Schwaiger Karl, Koeninger Fabian, Wimbauer Julia, Heinrich Klemens, Gala-Kokalj Alexandra, Wechselberger Gottfried
Hospital of the Barmherzige Brüder Salzburg, Department of Plastic, Aesthetic and Reconstructive Surgery, Paracelsus Medical University Salzburg (PMU), Salzburg, Austria.
Medicine (Baltimore). 2019 Jul;98(30):e16659. doi: 10.1097/MD.0000000000016659.
Papillary thyroid cancer accounts for up to 85% of all cases of thyroid carcinoma. This disease entity is notorious for metastatic invasion of adjacent lymph nodes, including the cervical lymph nodes, potentially presenting as a growing lateral neck mass. However, these lesions tend to be recognized and diagnosed soon due to the palpable mass.
This report describes a very rare case of a huge slow-growing neck metastasis based on a 6 mm papillary thyroid microcarcinoma. This patient presented with a painless, but continuously growing right lateral neck mass. Aside from that, no specific complaints were mentioned.
The underlying cause of this patient's neck mass turned out to be an occult papillary thyroid microcarcinoma (Ø 6 mm) with metastatic invasion and subsequent cystic degeneration of cervical lymph nodes. Accurate diagnosis was made after surgical intervention through histopathological analysis.
The patient underwent complete resection of the cervical mass in conjunction with total thyroidectomy and right cervical neck dissection, followed by adjuvant iodine- and chemotherapy.
Margin free surgical resection without any postoperative complications could be achieved. The patient received iodine supplementation and remained free of recurrence during regular clinical follow-ups for 2 years. The therapy was curative.
This case report emphasizes the importance of a thorough diagnostic work-up including preoperative tissue sampling of any cervical neck mass, since a benign appearance on imaging does not exclude a malignant process.
甲状腺乳头状癌占所有甲状腺癌病例的85%。这种疾病实体因转移侵犯相邻淋巴结（包括颈部淋巴结）而臭名昭著，可能表现为侧颈部肿块逐渐增大。然而，由于可触及肿块，这些病变往往很快被识别和诊断出来。
本报告描述了一例极为罕见的病例，基于一个6毫米的甲状腺乳头状微小癌出现巨大且生长缓慢的颈部转移灶。该患者表现为右侧颈部无痛但持续增大的肿块。除此之外，未提及其他特殊不适。
该患者颈部肿块的根本原因是隐匿性甲状腺乳头状微小癌（直径6毫米）伴转移侵犯及随后颈部淋巴结的囊性变。通过手术干预及组织病理学分析后做出准确诊断。
患者接受了颈部肿块完整切除，同时行全甲状腺切除术及右侧颈部淋巴结清扫术，随后进行辅助碘治疗和化疗。
实现了切缘阴性的手术切除，且无任何术后并发症。患者接受了碘补充治疗，在为期2年的定期临床随访中未出现复发。治疗具有治愈性。
本病例报告强调了全面诊断检查的重要性，包括对任何颈部肿块进行术前组织取样，因为影像学表现为良性并不能排除恶性病变。
