Larenkse yayılan nüks tiroid papiller karsinomuna cerrahi yaklaşım: Olgu sunumu

Elli dört yaşında erkek hasta, boyun ön tarafında üç aydır var olan şişlik yakınması ile başvurdu. Hastaya 12 ay önce tiroid papiller karsinomu nedeniyle başka bir merkezde sağ total, sol totale yakın tiroidektomi ve sağ tarafa modifiye radikal boyun diseksiyonu yapılmıştı. Hastanın muayenesinde, boyun orta hatta yaklaşık 4x5 cm çapında ve larenkse fikse bir kitle ve iki taraflı multipl lenfadenopatiler görüldü. Fiberoptik direkt larengoskopik incelemede, larenks lümenini dolduran, ön komissürü tutan lobule konturlu bir kitle ve sağ kord vokalin fikse olduğu görüldü. Yapılan biyopside tiroid papiller karsinom ile uyumlu histopa- tolojik bulgular saptandı. Larenks invazyonu göste- ren nüks tiroid papiller karsinomu nedeniyle hastaya total larenjektomi, iki taraflı boyun diseksiyonu ve pektoralis majör miyokutanöz flebi ile rekonstrüksi- yon yapıldı. Histopatolojik incelemede, nüks papiller karsinomun larenkse infiltre olduğu görüldü. Cerrahi sonrasında I-131 tedavisi gören hastanın 10 aylık takibinde herhangi bir nüks ya da uzak metastaz saptanmadı

Anahtar Kelimeler:

Karsinom, papiller/cerrahi, larenks neoplazileri, tiroid neoplazileri/cerrahi

Surgical approach to recurrent papillary thyroid carcinoma involving the larynx: a case report

A 54-year-old male patient presented with a complaint of a mass in the anterior aspect of the neck of three-month duration. He had a history of total and near total thyroidectomy in the right and left lobes, respectively, and right modified radical neck dissection at another center 12 months before. Physical examination showed a laryngeal mass, 4x5 cm in size, in the midline of the neck, and bilateral and multiple lymphadenopathies. Fiberoptic laryngoscopy showed a lobular contour mass filling the laryngeal lumen and involving the anterior commissure and a fixed right vocal cord. Biopsy result of the lesion was consistent with papillary carcinoma of the thyroid. The patient underwent total laryngectomy and bilateral neck dissection followed by reconstruction with the pectoralis major myocutaneous flap. Histopathologic examination showed laryngeal infiltration of the recurrent papillary thyroid carcinoma. Postoperative radioiodine I-131 therapy was administered. No recurrences or distant metastasis were detected within a follow-up period of 10 months.

Keywords:

Carcinoma, papillary/surgery, laryngeal neoplasms, thyroid neoplasms/surgery,

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