Metastatic Disease to the Neck Masquerading as Thyroid Carcinoma

Abstract

A 50 year old woman with a past medical history of hypertension, anemia, and migraine presented to the endocrinologist for evaluation of a lump in her right neck that was painful and tender. She also complained of dysphagia. Her thyroid gland was not enlarged; however, she had enlarged lymph nodes in her right lateral neck region. Laboratory testing revealed a normal TSH. Ultrasound of her neck and thyroid revealed two hypoechoic nodules in the right lower pole of the thyroid that appeared cystic in addition to matted lymph nodes lateral to the right carotid artery (Figures 1 A1B). Fine needle aspi- ration (FNA) of the right cervical lymph node was performed and was positive for metastatic carcinoma. FNA of the right thyroid nodule was also positive for malignant cells, with differential diagnoses including Hurthle cell carcinoma, anaplastic thyroid carcinoma, or carcinoma from another site (Figure 2 A, B). Suspicious lymph nodes were also noted in the left neck region and FNA of these lesions showed rare abnormal cells, suspicious for metastatic thyroid cancer to lymph nodes. Further imaging was performed including chest CT that revealed extensive right supraclavicular, mediastinal, and right hilar lymphadenopathy, scattered right lung nodules sus- picious for malignancy, and a large lobulated mass at the ileocecal junction with adjacent prominent lymph nodes, likely representing malignancy.