Background: Up to 85% of thyroid carcinoma cases are papillary thyroid cancers. It may be the only or initial
symptom of the disease, undergoing cystic transformation and manifesting as lateral neck metastases or regional
lymph nodes from an unknown primary source.
Patients and methods: Between January 2020 and May 2023, five individuals exhibiting a lateral cervical swelling
in conjunction with a clinically unremarkable thyroid gland were managed within the surgical oncology division
of the general surgery department at Tanta University Hospital, Egypt. A mass was found in the supraclavicular
area in two patients, the mid-anterior border of the right sternomastoid muscle region in one case, and the
submandibular region in two cases. In all cases, there were no detectable thyroid gland masses. The clinical
examination revealed no enlargement of the thyroid gland. The patients underwent indirect laryngoscopy, free T3,
free T4, fine needle aspiration cytology (FNAC), neck ultrasonography, and CT scan.
Results: Sub-centimetric nodules were found in two cases with non-suspicious cervical lymph nodes, while the
neck ultrasonography and CT scan revealed cystic swelling and a normal thyroid gland in three cases. In two
cases, the FNAC revealed benign cells consistent with a branchial cyst; in one case, it revealed a parotid tail tumor;
in the final two cases, it revealed malignant cells. The indirect laryngoscope, TSH, free T3, and free T4 were all
normal. In every case, the histology revealed occult metastatic papillary thyroid cancer that had spread to a cystic
lymph nodal tissue. The patients had radioactive iodine therapy after a modified cervical lymph node dissection in
addition to a total thyroidectomy.
Conclusion: while addressing a cystic lesion in the neck, surgeons should take into account the potential for nodal
metastases from hidden malignancies, this condition may be attributed to pathologies such as papillary thyroid
carcinoma.