Long-standing lateral neck mass as the initial manifestation of well-differentiated thyroid carcinoma

Objective: To analyze the presentation, evaluation, and treatment of a subs et of patients with well-differentiated thyroid carcinoma who present with a lateral neck mass and no palpable disease in the thyroid gland. Study Design: A retrospective review of all patients undergoing thyroidecto my for malignancy, Methods: A database of all thyroidectomies performed for malignancy by the Vanderbilt University Department of Otolaryngology--Head and Neck Surgery f rom 1992 to 1997 was created, Patients who presented with an isolated neck mass without evidence of palpable disease in the thyroid were selected for the study population. Results: There were 60 cases of thyroid malignancy, with 14 cases (23.3%) t hat presented as isolated lateral neck mass. The characteristics of this gr oup (compared with the population of all thyroid malignancies) include youn ger age at presentation (37.7 +/- 15.2 y vs. 49.8 +/- 15.6 y; Student ttest : P = .019) and long-standing presence of symptoms (27.4 +/- 39.6 mo vs. 3. 6 +/- 3.9 mo; P = .023), These patients generally presented from a referrin g facility after having an excisional biopsy, which was 100% accurate. Fine -needle aspiration is becoming more useful and was 66.7% accurate. Histolog ical examination revealed cancer in the thyroid gland in all patients, 11 c ases of papillary carcinoma, 2 follicular carcinomas, and one medullary car cinoma. The mean size of the primary focus was 10.9 +/- 8.7 mm, with 29% de monstrating bilateral disease and 14% demonstrating multifocal disease in t he ipsilateral gland, The neck specimens revealed an average of 5.3 +/- 3.2 metastatic nodes in levels II-TV and 3.9 +/- 4.6 metastatic nodes in the p aratracheal region. Conclusion: Based on this patient population, the longstanding lateral neck mass in the young patient should raise the physician's index of suspicion for thyroid carcinoma. Fine needle aspiration should be used in conjunction with judicious excisional biopsy. The bilateral and multifocal nature of o therwise occult primary disease argues for total thyroidectomy in this sett ing.