Tastekin E, Can N, Ayturk S, Celik M, Ustun F, Guldiken S, Sezer A, Celik H, Koten M
Trakya University, Faculty of Medicine, Department of Pathology, Edirne, Turkey.
Trakya University, Faculty of Medicine, Department of Endocrinology, Edirne, Turkey.
Acta Endocrinol (Buchar). 2016 Jan-Mar;12(1):72-76. doi: 10.4183/aeb.2016.72.
Occult papillary thyroid carcinoma presented as isolated cervical lymphadenopathy without clinical and radiologic findings has been rarely reported.
A 47 years old female patient admitted to otorhinolaryngology clinic with 4X3 cm sized cervical mass. Physical examination of the patient was noted as a nontender, firm, mobile lymph node at right lateral cervical region. There was no inflammatory or infection disease in the history of patients anamnesis and no abnormal value on laboratory tests. Ultrasound screening of the neck detected a lymph node with suspicious features for malignancy. Head and neck examination was normal and there is no evidence of a tumoral mass or nodule in the thyroid gland. Whole body scan of MRI showed no pathologic sign both in the neck and body. Excisional biopsy was performed and revealed a carcinoma with papillary morphology. Immunohistochemical staining features of the tumor confirmed a papillary carcinoma derived from the thyroid gland. Second look USG of the neck and thyroid was performed but it revealed no tumoral mass. The patient underwent total thyroidectomy with right functional and central lymph node dissection. Histological examination of the thyroid gland showed multicentric 2 mm sized, three foci of papillary carcinoma located in bilateral thyroid lobes and metastatic lymph nodes in the right side of the neck.
A metastatic cervical lymph node can be evidence of a clinically undetected occult papillary thyroid carcinoma. Specific immunohistochemistry staining of specimen may lead to appropriate surgery and progression of carcinoma may be hindered by application of additional RAI therapy.
隐匿性甲状腺乳头状癌表现为孤立性颈部淋巴结病，无临床及影像学表现，此类报道少见。
一名47岁女性患者因4×3 cm大小的颈部肿物入住耳鼻喉科门诊。体格检查发现患者右侧颈部区域有一个无压痛、质地硬、可活动的淋巴结。患者既往史无炎症或感染性疾病，实验室检查无异常值。颈部超声筛查发现一个具有恶性可疑特征的淋巴结。头颈部检查正常，甲状腺无肿瘤性肿物或结节证据。MRI全身扫描显示颈部和身体均无病理征象。进行了切除活检，结果显示为具有乳头状形态的癌。肿瘤的免疫组化染色特征证实为源自甲状腺的乳头状癌。再次进行颈部和甲状腺超声检查，但未发现肿瘤性肿物。患者接受了全甲状腺切除术及右侧功能性和中央淋巴结清扫术。甲状腺组织学检查显示双侧甲状腺叶有多个2 mm大小的乳头状癌病灶，位于颈部右侧的淋巴结有转移。
转移性颈部淋巴结可能是临床未检测到的隐匿性甲状腺乳头状癌的证据。标本的特异性免疫组化染色可指导进行适当的手术，额外的放射性碘治疗可能会阻碍癌的进展。
