SUPERIOR MEDIASTINAL DISSECTION IN THE TREATMENT OF HURTHLE CELL-CARCINOMA OF THE THYROID

Background: Hurthle cell carcinoma of the thyroid frequently metastasi zes to regional lymph nodes. Delayed lymph node dissection may become necessary, adding little risk to patient survivability; however, metas tatic disease to the superior mediastinum that cannot be promptly dete cted, represents a survival threat that deserves special attention. Th e purpose of this study is to review our experience in managing Hurthl e cell carcinoma of the thyroid and make recommendations for appropria te treatment. Patients and Methods: A retrospective review of 371 thyr oid neoplasms seen between 1987 and 1994 yielded six patients with Hur thle cell carcinoma of the thyroid gland. These include three cases tr eated with thyroidectomy and transcervical superior mediastinal dissec tion (SMD) as initial treatment and three cases treated with thyroidec tomy alone. Results: Of the three patients treated with SMD as part of their initial treatment, one had occult micrometastases to the superi or mediastinum. All three patients remain alive and disease free at le ast 3 years later, whereas all three patients treated with thyroidecto my alone developed superior mediastinal metastases and died of their d isease. Conclusion: We propose that at the time of initial surgery, a transcervical SMD may prevent spread to the superior mediastinum and t herefore, improve survivability. Copyright (C) 1997 by W.B. Saunders C ompany.