Kim, William1; Kung, Jacqueline2; O’Leary, Miriam1
1 Department of Otolaryngology – Head and Neck Surgery, Tufts Medical Center, Boston, MA, USA
2 Department of Endocrinology, Tufts Medical Center, Boston, MA, USA
Background: Though occult well-differentiated thyroid carcinoma is not uncommon, incidental finding of a cervical metastasis without a clear primary tumor in the thyroid gland is unusual. Such discovery incites controversy in regards to its significance and management.
Purpose: To report a case series of incidentally found metastatic papillary thyroid cancer without a primary thyroid origin. To discuss and review the possible management options.
Methods: A retrospective chart review of two cases at an urban tertiary medical center was performed. Clinical, radiographic, and pathologic data were collected and reviewed. A literature search of occult cervical metastasis of papillary thyroid cancer was performed.
Results: Two patients were found to have incidental small foci of papillary thyroid cancer in their cervical lymph nodes. One patient had a history of head and neck cancer and subsequent radiation, and the other had a history of non-toxic multinodular goiter with negative fine needle aspiration of thyroid nodules that met criteria. Metastatic papillary thyroid carcinoma was found in level 2 and level 4, respectively. Both had no clear primary thyroid cancer on imaging.
Discussion/Conclusion: Cervical metastasis of papillary thyroid cancer is treated aggressively as it is considered advanced stage pathology. However, without a defined primary tumor, microcarcinoma is assumed, and the need for aggressive surgery is debatable. Management should differ depending on the patients’ risk factors and prognosis from other medical conditions.