Occult Papillary Microcarcinoma of the Thyroid Presenting as Large Cervical Node Metastases

Abstract

A 36-year-old woman was presented to our department with a large mass (diameter ∼5 cm) in the left lateral compartment of the neck. Preoperative imaging evaluation, including neck ultrasonography and computed tomography, revealed the presence of two large lymph nodes in the left lateral compartment of the neck (Figures 1 & 2; see overleaf). Of note, the thyroid gland was without pathological imaging findings. Fine-needle aspiration cytology of the mass revealed findings sug gestive of thyroid papillary carcinoma. The patient was operated and a total thyroidectomy with a left modified radical neck dis section was performed. Histology revealed the presence of a microscopic (2 mm) foci of papillary thyroid cancer in the left thyroid lobe; metastases were detected in the two enlarged lymph nodes, while the other 30 lymph nodes in the surgical specimen were tumor-free. Postoperative course was uneventful and the patient was discharged on postoperative day 4. The patient received postoperative adjuvant radioiodine therapy (radioiodine uptake: 1%). She is under suppressive hormone therapy and is doing well, 9 months after surgery. Occult thyroid cancer is typically diagnosed during investigation of the patient who presents with lymph node or other metastases [1–3]. Surgery followed by adjuvant radiodine therapy is the treatment of choice. Prognosis is determined by the extent of disease.