Occult Primary Thyroid Carcinoma presenting as lateral cervical mass: Report of two cases

Abstract

Background: Thyroid cancer presenting with cervical lymphadenopathy as a sole occurrence is uncommon. It usually presents as a palpable thyroid mass or nodule. Isolated cervical lymphadenopathy is rare and hence poses a diagnostic challenge. Fine needle aspiration-cytology (FNAC) or biopsy are important modalities which help establish the origin.Case Report: Two cases of lateral cervical lymphadenopathy with no other specific clinical findings were encountered within a span of two weeks with different clinical backgrounds. First to present was a 28 year old young male with a months' history of lateral cervical swelling. Later a 58 year old male also presented without any history of overt primary thyroid carcinoma. FNAC in both the cases confirmed presence of metastasis from occult primary papillary cancer thyroid. Following this ultrasonography neck was performed which revealed a solid-cystic mass in both the cases. In the younger male an ill-defined solid nodule with microcacifications was identified in the left thyroid lobe while in the case of elderly male; thyroid gland was normal. Subsequently both underwent total thyroidectomy with left neck dissection and histologically proven primary papillary thyroid cancer was found. Conclusion:Posterior cervical lymphadenopathy occurring primarily as a result of papillary carcinoma thyroid is rare.