Volumineuse adénopathie cervicale kystique métastatique d´un microcarcinome papillaire de la thyroïde

Abstract

Cervical cystic lymph node metastasis may be confused with a branchial cyst or a cystic lymphangioma. It may be the only tell-tale sign of a papillary carcinoma of the thyroid gland. We here report the case of a 50-year-old patient presenting with a swelling in the right lower region of the jugular vein and carotid artery which had grown over the preceeding three years. Clinical examination showed renitent swelling. There was no palpable thyroid nodule. Cervical ultrasound showed a fluid cystic lesion measuring 10 cm and containing some septa. It didn´t show any thyroid nodule. Cervical computed tomography (CT) scan showed right laterocervical cystic mass containing peripheral calcifications and pressing the internal jugular vein and the sternocleidomastoid muscle. The patient underwent cervicotomy. Extemporaneal anatomopathological examination showed metastasis from papillary microcarcinoma of the thyroid gland. The patient underwent total thyroidectomy associated with bilateral central compartment and right lateral side compartment dissection. Anatomopathological examination showed nonencapsulated papillary thyroid microcarcinoma measuring 3 mm along its longer axis. The patient had lymph node metastases in the left and right sectors VI and in the right sector IV. The patient underwent two cycles of radioiodine therapy with excellent outcome.