27 years old man with cervical mass

 

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Doctor's Information

Name : Morteza
Family : Sanei Taheri
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Sayed Mohammad Emrani

 

Case Section

Head & Neck Imaging

 

Patient's Information

Gender : Male
Age : 27

 

Clinical Summary

27 years old man with cervical mass

 

Imaging Findings

cervical lymphadenopathy in left internal jugular chain and posterior triangle,left supraclavicular ,and right perithyroidal are seen .On sonograohy and neck CT scan no thyroid nodule is detected.

 

Differential Diagnosis

.thyroglossal duct cyst (only if single) .branchial cleft cyst (only if single) . cystic metastasis . abscess including tuberculous lymphadenitis . multiple neurofibromas

 

Final Diagnosis

Metastatic PTC

 

Discussion (Related Text)

Clinical presentation Presentation is usually with a solitary palpable thyroid mass. Papillary carcinoma has a tendency to metastasise early to local lymph nodes, with 50% (39-90% 2 ) of patients having nodal involvement at presentation 1 (c.f. 10% for follicular thyroid cancer). These metastases are usually to the ipsilateral jugular chain (87.8%) and are usually confined to the mid and lower lymph node levels, level III and IV (73.2%) 1. In approximately 20% of patients lymph node metastases are the first presentation, with 50% of children and 20% of adults a palpable cervical lymph node palpable at the time of diagnosis 4. Distal haematogeneous dissemination is less common than with follicular cancer, with only in 5-10% of patients at presentation. CT CT is best at staging lymph node involvement (see thyroid cancer staging). Involved lymph nodes tend to have 1: • cystic components: ~ 35 % • thick nodular walls: ~ 40 % • septae: ~ 60 % • purely cystic nodes are uncommon and more frequent in young patients. • calcification may be seen occasionally • the so-called lateral aberrant thyroid is actually a lymph node metastasis from papillary thyroid carcinoma .

 

References

Papillary thyroid cancer Dr Jan Frank Gerstenmaier and Dr Frank Gaillard et al.

 

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