Retropharyngeal Lymph Node Metastases in Papillary Thyroid Carcinoma: A Case Series and Literature Review.

Introduction: The prevalence of retropharyngeal lymph node metastases in papillary thyroid carcinoma is low. The objective of this retrospective study was to assess our institutional experience with the management of such metastases and to compare results with other published series.

Methods: We conducted a retrospective analysis of patients diagnosed with papillary thyroid carcinoma and retropharyngeal lymph node metastases who were followed at the Endocrinology Department of the Instituto Português de Oncologia de Lisboa Francisco Gentil. To identify published cases in the literature, a comprehensive search was conducted using the Medline and PubMed databases from January 1970 to June 2025.

Results: We have identified a total of 15 patients. Twelve (80.0%) were women. The median age at initial surgery was 55.7 years (range 20.6 - 84.0 years) and the median duration of follow-up was 9.8 years (range 0.5 - 36.3 years). Five patients (33.3%) were diagnosed with retropharyngeal lymph node metastases during initial tumor staging and 10 (66.7%) in the follow-up, in eight patients (80.0%) due to biochemical persistence of the disease, and in two (20.0%) after cervical lymph node recurrence. Of the 15 patients, seven (46.7%) received no treatment for retropharyngeal lymph node metastases (surveillance group), and eight (53.3%) were treated (therapy group) and, from these, four (26.7%) underwent surgery, two (13.3%) received radiotherapy, one (6.7%) underwent radiosurgery and one (6.7%) underwent both surgery and radiotherapy.

Conclusion: Most patients with retropharyngeal lymph node metastases are diagnosed post-thyroidectomy, due to biochemical persistence of the disease or cervical lymphatic recurrence. Retropharyngeal lymph node metastases are commonly single and located ipsilaterally to the primary tumor and co-occur frequently with distant metastases.