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7 year relapse part II.

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  • 7 year relapse part II.

    Hi all,

    It's been a long time since I've posted about my relapse. Iím not sure why I couldnít post onto the original thread, but hereís the hyperlink for some background:

    I was able to get in Dr. Feldman at MSKCC. 4xBEP in the bag and the masses around the thyroid and the cervical lymph nodes (levels 2-4) all showed marked decreases. All by at least 50% and most by 75%. When comparing my neck CT pre and post chemo, chief ENT Dr. Wong at MSKCC said it was the most significant response to chemo he had ever seen. There were also mets to the kidney (chemo shrunk mass by 75%), the right lung (now so small it will be monitored) and the mediastinum (shrunk but not significantly).

    At first, a total thyroidectomy and bilateral lymph node dissection (levels 2-4) were put on the table for an upcoming 2/10/18 surgery. There are still a couple of nodes that fall >1cm with the largest being 1.4cm (see below for written report from the post chemo CT). After conferring with a few of his colleagues (including Sheinfeld), Dr. Feldman suggested to only go for the total thyroidectomy and cut out some surrounding lymph nodes for biopsy. If they come back necrotic or all clear, he would put his bet that the rest of the nodes in the neck are cancer free (and confirm no active EC with a post surgery PET). Not going through with the neck dissection is due to the invasive 10 hour nature of the surgery and potential serious complications involved. If positive nodes or teratoma found, we'll move ahead with the bilateral neck dissection. That being said, the risk of teratoma is real (original path had 50% teratoma, post RPLND path was 100% pure EC). I'm concerned that not going through with a bilateral node dissection would be too risky.

    Does anyone have any objective opinions on this situation? Would you go straight ahead with the bilateral neck dissection or follow the lead of MSKCC team and do thyroidectomy and surveillance? Should I reach out to Dr. Einhorn for his opinion? There's a lot going on, and germ cell tumor thyroid involvement seems to be uncharted waters in medical literature so there's not much to hang my hat on.

    As for the other mets, they will be taken care of after this first operation.

    Thanks everyone,


    FINDINGS: SOFT TISSUES: Prior CT neck dated October 11, 2017 had demonstrated expansile complete infiltration of the bilateral thyroid glands. On the current examination there is been a significant interval contraction in size of the thyroid lobes, with only minor residual heterogeneity of the intrinsic composition of both glands. No suspicious abnormal enhancement or masses are identified in the upper aerodigestive tract structures, parotid glands or submandibular glands. Unchanged subcentimeter cystic thyroglossal duct remnant as seen on series 2 image 74. NODES: Significant interval decrease in the previously enlargedcystic/necrotic heterogeneously enhancing nodes, for example -Right level IIB node now measuring 1.2 x 0.8 cm, previously 2.5 x 1.8 cm (series 2 image 50). -Left level IIB node now measuring 0.6 x 0.37 m, previously 1.7 x 1.6 cm on series 2 image 47). -Right levelIII node now measuring 0.7 x 0.3 cm, previously 2.5 x 1.6 cm (series 2 image 67). -Now wispy left level IV node measuring 0.7 x 0.5 cm, previously 2.5 x 2.4 cm (series 2 image 88); and -Left tracheoesophageal groove node measuring 1.4 x 0.5 cm,previously 2.2 x 1.6 cm (series 2 image 95). No new adenopathy.
    Right I/O 1/29/10, Teratoma (50%), Embroyonal Carcinoma (40%) and yolk sac
    RPLND - 4/5/10, Stage II
    Bowel Obstruction surgery post-RPLND - 4/26/10