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

Authors

  • Shalini Bahadur M.D., Associate Professor, Dept. of Pathology;NDMC and Hindurao hospital.
  • Priyanka Anand M.D., Senior Resident, Dept. of Pathology; NDMC and Hindurao hospital
  • Kamlesh Prajapati D.C.P, D.N.B Resident, Dept. of Pathology;NDMC and Hindurao hospital.
  • Namrata Nargotra M.D., Head of Department, Dept. of Pathology;NDMC and Hindurao hospital

Keywords:

Cervical lymphadenopathy, Papillary thyroid cancer, Fine needle aspiration- cytology, Histologic examination

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.

 

DOI: 10.21276/APALM.1149

Author Biographies

Shalini Bahadur, M.D., Associate Professor, Dept. of Pathology;NDMC and Hindurao hospital.

Department of Pathology,Associate Professor

Priyanka Anand, M.D., Senior Resident, Dept. of Pathology; NDMC and Hindurao hospital

Department of Pathology, Senior Resident

Kamlesh Prajapati, D.C.P, D.N.B Resident, Dept. of Pathology;NDMC and Hindurao hospital.

Department of Pathology, DNB Resident

Namrata Nargotra, M.D., Head of Department, Dept. of Pathology;NDMC and Hindurao hospital

Deparment of Pathology, Head of department

References

1. Maceri DR, Babyak J, Ossakow SJ. Lateral neck mass. Sole presenting sign of metastatic thyroid cancer. Arch Otolaryngol Head Neck Surg. 1986;112:47–9.
2. Park CS, Min JS. Lateral neck mass as the initial manifestation of thyroid carcinoma. Head Neck. 1989;11:410–13.
3. Machado NO, Chopra PJ, AI Hamdani A. Papillary Carcinoma of the thyroid presenting primarily as cervical lymphadenopathy: An approach to management. Sultan Qaboos Univ Med J. 2009;9(3):328-32.
4. De Jong SA, Demeter JG, Jarosz H, Lawrence AM, Paloyan E. Primary papillary thyroid carcinoma presenting as cervical lymphadenopathy: the operative approach to the lateral aberrant thyroid: Am Surg. 1993;59:172–7.
5. McGuirt FW. Differential diagnosis of Neck Masses. In: CummingC, et al., eds. Otolaryngology Head Neck Surgery. St. Louis: Mosby-Year Book, 1993: 1543–1553.
6. Bagwan IN, Kane SV, Chinoy RF. Cytologic evaluaton of the enlarged neck node: FNAC utility in metastatic neck disease. Int J Pathol 2007;6:2.
7. Alam K, Khan A, Siddiqui F, Jain A, Haider N, Maheshwari V. Fine needle aspiration cytology (FNAC): A handy tool for metastatic lymphadenopathy. Int J Pathol 2010;10:2.
8. Khajuria R, Goswami KC, Singh K, Dubey VK. Pattern of lymphadenopathy on fine needle aspiration cytology in Jammu. JK Sci 2006;8:157-9.
9. Sanders LE, Rossi RL. Occult well differentiated thyroid carcinoma presenting as cervical node disease. World J Surg 1995;19:642–647.
10. Vassilopoulou-Sellin R, Weber RS. Metastatic cancer as an incidental finding during neck dissection: significance and management. Head Neck 1992;14:459–463.
11. Nussbaum M, Bukachevsky R. Thyroid carcinoma presenting as a regional neck mass. Head Neck Surg 1990;12:114–117.
12. Cady B, Myssiorek D, Thompson N, et al. Management of papillary carcinoma of the thyroid, metastatic to the lateral neck, without apparent primary carcinoma in the thyroid gland. Collected Lett Surg 1993;16:1.
13. Ravetto C, Colombo L, Dottorini ME. Usefulness of fine-needle aspiration in the diagnosis of thyroid carcinoma. Cancer Cytopathol 2000;90:357-363.
14. Mehmood RK, Basha SL, Ghareeb E. A case of papillary carcinoma arising in ectopic thyroid tissue within a branchial cleft cyst with neck node metastasis. Ear, Nose and Throat Journal 2006;85:675-676.
15. Wang Z, Qui S, Mahmoud A. Histopathologic and immunohistochemical characterization of a primary papillary thyroid carcinoma in the lateral cervical lymph node. Experimental and Molecular Pathol 2007;82:91-94.
16. Holmes BJ, Sokoll LJ. Measurement of fine needle aspiration thyroglobulin level increases the detection of metastatic papillary thyroid carcinoma in cystic neck lesions. Cancer Cytopathol 2014;122:521-526.

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Published

28-03-2017

How to Cite

1.
Bahadur S, Anand P, Prajapati K, Nargotra N. Occult Primary Thyroid Carcinoma presenting as lateral cervical mass: Report of two cases. Ann of Pathol and Lab Med [Internet]. 2017 Mar. 28 [cited 2025 Feb. 5];4(2):C59-62. Available from: https://pacificejournals.com/journal/index.php/apalm/article/view/apalm1149

Issue

Vol. 4 No. 2 (2017)

Section

Case Report

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Copyright (c) 2017 Shalini Bahadur, Priyanka Anand, Kamlesh Prajapati, Namrata Nargotra

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