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CORRESPONDENCE
Year : 2018  |  Volume : 14  |  Issue : 6  |  Page : 1437-1438

Cystic lateral neck mass: Thyroid carcinoma metastasis to branchial cleft cyst


1 Department of Internal Medicine, Akdeniz University School of Medicine, Antalya, Turkey
2 Department of Endocrinology and Metabolism, Akdeniz University School of Medicine, Antalya, Turkey

Date of Web Publication28-Nov-2018

Correspondence Address:
Gokhan Tazegul
Department of Internal Medicine, Akdeniz University School of Medicine, Antalya
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.188440

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 > Abstract 


Etiologies of lateral cervical masses are complex, most commonly these masses are branchial cleft cysts; however, metastatic thyroid carcinoma should be included in the differential. We report a case of lateral cystic neck mass in a 22-year-old female patient diagnosed as metastatic papillary thyroid carcinoma. The patient was diagnosed after she underwent surgery for branchial cleft cyst. The patient underwent thyroidectomy which revealed multifocal micropapillary thyroid carcinoma with capsular invasion and lymph node metastases. Radioactive iodine treatment was planned. Congenital malformations of the lateral neck may present themselves in the second and third decades of life. Ectopic thyroid tissue within a branchial cleft cyst may give rise to primary papillary carcinoma, as well as branchial cleft cyst may harbor metastases of primary thyroid papillary carcinoma. We classified our patient as a metastasis to the branchial cleft cyst rather than primary papillary carcinoma of the branchial cleft cyst.

Keywords: Branchial cleft cysts, congenital defect, fine-needle biopsy, thyroid neoplasms, thyroid nodule


How to cite this article:
Tazegul G, Bozoğlan H, Doğan &, Sari R, Altunbaş HA, Balci MK. Cystic lateral neck mass: Thyroid carcinoma metastasis to branchial cleft cyst. J Can Res Ther 2018;14:1437-8

How to cite this URL:
Tazegul G, Bozoğlan H, Doğan &, Sari R, Altunbaş HA, Balci MK. Cystic lateral neck mass: Thyroid carcinoma metastasis to branchial cleft cyst. J Can Res Ther [serial online] 2018 [cited 2020 Jul 14];14:1437-8. Available from: http://www.cancerjournal.net/text.asp?2018/14/6/1437/188440




 > Introduction Top


Etiologies of lateral cervical masses are complex and should be approached carefully. Neck masses can be roughly classified into three: Congenital, inflammatory, and neoplastic. Most commonly these masses are branchial cleft cysts; however, differentiation of malignant lesions from branchial cleft cysts is of clinical importance. It is hard to differentiate lateral neck masses by physical examination alone. Metastatic thyroid carcinoma, as well as cystic metastases of squamous cell carcinomas, should be included in the differential diagnosis.[1] Herein, we report a case of lateral cystic neck mass in a 22-year-old female patient diagnosed as metastatic papillary thyroid carcinoma.


 > Case Report Top


A 22-year-old female patient was admitted to the endocrinology outpatient clinic. She was followed up for a right lateral neck swelling for several months by Otorhinolaryngology Department. She had no other known diseases; she did not smoke nor use alcohol. She received several antibiotherapics without any alleviation of the mass. Therefore, excision of the mass was planned. Preoperative magnetic resonance imaging revealed a 35 mm × 20 mm cystic lateral neck mass [Figure 1] along with a 9 mm nodule in the right thyroid lobe [Figure 2]. Cystic mass was excised; pathology revealed normal colloidal thyroid tissue along with thyroid transcription factor-1 and thyroglobulin positive papillary thyroid carcinoma. Pathology commented that it could have originated from a branchial cleft cyst, or it could be metastatic. The patient was referred to endocrinology for further treatment postoperatively. On physical examination, a nodule on the lateral border of the right thyroid lobe was palpable. Other examination findings were unremarkable. Thyroid function tests were within normal limits. Fine-needle aspiration biopsy was negative for malignancy. Radioactive iodine was planned after thyroidectomy. The patient was referred for total thyroidectomy. Thyroidectomy revealed two foci (0.9 and 0.5 cm) of micropapillary thyroid carcinoma, capsular invasion was present, surgical margins were negative. Four out of 14 lymph nodes were positive for metastasis. The patient received levothyroxine replacement and was referred for radioactive iodine treatment.
Figure 1: A cystic lateral neck mass of 35 mm × 20 mm dimensions can be seen on frontal section

