Pattern of Lymphatic spread in medullary thyroid carcinoma

Maqbool Ahmed Baloch, Sabah Kaleem Baloch


Background: Medullary cancer arises from C- cells and accounts for 5-10 % of thyroid cancers. Most common site of metastasis is central compartment of neck and then ipsilateral neck nodes. Involvement of contralateral neck nodes shows poor prognosis. The only curative treatment in medullary cancer is surgery. The objective of this study was to see the pattern of lymphatic spread in medullary carcinoma.

Material & Methods: It was a retrospective review from 1995 to 2010. The patients who were treated initially outside were excluded.

Results: Total number of the patients were 40; 25(62.5%) males and 15(37.5%) females. Mean age was 46.2 years. In all patients, diagnosis was made on FNAC. Patients were divided in three groups on the basis of primary tumor size. In group A (16 patients), tumor size was less than 2 cm, in group B (13 patients), tumor size was 2-4cm and in group C (11 patients), tumor size was more than 4cm. On final histopathology reports, in Group A, 6(37.5%) patients had positive central neck nodes. In group B, central neck nodes were positive in 8(61.5%) patients and 3(23%) patients also had ipsilateral positive nodes. All patients in Group C shown metastasis in central nodes (100%), while 5(45.45%) patients had positive ipsilateral nodes and 3(27.27%) patients had contralateral positive nodes.

Conclusion: Chances of metastasis increase with tumor size and the most common site is the central neck compartment.

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