Neck Masses as The First Presentation of Occult Papillary Thyroid Carcinoma: Case Series

Abstract

Background: Papillary Thyroid Carcinoma (PTC) is the most common thyroid cancer. It can be found incidentally during thyroidectomy or can present as an enlarged cervical lymph node which is difficult to be diagnosed unless confirmed by ultrasonography and fine needle aspiration cytology (FNAC). Objective: The aim of the current study is to report our experience in diagnosing Occult PTC (OPTC) presenting as a cervical mass without any evident thyroid enlargement. Patients and methods: Retrospective reviews of reports of all patients presented to our hospital complaining of a mass in the neck were enrolled in this study. Data regarding their history, investigations, ultrasound and Fine Needle Aspiration Cytology (FNAC) were reviewed. Cases investigated and diagnosed initially as OPTC were included. Diagnosis was confirmed by histopathological examination of the resected specimens. Results: Eleven out of 62 (17.7%) cases with cervical masses were diagnosed as OPTC based on ultrasound and FNAC findings later confirmed by histological examination of their specimens. Six of them were females and 5 were males with a mean age of 36.9 years. The mean duration of these masses was 2.3 months. Hemithyroidectomy was done for 2 patients for unilateral small masses in the thyroid with the remainder undergone a total thyroidectomy with modified lymph node dissection. Conclusion: OPTC can present for the first time as a neck mass without clinically apparent thyroid enlargement. Physicians should keep the possibility of OPTC in the differential diagnosis of all adult neck masses in order to avoid any delay in diagnosis and to achieve the proper management plan.