Occult Thyroid Carcinoma with Cervical Lymph Node Metastasis: A Rare Case Report

Area of Science:

• Oncology
• Endocrinology
• Head and Neck Surgery

Background:

• Cervical lymph node metastasis is a common presentation of papillary thyroid carcinoma (PTC).
• Occult thyroid carcinoma is defined by cervical lymph node metastasis with an undetectable or microcarcinoma primary tumor.
• Advances in imaging and histology have reduced the incidence of occult thyroid cancer.

Purpose of the Study:

• To report a case of occult thyroid carcinoma presenting with extensive cervical lymph node metastasis.
• To discuss the diagnostic and therapeutic challenges associated with this rare entity.
• To review potential hypotheses for the development of occult thyroid carcinoma.

Main Methods:

• A 38-year-old male presented with neck swelling, diagnosed via ultrasonography and fine-needle aspiration cytology as metastatic PTC.
• The patient underwent total thyroidectomy, central compartment clearance, and bilateral functional neck dissection.
• Post-operative radioactive iodine (RAI) screening and therapy were administered.

Main Results:

• Final histopathology staging was pT0N1b, confirming the absence of a primary tumor.
• The patient achieved disease-free status 1 year post-treatment with RAI.
• The case underscores the complexity of managing occult thyroid carcinoma.

Conclusions:

• Occult thyroid carcinoma is a rare diagnosis requiring tailored treatment strategies.
• Potential etiologies include tumor regression, ectopic thyroid tissue, or missed pathological findings.
• Multidisciplinary management and regular follow-up are crucial for successful outcomes.