Occult Thyroid Papillary Carcinoma Found Incidentally in the Cervical Lymph Nodes.

Rita Roque, Carla Rocha, Sância Ramos, Humberto Messias.

The authors report a case of a renal insufficient 45 years old male patient with family history of thyroid papillary carcinoma who had a thyroid macro-nodule. The fine-needle aspiration biopsy of thyroid nodule was benign.

The nephrologist  submitted the patient for surgical specialist observation. Considering the clinical risk factors for thyroid neoplasm, the  lobectomy for histological examination was planned. The extemporaneous exam of thyroid specimen was consistent with benign lesion. Besides that, the surgeon decided for additional central lymph node dissection. Because the patient was also renal insufficient with secondary hyperparathyroidism, parathyroidectomy of the two glands homolateral was  performed.

Papillary carcinoma lymph node metastasis were found but the thyroid nodule shows to be benign.

A completion total thyroidectomy, central lymph node dissection and completion total parathyroidectomy with auto-transplantation were performed.

No papillary carcinoma was found within the thyroid parenchyma.

The patient was treated with radioiodine ablation.

The authors discuss this interesting case and review relevant literature.

As others, they propose the possibility that thyroid carcinoma in the cervical lymph nodes is not necessarily metastatic, but may occasionally arise from heterotopic thyroid tissue.