; 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
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.
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.
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.
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.
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.