PRIMARY PAPILLARY THYROID-CARCINOMA PRESENTING AS CERVICAL LYMPHADENOPATHY - THE OPERATIVE APPROACH TO THE LATERAL ABERRANT THYROID

In contrast to a few follicles arranged in a wedge-shaped segment at t he periphery of a lymph node, a significant amount of thyroid tissue i n a cervical lymph node is considered evidence of metastatic thyroid c arcinoma. In a consecutive series of 243 patients with papillary carci nomas, 52 presented with lateral cervical masses that proved to be lym ph nodes with metastatic thyroid carcinoma, in the absence of readily palpable thyroid nodularity. The metastatic disease was demonstrated b y excisional biopsy in 40 patients and fine needle aspiration cytology in 12 patients. Thirty-two (of the 52) underwent further diagnostic w ork-up, consisting of radionuclide scintigraphy and ultrasonography, w ith the demonstration of abnormalities consistent with a thyroid neopl asm in 75 per cent (24/32) of these patients. The remaining 20 patient s had no additional studies except for chemical thyroid function evalu ation. The operative treatment in all 52 patients was total thyroidect omy and unilateral or bilateral modified neck dissections, when extens ive cervical adenopathy was encountered. Papillary thyroid carcinoma, ranging in size from 2 to 14 mm, was found in the lobe ipsilateral to the presenting cervical node metastasis, in all specimens. In addition , contralateral cervical lymph node metastases were found in five (10% ) of these patients, with no evidence of thyroid carcinoma in the corr esponding thyroid lobe. With a mean follow-up period of 9 years, all p atients are alive with no evidence of recurrence. We conclude that met astatic papillary tumor in cervical lymph nodes that stain positive fo r thyroglobulin indicate the presence of a thyroid carcinoma, usually in the ipsilateral lobe, even though we could not demonstrate thyroid pathology preoperatively in such lobes in 25 per cent of the patients in this series. Excellent prognosis can be expected with total thyroid ectomy and appropriate unilateral or bilateral neck dissection.