mCi). On the time of patient presentation in the Center we have found right axillary lymphadenopathy, occipital lymphadenopathy and multiple pulmonary metastases. In our clinic we have performed removal of occipital lymph node metastases and right axillary metastases dissection. Postoperative pathology report has shown infiltration of the cervical and axillary lymph nodes by metastatic papillary TC. After Surgery patient received 131-I therapy one more again (after 3 months - 110 mCi, after 9 months - 150 mCi). Unfortunately, she died after 18 months later. The reason of death was progression of distant metastases at lungs. Follow up period from the initial operation made 32.5 years. Conclusion and discussion. Papillary thyroid cancer patient’s progression free survival is more 10 years. As a rule a papillary TC patients has survived for many years after the initial surgery. Exclusively rarely TC metastases can emerge in different atypical places and in the axillary lymph nodes also (more than 31 years after initial Surgery) that maybe associated with a poor prognosis. Case report is unique, because there are 16 equal clinical cases in world literature.