Surgical approach for nodular neck lesions mimicking primitive thyroid neoplasms Report of three cases

The finding of a neck nodular lesion provides strong suspicion of primary thyroid malignancy. Direct extension into the thyroid parenchyma of carcinomas arising from pharynx, larynx, trachea or esophagus, nervous structures has been also observed in the minority of cases. The intent of our study is to present and discuss rare conditions presenting asymptomatic neck masses, with particular emphasis on pre-operative characteristics and diagnostic criteria.

In our retrospective analysis, we present three cases of nodular neck lesions that have mimicked primitive thyroid pathologies at the first diagnosis.

A 53-mm nodular mass in the right thyroid lobe was observed in one patient. The definitive diagnosis was Castleman's disease. The second case presented a 20-mm hypoechoic lesion in the contest of a multinodular goiter. The pre-operative suspect was thyroid carcinoma with lymphnode metastases but the definitive histology documented an 'ancient schwannoma'. A further patient presented bilateral supra-clavear and cervical lymphnodes in a multinodular goiter, initially interpreted as thyroid carcinoma with loco-regional spread. After a total thyroidectomy and cervical lymphadenectomy, the definitive histology documented foci of poorly differentiated carcinoma in cervical lymphnodes and a multinodular goiter without atypical cellularity. The patient is considered to have an occult tumor, probably arising from the breast, and she was scheduled in an oncological program.

Nodular neck lesions are frequently misdiagnosed as primitive thyroid nodules in the common clinical practice. In these rare conditions, surgical exploration is advocated to reach the definitive diagnosis, to indicate the most appropriate treatment and to avoid unnecessary thyroidectomy.

Ancient Schwannoma, Castleman's disease, Nodular neck lesion, Thyroid nodule.