Papillary Carcinoma of theThyroid Presenting Primarily as Cervical Lymphadenopathy An approach to management
Journal Title: Sultan Qaboos University Medical Journal - Year 2009, Vol 9, Issue 3
Abstract
Papillary carcinoma of thyroid usually presents as a palpable thyroid mass. Tis could be associated with pain, hoarseness, stridor or dysphagia. Rarely, it presents solely as cervical lympadenopthy in the presence of an otherwise grossly normal thyroid gland. Tis could pose management problems. We report here a middle-aged lady who presented with cervical lymphadenopathy which on fne needle aspiration cytology was confrmed as metastatic papillary thyroid carcinoma. Te thyroid gland was, however, normal on clinical examination and radiological investigations. Neck exploration confrmed a grossly normal thyroid gland; however, the cervical lymph node was found to invade the internal jugular vein. She underwent a total thyroidectomy and unilateral functional block dissection with resection of the involved segment of the internal jugular vein. Histopathology confrmed metastasis in the lymph node and a 2mm sized microcarcinoma in the resected thyroid gland. A radioactive iodine scan in the postoperative period revealed no other metastasis. Te patient was prescribed lifelong thyroxine. She is on regular follow-up and 4 years following surgery continues to do well.
Authors and Affiliations
Norman O Machado| Departments of Surgery, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman, Pradeep J Chopra| Departments of Surgery, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman, Aisha Al Hamdani| Departments of Pathology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
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