Cervical cystic lymph node metastasis as first manifestation of occult papillary thyroid carcinoma: Report of seven cases

Background. Cervical cystic lymph node metastases as first and sole manifes tation of occult papillary thyroid carcinoma are observed exceptionally rar ely. In the seven patients here reported, a cystic, ovoid mass in the later al aspect of the neck was the initial symptom of the papillary microcarcino ma. Methods. There were six men and one woman, aged between 17 and 54 years (me an 31.7 years), who complained of round, movable, painless masses in the la teral aspect of the neck. Two patients were first seen with two cervical tu mors. Tumors had been present from a few days to 12 months (mean 5.1 months ). The cystic nature of tumors was demonstrated by echographic studies. In all cases, thyroid tumors were not palpable on physical examination and no abnormalities of the thyroid gland were shown by other diagnostic procedure s. Results. The diagnosis was made preoperatively by fine-needle aspiration cy tology of the nodes in five of the seven cases. All patients underwent thyr oidectomy with conservative neck dissection followed by radioactive iodine therapy. After a follow-up period from 1 to 7 years, all patients are alive with no apparent signs of recurrence or metastasis. Conclusions. In a young patient with solitary lateral cervical cyst, the di agnosis of lymph node metastasis from occult papillary thyroid carcinoma sh ould be considered. Any lateral mass requires tissue diagnosis, and fine-ne edle aspiration is usually adequate for clarification of the histology. Ips ilateral modified neck dissection and total thyroidectomy followed by radio active iodine therapy offers a favorable prognosis. (C) 1999 John Wiley & S ons, Inc.