Thyroid carcinoma presenting as a regional neck mass.

Area of Science:

• Oncology
• Endocrinology
• Surgical Pathology

Background:

• Thyroid carcinoma can present with varied clinical manifestations.
• A subset of patients presents with cervical lymphadenopathy and a clinically normal thyroid gland.
• The clinical behavior and prognosis of this specific presentation are not well-defined.

Purpose of the Study:

• To evaluate the clinicopathological features and outcomes of thyroid carcinoma presenting as a regional neck mass.
• To compare the aggressiveness and recurrence rates of this presentation versus typical thyroid carcinoma.

Main Methods:

• Retrospective review of 197 thyroid carcinoma patients treated between 1978-1988.
• Analysis of a subgroup of 27 patients presenting with a regional cervical mass and normal thyroid gland.
• Comparison of recurrence rates between the subgroup and 170 patients with palpable thyroid masses.

Main Results:

• Excisional biopsy confirmed metastatic thyroid carcinoma in all 27 patients.
• Thyroid scans showed 42% sensitivity; fine-needle aspirations were non-diagnostic in 3 cases.
• Surgical specimens revealed extensive disease (multicentricity, extracapsular spread) and an 11.5% recurrence rate in this subgroup, compared to 1.8% in the larger cohort.

Conclusions:

• Thyroid carcinoma presenting as a regional neck mass is associated with extensive disease at diagnosis.
• This presentation exhibits a significantly higher recurrence rate, suggesting a more aggressive disease behavior.
• Early diagnosis and comprehensive management are crucial for patients with this atypical presentation.