An Unusual Presentation of Papillary Thyroid Carcinoma That Resembles Lymphoma: A Case Report

Papillary thyroid carcinoma often emerges within the middle-aged group as a painless, irregular thyroid mass, and it can be accompanied by other symptoms such as hoarseness and dysphagia. Cervical node metastasis typically involves the ipsilateral jugular chain and remains confined to cervical node levels III and IV in most of the patients. Here, we present a case highlighting the uncommon presentation of papillary thyroid carcinoma. A 63-year-old Malay man with no known medical issues initially exhibited a painless swelling on the right neck level V region. The swelling progressively grew in size and later extended toward the anterior and contralateral sides of the neck for a duration of a year. He reported a weight loss of 10 kg past a year and experienced consistent fatigue. Physical examination showed multiple firm swellings with regular borders over levels I to V bilaterally. The swellings did not move upon swallowing. Due to the absence of initial thyroid swelling and the presence of multiple cervical lymphadenopathies in his medical history, lymphoma was suspected. A referral to ENT was made for an excision biopsy, but the procedure was abandoned to prevent potential injury to important underlying structures such as blood vessels and nerves. An ultrasound-guided biopsy was subsequently performed over multiple neck regions. It resulted in papillary thyroid carcinoma instead of lymphoma. Despite a suggestive history of lymphoma, papillary thyroid carcinoma should be considered a potential differential for a multilobulated neck mass. Excision biopsy has the potential to upstage the tumor and worsen the patient's prognosis. Fine-needle aspiration for cytology should be prioritized when investigating any neck swelling.