Occult Papillary Thyroid Carcinoma Presenting as Cystic Lateral Neck Swelling. Case Series and Review of Literature. | ||||
| Ain Shams Journal of Surgery | ||||
| Volume 17, Issue 4, October 2024, Page 356-362 PDF (760.54 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ASJS.2024.319367.1160 | ||||
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| Authors | ||||
| Waleed Yusif El Sherpiny* 1; Hossam Ramadan Moussa1; Mohamed Mahmoud Ghazaly1; Mohamed Ali Mlees2 | ||||
| 1Department of General Surgery, Facutly of Medicine, Tanta University, Tanta, Egypt | ||||
| 2Department of General Surgery, Surgical Oncology Unit, Faculty of Medicine, Tanta University, Egypt | ||||
| Abstract | ||||
| Background: Up to 85% of thyroid carcinoma cases are papillary thyroid cancers. It may be the only or initial symptom of the disease, undergoing cystic transformation and manifesting as lateral neck metastases or regional lymph nodes from an unknown primary source. Patients and methods: Between January 2020 and May 2023, five individuals exhibiting a lateral cervical swelling in conjunction with a clinically unremarkable thyroid gland were managed within the surgical oncology division of the general surgery department at Tanta University Hospital, Egypt. A mass was found in the supraclavicular area in two patients, the mid-anterior border of the right sternomastoid muscle region in one case, and the submandibular region in two cases. In all cases, there were no detectable thyroid gland masses. The clinical examination revealed no enlargement of the thyroid gland. The patients underwent indirect laryngoscopy, free T3, free T4, fine needle aspiration cytology (FNAC), neck ultrasonography, and CT scan. Results: Sub-centimetric nodules were found in two cases with non-suspicious cervical lymph nodes, while the neck ultrasonography and CT scan revealed cystic swelling and a normal thyroid gland in three cases. In two cases, the FNAC revealed benign cells consistent with a branchial cyst; in one case, it revealed a parotid tail tumor; in the final two cases, it revealed malignant cells. The indirect laryngoscope, TSH, free T3, and free T4 were all normal. In every case, the histology revealed occult metastatic papillary thyroid cancer that had spread to a cystic lymph nodal tissue. The patients had radioactive iodine therapy after a modified cervical lymph node dissection in addition to a total thyroidectomy. Conclusion: while addressing a cystic lesion in the neck, surgeons should take into account the potential for nodal metastases from hidden malignancies, this condition may be attributed to pathologies such as papillary thyroid carcinoma. | ||||
| Keywords | ||||
| Hidden metastatic disease; Cystic enlargement; Papillary carcinoma; Thyroid gland | ||||
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