Diffuse sclerosing variant of thyroid papillary carcinoma in 12-year-old girl with non-recurrent laryngeal nerve

DOI 22 References
  • Nario Kazuhiko
    Department of Otorhinolaryngology, Head and Neck Surgery, Nara Medical University
  • Shimizu Naoki
    Department of Otorhinolaryngology, Head and Neck Surgery, Nara Medical University
  • Ohta Ichiro
    Department of Otorhinolaryngology, Head and Neck Surgery, Nara Medical University
  • Hosoi Hiroshi
    Department of Otorhinolaryngology, Head and Neck Surgery, Nara Medical University

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Other Title
  • 非反回神経を伴った小児甲状腺びまん性硬化型乳頭癌例

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  We report a diffuse sclerosing variant of thyroid papillary carcinoma with non-recurrent laryngeal nerve. A 12-year-old girl with anterior neck swelling and hoarseness was referred to our hospital. Flexible fiberscopy revealed that the vocal cord was fixed on the left side. On ultrasonogram, numerous minute calcifications were seen with diffuse swelling of the thyroid gland without forming nodules. Computed tomography (CT) and magnetic resonance imaging showed a retro-esophageal right subclavian artery arising from the dorsal part of the aortic arch, which preoperatively reminded us of a non-recurrent laryngeal nerve on the right side. Chest CT revealed a small lung metastasis. Based on all the imaging results, a diffuse sclerosing variant of papillary carcinoma was strongly suspected. Fine needle aspiration confirmed a diagnosis of papillary carcinoma.<br/>  Total thyroidectomy with bilateral neck dissection was performed. During the operation, we recognized the right-side non-recurrent laryngeal nerve, which derives from the main vagal nerve trunk. After surgery, the right-side vocal cord movement was normal, indicating that the right-side non-recurrent laryngeal nerve was not damaged. Damage to the right-side non-recurrent laryngeal nerve would have caused bilateral vocal cord paralysis, and a tracheotomy would have been unavoidable. Fortunately, the patient required no airway intervention and was able to maintain a good quality of life afterwards.<br/>  Although a non-recurrent laryngeal nerve is rare, head and neck surgeons must be aware of non-recurrent laryngeal nerves resulting from anomalous embryonic development of the aortic arches.

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