J Korean Soc Endocrinol.  2005 Oct;20(5):507-512. 10.3803/jkes.2005.20.5.507.

A Case of Papillary Thyroid Microcarcinoma Presenting as a Contralateral Cervical Lymph Node Metastasis

• Choi JW
• Jeon JS
• Kim NI
• Kim SC
• Kim SW
• Myung SJ
• Eum WY

• KMID: 2200599
• DOI: http://doi.org/10.3803/jkes.2005.20.5.507

Abstract

Papillary carcinomas account for 85~90% of all thyroid cancers, with the tumor size considered an important prognostic factor. As the use of high-resolution ultrasonography and fine needle aspiration biopsy have increased, the diagnosis of papillary microcarcinomas of the thyroid gland; defined by the World Health Organization as being less than 1 cm in diameter, has increased. They are generally associated with an excellent prognosis, with distant metastasis being extremely rare. They usually remain clinically silent until their incidental histological diagnosis by autopsy or surgical material. The incidence discovered at autopsy varies between 3 and 36%. Cervical lymph node metastases from papillary microcarcinomas have often been discovered, which may be the first and sole manifestation of the disease, without clinical suspicion of a thyroid tumor. Herein, the case of a papillary thyroid microcarcinoma, diagnosed after a total thyroidectomy due to its first presentation as a contralateral cervical lymph node metastasis, without evidence of a clinical thyroid tumor, is described.

MeSH Terms

Autopsy
Biopsy
Biopsy, Fine-Needle
Carcinoma, Papillary
Diagnosis
Incidence
Lymph Nodes*
Neoplasm Metastasis*
Prognosis
Thyroid Gland*
Thyroidectomy
Ultrasonography
World Health Organization

Figure

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  Fig. 1 Neck ultrasonogram. A 30×19×14 mm, well demarcated, lobulating mass with cystic and solid component was detected in the left upper posterior cervical triangle.

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  Fig. 2 Computed tomography of the neck after removal of cervical lymph node (left). No discrete mass in both lobes of the thyroid gland.

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  Fig. 3 Histology of the excised neck mass shows compacted of the tumor cells, characteristics of papillary thyroid carcinoma, and is surrounded by lymphocytic infiltration suggestive of cervical lymph node metastasis. (H-E stain, A: ×100, B: ×400)

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  Fig. 4 A. After total thyroidectomy, the characteristic papillary structures and fibrovascular cores were found in tumor tissue. (H-E stain, ×50) B. The lining epithelium shows atypical nucleus characteristics of papillary carcinoma including nuclear grooving and intranuclear inclusion body. (H-E stain, ×400)

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  Fig. 5 Whole body scan was taken 6 months after total thyroidectomy. 72-hour image after I-131 (29.9 mCi) showed no uptake in thyroid bed.

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  Fig. 6 Normal 18F-fluorodeoxyglucose positron emission tomogram was taken after total thyroidectomy and remnant ablations.

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