Cervical Lymphadenopathy Revealing Papillary Thyroid Carcinoma: A Case Report and Review of Literature

Abstract

Introduction: Cervical lymphadenopathy can be caused by various factors, including infections and malignancies. Papillary thyroid carcinoma (PTC) is a type of thyroid cancer that can lead to metastasis in the cervical neck lymph nodes. Ultrasound is recommended for preoperative lymph node evaluation, and preventive central lymph node dissection is advised for moderate- and high-risk PTC patients. This case study describes a young patient who was diagnosed with PTC through cervical ultrasound and biopsy of the cervical adenopathy. Case Presentation: A 27-year-old patient with no significant medical history presented with a left jugulo-carotid lymph node of about 1 cm. A cervical ultrasound showed three suspicious lymph nodes with a left thyroid nodule. An excision biopsy of the largest lymph node revealed thyroid tissue with abnormalities suggesting papillary carcinoma with nodal metastasis. A total thyroidectomy was performed with central and homolateral lymph node dissection, revealing an encapsulated papillary carcinoma with nodal metastasis. The patient received radioactive iodine therapy and was placed on L-thyroxine for substitution and suppression. Regular follow-up is assured. Discussion: Lymphadenopathy can result from regional or systemic disease and may indicate an underlying condition. PTC should be considered in any patient with cervical adenopathy, even if the thyroid is normal in size. The combination of radiology and fine-needle aspiration cytology (FNAC) is essential for diagnosing cervical masses and their metastatic origin. Total thyroidectomy with ipsilateral and/or contralateral cervical lymph node dissection is the best treatment for lymph nodes revealing PTC, followed by post-surgical radiation therapy. The prognosis remains favorable, although lymph node metastases are a predictor of recurrence. Conclusion: PTC, which mainly presents as cervical lymphadenopathy, is rare. Early detection and proper management of PTC are crucial for the patient's long-term outcome. With careful monitoring and regular follow-up, patients with PTC can achieve a favorable prognosis and quality of life. Keywords: Papillary thyroid carcinoma, Cervical lymphadenopathy, fine-needle aspiration cytology, Total thyroidectomy, lymph node dissection, radioactive iodine therapy.