Abstract
The patient was a 77-year-old woman who complained of a mass in the neck. Total thyroidectomy and left D2a neck dissection were performed (tall cell variant papillary carcinoma, pT4a pNlb pEX2-left recurrent nerve, no invasion to trachea). Two months after the operation, she felt progressive dyspnea. A tracheal tumor just under the crycoid cartilage was shown by neck CT examination and poorly differentiated papillary carcinoma was suggested by fine needle aspiration biopsy. Laryngotracheal resection to the level of the top of the sternum with cleidotomy, right neck dissection and local esophagectomy with reconstruction by a forearm free flap were performed. Because a histopathological examination showed squamous cell carcinoma and stain of TTF-1 and thyroglobulin were negative, we diagnosed the case as double primary cancer. Postoperative radiation of 50Gy was performed, but half a year later lung and multiple bone metastases were detected.
