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Diagnosis and Treatment > Medication

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Alexa Clark Department of Medicine, Department of Medicine, Queen’s University, Kingston, Ontario, Canada

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Marosh Manduch Department of Pathology and Molecular Medicine, Department of Medicine, Queen’s University, Kingston, Ontario, Canada

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Russell Hollins Department of Otolaryngology, Department of Medicine, Queen’s University, Kingston, Ontario, Canada

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Sara Awad Division of Endocrinology and Metabolism, Department of Medicine, Queen’s University, Kingston, Ontario, Canada

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Summary

We report a case of metastatic papillary thyroid carcinoma presenting with a recurrent right-sided cervical lymph node necrotic cyst. A 55-year-old woman presented with a 3-month history of a right-sided upper neck mass following an upper respiratory tract infection. Past medical history includes a right-sided nephrectomy secondary to a benign renal tumor and hypertension. She was evaluated by Otolaryngology, and fine-needle aspiration was performed. The mass recurred 2 months following aspiration. Ultrasound of the neck showed a 2.2 × 1.4 × 1.9 cm right cervical lymph node with a small fatty hilum but a thickened cortex. Neck computed tomography (CT) scan showed a well-defined 2.3 cm mass in the right upper neck corresponding to a necrotic cervical lymph node at level IIA. It also revealed a 7 mm calcified left thyroid nodule. Cytology revealed a moderate collection of murky fluid with mildly atypical cells presumed to be reactive given the clinical history of infection. The cyst had re-grown 2 months following aspiration. Excisional biopsy was performed and revealed metastatic classic papillary thyroid carcinoma (PTC). Subsequently, a total thyroidectomy and right neck dissection was performed. Pathology confirmed metastatic unifocal classic PTC of the right thyroid lobe and two lymph node metastases out of a total of 17 resected lymph nodes. The patient underwent radioactive iodine ablation. Subsequent I-131 radioiodine whole-body scan showed no evidence of metastases. In conclusion, metastatic PTC should be considered in the differential diagnosis of a recurrent solitary cystic cervical lymph node.

Learning points:

  • Metastatic PTC should be considered in the differential diagnosis of a recurrent solitary cystic cervical lymph node.

  • A dedicated thyroid ultrasound is the preferred modality for identifying thyroid lesion over computed tomography.

  • There is a risk of non-diagnostic cytology following FNA for cystic neck lesions, largely predicted by the cyst content of the nodule.

Taxonomy:
Clinical Overview, Gland/Organ, Thyroid, Topic, Endocrine-related cancer, Hormone, Thyroxine (T4), TSH, Condition/ Syndrome, Lymphadenopathy, Papillary thyroid cancer, Thyroid nodule, Patient Demographics, Age, Adult, Gender, Female, Ethnicity, White, Country of Treatment, Canada, Diagnosis and Treatment, Signs and Symptoms, Neck mass, Thyroid nodule, Investigation, CT scan, Fine needle aspiration biopsy, Histopathology, Radionuclide imaging, Surgical biopsy, Thyroglobulin, Thyroid antibodies, Thyroid ultrasonography, Intervention, Lymph node dissection, Radionuclide therapy, Thyroidectomy, Medication, Amlodipine, Levothyroxine, Radioiodine, Related Disciplines, Otolaryngology, Publication Details, Case Report Type, Error in diagnosis/pitfalls and caveats
DOI:
https://doi.org/10.1530/EDM-18-0105
Volume/Issue:
Volume 2019: Issue 1
Open access