[Cystic cervical lymph node swelling - Thyroglobin-FNA allows to diagnose metastasizing papillary thyroid carcinoma]. / Zystische zervikale Lymphknotenschwellung ­ TG-Bestimmung im Punktat sichert das lymphatisch metastasierte papilläre Schilddrüsenkarzinom.

HISTORY: A patient presented with a cystic mass in the lateral triangle of the neck. FINDINGS AND DIAGNOSIS: After ultrasound and MRI, a fine needle aspiration cytology (FNAC) was performed. It did not reveal malignant disease. By virtue of repeated FNAC and detection of thyroglobin in the cyst fluid, the diagnosis of thyroid carcinoma was firmly established. THERAPY AND COURSE: The necessary surgery could be performed in a single step intervention. Three weeks after surgery, radioiodine therapy with 3.7 GBq I131 was performed. CONCLUSION: Swelling of the cervical lymph nodes may have many causes, and rarely may be the metastasis of a thyroid carcinoma. We present a simple way to detect lymphatic metastatic thyroid carcinoma with the help of a case report.

Pylorus drainage procedures in thoracoabdominal esophagectomy - a single-center experience and review of the literature.

BACKGROUND: Pylorotomy and pyloroplasty in thoracoabdominal esophagectomy are routinely performed in many high-volume centers to prevent delayed gastric emptying (DGE) due to truncal vagotomy. Currently, controversy remains regarding the need for these practices. The present study aimed to determine the value and role of pyloric drainage procedures in esophagectomy with gastric replacement. METHODS: A retrospective review of prospectively collected data was performed for all consecutive patients who underwent thoracoabdominal resection of the esophagus between January 2009 and December 2016 at the Katharinenhospital in Stuttgart, Germany. Clinicopathologic features and surgical outcomes were evaluated with a focus on postoperative nutrition and gastric emptying. RESULTS: The study group included 170 patients who underwent thoracoabdominal esophageal resection with a gastric conduit using the Ivor Lewis approach. The median age of the patients was 64 years. Most patients were male (81%), and most suffered from adenocarcinoma of the esophagus (75%). The median hospital stay was 20 days, and the 30-day hospital death rate was 2.9%. According to the department standard, pylorotomy, pyloroplasty, or other pyloric drainage procedures were not performed in any of the patients. Overall, 28/170 patients showed clinical signs of DGE (16.5%). CONCLUSIONS: In the literature, the rate of DGE after thoracoabdominal esophagectomy is reported to be approximately 15%, even with the use of pyloric drainage procedures. This rate is comparable to that reported in the present series in which no pyloric drainage procedures were performed. Therefore, we believe that pyloric drainage procedures may be unwarranted in thoracoabdominal esophagectomy. However, future randomized trials are needed to ultimately confirm this supposition.