Review Question - QID 217079

This patient who presents to the emergency department with signs of sacral compression (low back pain and constipation) and imaging showing widely dispersed lesions most likely has metastatic cancer. The biopsy findings are consistent with follicular thyroid carcinoma, which would first disseminate to the jugular lymph nodes.

Lymph nodes are organized regionally and function to drain excess fluid from peripheral tissues in the form of lymph. The lymphatic network is useful in communicating information about infectious organisms to the rest of the body; however, it can also be hijacked by neoplasms during the process of metastasis. Each organ characteristically drains to a specific set of regional lymph nodes, which means that obtaining a biopsy of these "sentinel lymph nodes" can provide early information about whether a particular form of cancer is in the process of metastatic spread. For example, most head and neck cancers spread first to the cervical or jugular lymph nodes because these nodes drain fluid from head and neck tissues.

Vayisoglu and Ozcan discuss lymph node involvement in patients with neoplasms of the thyroid. They find that jugular and cervical lymph nodes are commonly involved in these neoplasms, but the diagnostic and prognostic value of these nodes is still not clear.

Figure/Illustration A is a histologic slide consistent with follicular thyroid carcinoma. The large eosinophilic proteinaceous collections surrounded by a single layer of cuboidal cells (examples demonstrated in yellow circles) resemble dysplastic thyroid follicle colloid collections.

Incorrect Answers:
Answer 1: Axillary lymph nodes drain the deep structures of the arm as well as the breast and would be involved in adenocarcinoma of the breast.

Answer 2: Inguinal lymph nodes drain the deep structures of the leg as well as perineal structures and would be involved in lower extremity liposarcoma.

Answer 4: Mediastinal lymph nodes drain the heart as well as the hilar structures of the lung and would be involved in squamous cell cancer of the lung.

Answer 5: Retroperitoneal lymph nodes drain the kidneys as well as the adrenal glands and would be involved in renal carcinomas.

Bullet Summary:
Head and neck cancers usually first involve the cervical and jugular lymph nodes during the process of metastasis.