Clark Alexa, Manduch Marosh, Hollins Russell, Awad Sara
Endocrinol Diabetes Metab Case Rep. 2019 Jul 15;2019(1):18-0105. doi: 10.1530/EDM-18-0105.
We report a case of metastatic papillary thyroid carcinoma presenting with a recurrent right-sided cervical lymph node necrotic cyst. A 55-year-old woman presented with a 3-month history of a right-sided upper neck mass following an upper respiratory tract infection. Past medical history includes a right-sided nephrectomy secondary to a benign renal tumor and hypertension. She was evaluated by Otolaryngology, and fine-needle aspiration was performed. The mass recurred 2 months following aspiration. Ultrasound of the neck showed a 2.2 × 1.4 × 1.9 cm right cervical lymph node with a small fatty hilum but a thickened cortex. Neck computed tomography (CT) scan showed a well-defined 2.3 cm mass in the right upper neck corresponding to a necrotic cervical lymph node at level IIA. It also revealed a 7 mm calcified left thyroid nodule. Cytology revealed a moderate collection of murky fluid with mildly atypical cells presumed to be reactive given the clinical history of infection. The cyst had re-grown 2 months following aspiration. Excisional biopsy was performed and revealed metastatic classic papillary thyroid carcinoma (PTC). Subsequently, a total thyroidectomy and right neck dissection was performed. Pathology confirmed metastatic unifocal classic PTC of the right thyroid lobe and two lymph node metastases out of a total of 17 resected lymph nodes. The patient underwent radioactive iodine ablation. Subsequent I-131 radioiodine whole-body scan showed no evidence of metastases. In conclusion, metastatic PTC should be considered in the differential diagnosis of a recurrent solitary cystic cervical lymph node.
Metastatic PTC should be considered in the differential diagnosis of a recurrent solitary cystic cervical lymph node. A dedicated thyroid ultrasound is the preferred modality for identifying thyroid lesion over computed tomography. There is a risk of non-diagnostic cytology following FNA for cystic neck lesions, largely predicted by the cyst content of the nodule.
我们报告一例转移性乳头状甲状腺癌，表现为右侧颈部淋巴结复发性坏死性囊肿。一名55岁女性，在上呼吸道感染后出现右侧上颈部肿块3个月。既往病史包括因良性肾肿瘤继发的右侧肾切除术和高血压。她接受了耳鼻喉科评估，并进行了细针穿刺抽吸。抽吸后2个月肿块复发。颈部超声显示右侧颈部有一个2.2×1.4×1.9厘米的淋巴结，有一个小的脂肪性 hilum，但皮质增厚。颈部计算机断层扫描（CT）显示右上颈部有一个边界清晰的2.3厘米肿块，对应于IIA水平的坏死性颈部淋巴结。还发现左侧甲状腺有一个7毫米的钙化结节。细胞学检查显示有中等量浑浊液体，有轻度非典型细胞，鉴于感染的临床病史推测为反应性。抽吸后2个月囊肿再次生长。进行了切除活检，结果显示为转移性经典乳头状甲状腺癌（PTC）。随后进行了全甲状腺切除术和右侧颈部清扫术。病理证实为右侧甲状腺叶转移性单灶性经典PTC，在总共切除的17个淋巴结中有两个淋巴结转移。患者接受了放射性碘消融。随后的I-131放射性碘全身扫描未显示转移迹象。总之，在复发性孤立性囊性颈部淋巴结的鉴别诊断中应考虑转移性PTC。
在复发性孤立性囊性颈部淋巴结的鉴别诊断中应考虑转移性PTC。对于识别甲状腺病变，专用甲状腺超声是优于计算机断层扫描的首选检查方式。对于囊性颈部病变，细针穿刺抽吸后存在非诊断性细胞学检查的风险，很大程度上由结节的囊肿内容物预测。
