Papillary thyroid carcinoma: occurrence and types of lymph node metastases

Fifty-seven (35.6%) of 160 patients with papillary thyroid carcinoma had lymph node metastases at the primary treatment. Children and adolescents were most frequently affected (69.2%), followed by the age group of 21-40-year olds (38.8%). Those older than 40 had the lowest incidence of lymph node metastases (29.6%; p less than 0.05). One fifth of all patients had lymph node metastases as first indication of papillary thyroid carcinoma. Two thirds of these patients were 40 years old or younger. Lymph node involvement affected the jugular vein in nearly all cases (78.8%) and the upper mediastinum as well in just under 15%. Women predominated (67.5 vs. 35.3%; p less than 0.05) if there was intrathyroidal tumor growth with lymph node metastases which occurred most frequently in the age group of 21-40-year olds. On the other hand, men had the highest incidence (67.7 vs. 32.5%; p less than 0.05) of lymph node metastases in connection with tumor growth outside the organ. Fixed lymph node metastases occurred more often in men, particularly in those older than 40 years of age. A pT4 stage (tumor growth outside the organ, 66.7%) was often present at the same time. Especially young patients had a high incidence of lymph node metastases in connection with multifocal intrathyroidal tumor growth, the lymph node metastases often being substantially larger than the mostly occult foci of thyroid carcinomas. Cystic degenerations were occasionally mistaken for cervical cysts.