Occult papillary thyroid cancer presenting as cystic metastasis of the lateral neck

Abstract

Rationale: Papillary thyroid cancer accounts for up to 85% of all cases of thyroid carcinoma. This disease entity is notorious for metastatic invasion of adjacent lymph nodes, including the cervical lymph nodes, potentially presenting as a growing lateral neck mass. However, these lesions tend to be recognized and diagnosed soon due to the palpable mass. Patient concerns: This report describes a very rare case of a huge slow-growing neck metastasis based on a 6 mm papillary thyroid microcarcinoma. This patient presented with a painless, but continuously growing right lateral neck mass. Aside from that, no specific complaints were mentioned. Diagnosis: The underlying cause of this patient's neck mass turned out to be an occult papillary thyroid microcarcinoma (Ø 6 mm) with metastatic invasion and subsequent cystic degeneration of cervical lymph nodes. Accurate diagnosis was made after surgical intervention through histopathological analysis. Interventions: The patient underwent complete resection of the cervical mass in conjunction with total thyroidectomy and right cervical neck dissection, followed by adjuvant iodine- and chemotherapy. Outcome: Margin free surgical resection without any postoperative complications could be achieved. The patient received iodine supplementation and remained free of recurrence during regular clinical follow-ups for 2 years. The therapy was curative. Lessons: This case report emphasizes the importance of a thorough diagnostic work-up including preoperative tissue sampling of any cervical neck mass, since a benign appearance on imaging does not exclude a malignant process.

Whispers in the Neck: Unmasking Cystic Metastases From Hidden Papillary Thyroid Carcinoma

“…Ultrasound is a very useful tool for the detection and assessment of thyroid gland lesions and cervical lymphadenopathy [ 9 , 10 ]. Sonographic features that are suggestive of malignancy include a predominantly solid composition, hypoechogenicity, absence of a hypoechoic halo, presence of microcalcifications, irregular margins, and increased vascularity [ 11 ].…”

Metastatic Mammary Carcinoma Presenting as a Large Cystic Axillary Mass: A Report of an Unusual Case

“…This occurs most frequently in lymph nodes of head and neck region, followed in decreasing frequency in inguinal, axillary, supraclavicular, and intrathoracic areas. 6,9,18 The primary tumors include papillary thyroid carcinoma, 1,2,3,4 malignant melanoma, 10 rectal adenocarcinoma, 5 pulmonary non-small cell carcinoma (squamous and adenocarcinoma), 6 salivary gland mammary-analogue secretory carcinoma, 7 tonsillar/oro/nasophanynx squamous cell carcinoma, 8,18 vulvar and other cutaneous squamous cell carcinoma, 9 and serous carcinoma of the gynecologic tract. 9 Within the literature for mammary carcinoma, only one previous report was identified.…”

“…Although uncommon, some metastatic cancers can present as cystic masses within lymph nodes. Cystic metastatic tumor deposits to lymph nodes have been described in patients with metastatic carcinoma of thyroid, 1,2,3,4 rectum, 5 lung, 6 salivary gland, 7 Waldeyer's ring, 8 and gynecologic tract origin, 9 as well as metastatic melanoma. 10 Cystic lymph node metastases of mammary carcinoma have been rarely reported.…”

Occult papillary thyroid carcinoma with cystic nodal metastasis mimicking a thyroglossal duct cyst: A case report

“…The prevalence of PTMC within autopsy series are 100–1000 times higher than clinically detected disease [10], suggesting that the majority of microcarcinomas remain latent. Nevertheless, there are cases within literature where occult PTC presents as a neck lump secondary to nodal metastases [11]. These cases are often mistaken for benign disease more commonly found within the region, thus resulting in a suboptimal treatment approach.…”