Occult papillary thyroid carcinoma presenting with cervical neck lymph node metastasis
Papillary thyroid cancer accounts for most cases of thyroid cancer. Neck lymph node metastases have been reported even in the absence of a primary tumor in the thyroid, and these cases are referred to as occult thyroid cancer (OTC). 74-year-old patient presented to the endocrinology department. Neck ultrasonography was conducted to assess the blood vessels. A 13 mm x 11 mm mass was incidentally found on the right thyroid that appeared benign. Additionally, a 22 mm x 16 mm mass was found at level III of the right neck lymph node, which appeared malignant. Another test was performed for thyroid, but no other abnormalities were observed in other areas. The right neck lymph nodes were confirmed to be a metastatic papillary carcinoma. Total thyroidectomy with right neck functional dissection was performed. The biopsy result confirmed that the right thyroid mass was a hyperplastic nodule, and also confirmed metastases to 7 of 21 neck lymph nodes. Although OTC has occasionally been reported in the past, its prevalence has decreased owing to improvements in ultrasonography and pathological tests. When a metastatic mass is found in neck lymph nodes but without a primary tumor in the thyroid, fine needle aspiration is the best diagnostic tool. If the biopsy result confirm metastatic thyroid cancer, total thyroidectomy and ipsilateral neck lymph nodes dissection should be performed.
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