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Figure 2: A 9 mm thyroid nodule along the upper border of right thyroid lobe can be seen on frontal and axial sections

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 > Discussion Top


Differential diagnosis of lateral neck masses includes inflammatory conditions such as cat-scratch disease, infectious mononucleosis, sialadenitis, or other reactive lymphadenopathies; congenital defects such as cystic hygromas or branchial cleft cysts, fistulae, and abscesses; and neoplastic conditions such as lymphoma, lymphangioma, schwannoma, tumors of the parotid gland, and various metastases. A retrospective analysis from Turkey on 630 cases of neck masses revealed that masses were 33.49% inflammatory, 18.9% congenital, and 47.6% neoplastic. However, papillary carcinomas represented only 2% of neoplastic neck masses and 0.9% of all neck masses. Lateral neck masses are more likely to be branchial cleft anomalies, lymphatic, or vascular malformations. Patients who are older and had a growth over 1–2 months rather than several days are more likely to have neoplastic masses.[2]

Congenital malformations of the lateral neck are rare; they may present themselves in the second and third decades of life.[3] Thyroid gland develops as a diverticulum from the foregut and descends along thyroglossal duct. Any pathology may result in ectopic thyroid tissue along or adjacent to its route, including branchial clefts.[4] Ectopic thyroid tissue within a branchial cleft cyst is rare however it may give rise to primary papillary carcinoma, as well as branchial cleft cyst may harbor metastases of primary thyroid papillary carcinoma. Up to 11% of lateral neck cysts in adulthood may harbor occult papillary thyroid carcinoma; however, a primary ectopic papillary thyroid carcinoma within a branchial cyst is only reported nine times as case reports.[5] We classified our patient as a metastasis to the branchial cleft cyst rather than primary papillary carcinoma of the branchial cleft cyst; since there was a multifocal micropapillary thyroid tumor with capsular involvement was present on the same side of the neck.

Treatment of lateral neck masses are usually surgical; it is important to have a focused approach when evaluating a patient with a neck mass. In light of this case, we urge all clinicians to use fine-needle aspiration on patients presenting with cystic neck masses and use further imaging studies to reveal possible primary thyroid pathologies to reduce the time to diagnosis and appropriate care.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 > References Top

1.
Veivers D, Dent J. Lateral cervical cysts: An Australian perspective. ANZ J Surg 2012;82:799-802.  Back to cited text no. 1
    
2.
Balikci HH, Gurdal MM, Ozkul MH, Karakas M, Uvacin O, Kara N, et al. Neck masses: Diagnostic analysis of 630 cases in Turkish population. Eur Arch Otorhinolaryngol 2013;270:2953-8.  Back to cited text no. 2
    
3.
Rosu S. Giant benign mass of the lateral neck: A case report. Rom J Morphol Embryol 2014;55:483-5.  Back to cited text no. 3
    
4.
Noussios G, Anagnostis P, Goulis DG, Lappas D, Natsis K. Ectopic thyroid tissue: Anatomical, clinical, and surgical implications of a rare entity. Eur J Endocrinol 2011;165:375-82.  Back to cited text no. 4
    
5.
Xu JJ, Kwan K, Fung K. Papillary thyroid carcinoma in a lateral neck cyst: Primary of ectopic thyroid tissue versus cystic metastasis. J Laryngol Otol 2013;127:724-7.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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