Occult Papillary Carcinoma Thyroid presenting as Lateral Cystic Neck Mass. – A Case Report & Review of Literature.

摘要

The appearance of a lateral cervical cystic mass as the only initial presenting symptom of occult thyroid carcinoma is uncommon. Its presence is often misdiagnosed due to the more frequent branchial cyst in young people. Although oronasopharyngeal squamous cell carcinoma has been reported as the main cause of lymph neck node metastasis, thyroid papillary carcinoma may be responsible for cervical cystic masses as the initial manifestation of the disease. This situation has been rarely reported, although solid masses are much more frequent. In most of these cases all such lesions may initially be considered as metastatic foci from a primary thyroid lesion. However, an alternative explanation by means of which ectopic thyroid tissue is associated with branchial cyst has to be considered, especially if no primary tumor is observed in the histological examination of thyroid gland. We present a rare case of cystic lymphnode metastasis of occult papillary carcinoma of the thyroid. We also discuss possible etiology for lateral papillary carcinoma in lateral neck cysts. Introduction Carcinoma of thyroid accounts for approximately 1% of Malignancies1. Papillary carcinoma is the most common type of thyroid malignances, with a female predominance1. 10% to 15% of these cases manifests as cervical lymphadenopathy & an occult primary lesion2. Isolated cystic metastases as the Presenting sign are extremely rare3,4. In the case reported, a cystic lesion in the patient’s neck laterally proved to be an Occult papillary carcinoma. Case Report A 35 yr old man presented with swelling in left lateral aspect of neck of 3 years duration, which was noticed as a result of trauma (fig 1). Swelling was gradually progressive initially and has increased rapidly since 2 months. No other symptoms were referred by the patient.