Journal of Thyroid Disorders and

Therapy Case Report

Papillary Thyroid Carcinoma Presenting As a Cystic Lesion in Neck: A Case

Report
Rizwan Khalid*
Department of Medicine, National University of Sciences & Technology, Lahore, Pakistan

ABSTRACT
Local lymphatic spread is common in patients with papillary thyroid carcinoma (PTC). Lymph node metastasis to the
neck may undergo cystic degeneration which consequently delays the diagnosis and the treatment of underlying
thyroid malignancy. In this study we presented a patient with a cystic lesion in the neck as the only finding on
physical examination. A benign etiology was considered initially, but papillary thyroid cancer was reported after
surgical excision of the lesion.
Keywords: Papillary Thyroid Carcinoma; Cystic Degeneration

INTRODUCTION Neck showed subtle enhancing nodule in right thyroid lobe and
Papillary thyroid carcinoma (PTC) is the most common type of one nodule seen in left thyroid lobe (Figure 1).
endocrine tumors and constitutes approximately 1% of all
malignancies. It usually presents as a mass in the thyroid gland
but presentation as a lump in the neck is not rare [1]. Lymph
node metastasis from PTC may rarely undergo cystic
transformation [2]. It may be indolent and mimic the clinical
course of a benign lesion which consequently delays the
diagnosis and treatment of the underlying malignancy. In this
study we described a patient presenting with a cervical lymph
node as the initial finding.

CASE DESCRIPTION
A 40 years old male presented in East Surgical Ward, Mayo
Hospital Lahore with complaint of right sided neck swelling for Figure 1: Enhanced CT Neck showed subtle enhancing nodule in
the last 8 months. There were no symptoms of fever, malaise, right thyroid lobe and one nodule seen in left thyroid lobe.
weight loss or dysphagia. There was no family history of thyroid
malignancy or head and neck irradiation in childhood. There
was no positive history of TB contact. On examination there was A large cystic lesion on right lateral side of thyroid gland
4 x 4 cm cystic swelling in right posterior cervical chain, painless extending up to lower neck with subtle necrosis and multiple
and mobile along with multiple enlarged ipsilateral cervical enlarged Lymph nodes along right internal jugular chain.
lymph nodes. Thyroid gland was not palpable. Thyroid scan Thyroid and cricoid cartilages are normal. Impression: Papillary
showed small Multinodular Goiter and Extra thyroidal swelling Papillary thyroid carcinoma with lymphadenopathy.
involving right side of neck. FNAC reveals hemorrhagic smear
Total thyroidectomy and right modified neck dissection was
with few atypical cells. Free T4 was 16.5 pmol/L (11.5-23.0
done. Post operative course was smooth. Histopathology report
pmol/L) and TSH 2.39 mlU/L (0.30-5.0 mlU/L). Enhanced CT
showed: Classical papillary thyroid carcinoma, multifocal, large
focus measures 2.5 cm. Lymphovascular invasion is noted.

Correspondence to: Rizwan Khalid, Department of Medicine, National University of Sciences & Technology, Lahore, Pakistan; Tel: +92-
3345442757; E-mail: [email protected]
Received: April 24, 2020; Accepted: May 04, 2020; Published: May 11, 2020
Citation: Khalid R (2020) Papillary Thyroid Carcinoma Presenting As a Cystic Lesion in Neck: A Case Report. Thyroid Disorders Ther. 9:235.
DOI: 10.35248/ 2167-7948.20.09.235
Copyright: © 2020 Khalid R. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Thyroid Disorders Ther, Vol.9 Iss.1 No:235 1

Khalid R

Metastatic carcinoma involving level 2 lymph nodes. 1 out of 10 CONCLUSION

positive lymph nodes in level 3. Metastatic papillary carcinoma Any cystic lesion in the neck should be assumed as malignant
level 4. All three lymph nodes positive in level 5. Salivary gland until proven otherwise. An FNA from the solid part of the cystic
uninvolved by tumor. He was referred for radioactive I131 lesion would be of great value to establish the diagnosis
ablation after scan. preoperatively which certainly saves time and avoids unnecessary
surgery.
DISCUSSION
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