Synchronous papillary thyroid carcinoma with metastatic nasopharyngeal carcinoma issues regarding its diagnosis and management

ABSTRACT

@#A 46-year old female presented with a one-year history of a right lateral neck mass which gradually increased in size and subsequently involved bilateral cervical nodes. Diagnosed as Papillary Thyroid Carcinoma Stage I (T1N2M0), she underwent Total Thyroidectomy, Central Neck Dissection, Modified Radical Neck Dissection, Type I, right and Modified Radical Neck Dissection Type III, left. Histopathology revealed papillary thyroid carcinoma with no lymphovascular and capsular invasion, and metastatic undifferentiated carcinoma in 15 out of 16 lymph nodes, probably nasopharyngeal in origin. Work up uncovered an erythematous, friable nasopharyngeal mass. Its histopathology was nasopharyngeal cancer, a second primary malignancy. The malignancies were treated as separate entities. The patient underwent chemoradiotherapy first for the nasopharyngeal cancer. Radioactive Iodine for the thyroid malignancy was given six months after completion of radiotherapy. Double primary malignancies deserve aggressive treatment. The sequence of therapy should be based on the severity of the malignancy.