Long‐Standing Lateral Neck Mass As the Initial Manifestation of Well‐Differentiated Thyroid Carcinoma

Abstract

Objective: To analyze the presentation, evaluation, and treatment of a s ubset of patients with well· differentiate d thyroid carcinoma who present with a lateral n eck mass and no palpable disease in the thyroid gland. t1. ,dy Desig n: A retros pective r eview of all patients und rgoing thyroidectomy for malignancy. Metliod.s: A databa of all thyroid ctomies performed for malignancy by the Va nderbilt University Depart· m nt of Otolaryngology-Head and N ck Surgery fro m 1992 to 1997 was created. Patie nts who pre· sented with an isolated n eck mas without evidence of palpable disea e in the thyroid were selecte d for the tudy population. R esults: There were 60 cases of thyroid malignancy, with 14 cases (23.3%) that presented as i olated late ral n eck mass. The characteris· tics of this group (com par · d with the population of all thyroid malignancies) include younger age at presen · tation (37. 7 ± 15.2 y vs. 49.8 ± 15.6 y; Student t test: P = .019) a nd long· tending pr sence of symptoms (27.4 ± 39.6 mo vs. 3.6 ± 3.9 mo; P = .023). These patients gen eraJJy pr sented from a referring facility after having an excisional biopsy, which was lOOo/o accurate. Fin -ne die aspiration is b coming more u seful a nd was 66.7% accurate. Histological examination revealed cane r in the thyroid gland in all patients, 11 cases of p a pillary carcinoma, 2 follicular carcinomas, and on medullary carcinoma. The m ean size of the primary focus was 10.9 ± 8.7 nun, with 29% d emons trating bilat ral dis a e and 14 d emon trating mul· tifocal di sea se in the ips ilnte ral gland. The neck specimen revealed an average of 5.3 ± 3.2 me tas tatic nod es in levels II-IV and 3.9 ± 4.6 metas tatic nodes in

Papillary carcinpma of thyroid-an unusual lateral neck presentation

“…Approximately 25% of papillary carcinomas are occult, discovered incidentally at surgery. (4,5) The appearance of a solitary lateral cervical cystic mass as the only initial presenting symptom of occult thyroid carcinoma is extremely rare, with approximately 40 cases previously reported in the literature. (6) Papillary thyroid carcinoma is a malignant epithelial tumour showing follicular cell differentiation with characteristic nuclear features i.e.…”

Metástasis cervical de carcinoma papilar tiroideo oculto

“…[16][17][18] Cuando un tumor tiroideo no se detecta con los métodos diagnósticos habituales y presenta como manifestación primaria la aparición de una adenopatía metastásica cervical se denomina carcinoma oculto. Esta forma de presentación en el carcinoma papilar llega a suponer del 10 al 26 % de los casos 1,16,[19][20][21][22][23][24] .…”

“…20,[23][24][25][26][27] Sin embargo, la presentación primaria de un carcinoma tiroideo papilar como metástasis cervical de naturaleza quística es extremadamente rara, habiéndose recogido 44 casos en la literatura científica. [8][9][10][11][12][13][14] El rápido crecimiento tumoral dentro de una adenopatía metastásica provocaría una necrosis licuefactiva central con la consiguiente degeneración quística del nódulo linfático, explicando los hallazgos en estos casos.…”

“…1,16,[19][20][21][22][23][24] These metastases normally appear as solid masses in the anterior compartment (central and paratracheal) and lateral (lower and mid-jugular region). 20,[23][24][25][26][27] However, the primary presentation of papillary thyroid carcinoma with cervical metastasis of a cystic nature is extremely rare, with only 44 cases recorded in the scientific literature.…”

“…1,16,[19][20][21][22][23][24] These metastases normally appear as solid masses in the anterior compartment (central and paratracheal) and lateral (lower and mid-jugular region). 20,[23][24][25][26][27] However, the primary presentation of papillary thyroid carcinoma with cervical metastasis of a cystic nature is extremely rare, with only 44 cases recorded in the scientific literature. [8][9][10][11][12][13][14] Rapid tumoral growth within metastatic lymph node inflammation provokes central liquefactive necrosis with the resulting cystic degeneration of the lymph node, thus explaining the findings in these cases.…”