CLINICALLY UNDETECTABLE OCCULT THYROID PAPILLARY CARCINOMA PRESENTING WITH CERVICAL LYMPH NODE METASTASIS.

Area of Science:

• Oncology
• Endocrinology
• Pathology

Background:

• Occult papillary thyroid carcinoma is rarely diagnosed solely through cervical lymphadenopathy without apparent thyroid abnormalities.
• This case highlights the diagnostic challenge of identifying thyroid cancer when initial clinical and radiological assessments are negative.

Observation:

• A 47-year-old female presented with a significant cervical mass, initially suspected as malignant on ultrasound.
• Despite a normal head and neck examination and no thyroid nodules, biopsy confirmed papillary carcinoma.
• Immunohistochemistry was essential in identifying the thyroid origin of the metastatic lymph node.

Findings:

• The patient underwent total thyroidectomy and lymph node dissection, revealing multicentric, small papillary thyroid carcinomas in both thyroid lobes.
• Metastatic lymph nodes were confirmed on the right side of the neck.

Implications:

• Cervical lymphadenopathy can be the primary indicator of an undetected occult papillary thyroid carcinoma.
• Accurate immunohistochemical analysis is vital for correct diagnosis and surgical planning.
• Adjuvant radioactive iodine (RAI) therapy may be beneficial in preventing disease progression.