Introduction: Cervical lymphadenopathy is often a diagnostic challenge to medical professional due to its varied etiologies. Malignancies and infections are the main causative factors that should be included in the differential diagnosis. Cervical lymphadenitis is a common manifestation of extra-pulmonary invasion of the tuberculosis. A cervical tuberculous lymphadenitis could be confused with metastatic lymph node of thyroid cancer.
Case reports: Case 1: A 37-year-old man complained of a tow months swelling in the left side of the neck. On examination, a solitary nodule in the right lobe of the thyroid with multiple painless enlarged left cervical lymphnodes were identified. Ultrasonography of the neck suggested a suspicious nodule in the right lobe of the thyroid with a 3 cm left cervical metastatic lymphadenopathy. The patient underwent total thyroidectomy with neck dissection. Histopathological analysis were performed on the total thyroidectomy specimen, the left side neck nodes (from level II to level VI) and the central compartment neck nodes. A papillary thyroid carcinoma in the right lobe was confirmed. The isthmus and left lobe were uninvolved. The lymph nodes isolated from the left chain (levels II-V) revealed tuberculous lymphadenitis. The lymph nodes isolated from the central compartment were free of tumor deposits. The patient was put on anti-tubercular therapy for 6 months. The radioiodine ablative treatment was given as per the protocol.
Case 2: A 48-year-old female presented to our department with a 4-months history of a gradually enlarging lateral mass of the neck. On examination a mass measuring 4 × 3 cm was palpated at the left thyroid lobe. An associated 3 cm lymphnode was also palpated at the left cervical area.The rest of the examination was otherwise unremarkable. A thyroid ultrasound showed a solid mass at the left lobe with multiple cervical lymph nodes of the left level II chain. The patient underwent total thyroidectomy with neck dissection. Histopathological examination confirmed papillary thyroid carcinoma at the left thyroid lobe associated with tuberculous lymphadenitis. The patient was put on anti-tubercular therapy for 6 months. The antimycobacterial therapy was well-tolerated. She underwent adjuvant high-dose radioactive iodine treatment with no untoward complications and she is currently on levothyroxine suppression therapy.
Conclusion: These cases show that cervical lymphadenopathy in a patient with papillary thyroid carcinoma may not always indicate metastatic spread from the disease. In developing countries, tuberculosis should be considered as an important differential diagnosis of cervical lymphadenopathy in a patient with papillary thyroid carcinoma.
18 - 21 May 2019
European Society of Endocrinology