Parapharyngeal Metastasis of an Occult Thyroid Carcinoma

A 36-year-old patient presented with dysphagia and cough. His medical history of interest included total thyroidectomy for multinodular goiter three years earlier. A cervical computed tomography scan demonstrated a nodule measuring 3.4 cm in the parapharyngeal space (Fig. 1). Fine needle aspiration revealed metastasis of papillary carcinoma. An I¹³¹ scan confirmed a single uptake in that area, while lab work revealed a thyroglobulin level of 4.9 ng/mL. The parapharyngeal mass was resected, and the histopathological study demonstrated papillary carcinoma metastasis. Stimulated thyroglobulin levels were normal 3 months later.

Fig. 1

Single lymph node metastases of thyroid cancer in the retropharyngeal and parapharyngeal spaces are very rare. They are due to the migration of cells through the direct lymphatic drainage pathway, as described by Rouvière.