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cystic lymph node metastasis of papillary thyroid carcinoma

Thursday 9 March 2017

cystic PTC; cystic papillary thyroid carcinoma; cystic nodal metastasis of papillary thyroid carcinoma; cystic papillary thyroid carcinoma metastasis; cystic lymph node metastasis of PTC

Diagnosis of cystic papillary thyroid carcinoma (PTC) lymph node metastasis at head neck region can be a challenge in the absence of known PTC history.

The congenital cystic lesions of head neck, especially thyroglossal duct cyst (TGDC) and branchial cleft cyst (BCC), are major differential diagnoses in this clinicopathological scenario.

The location of cyst and morphology of lining epithelium are critical clues for reaching correct diagnosis.

However it is not uncommon that the flattened bland epithelial lining can be seen in both cystic metastases and congenital cystic lesions.

Pax8 and TTF-1 are common markers in thyroid follicular epithelium.

IHC can help to diagnose cystic PTC metastasis to lymph node without prior malignancy history and cases of TGDC and BCC.

Both Pax8 and TTF-1 stainings highlighted the cyst lining in PTC metastatic lymph node, while they were negative in the lining of TGDC and BCC.

See also

- cystic cervical metastasis

Open references

- Papillary Thyroid Microcarcinoma with a Large Cystic Dilated Lymph Node Metastasis to the Neck Mimicking a Branchial Cleft Cyst: A Potential Pitfall.
Ozdamar OI, Acar GO, Kafkasli C, Kalcioglu MT, Zenginkinet T, Tamer HG.
Case Rep Otolaryngol. 2015;2015:796358. doi : 10.1155/2015/796358
PMID: 26240771 Free

Paywall references

- Papillary Thyroid Carcinoma Cervical Lymph Node Metastasis with Cystic Change Differentiated from Congenital Cystic Lesions with the Assistance of Immunohistochemistry: A Case Study.
Liang Y, Zuo T.
Head Neck Pathol. 2016 Oct 21.
PMID: 27770399

- Papillary thyroid carcinoma in a lateral neck cyst: primary of ectopic thyroid tissue versus cystic metastasis.
Xu JJ, Kwan K, Fung K.
J Laryngol Otol. 2013 Jul;127(7):724-7. doi : 10.1017/S0022215113001205
PMID: 23739638

- Incidence of occult thyroid carcinoma metastases in lateral cervical cysts.
Seven H, Gurkan A, Cinar U, Vural C, Turgut S.
Am J Otolaryngol. 2004 Jan-Feb;25(1):11-7.
PMID: 15011201

- Cystic lymph node metastases in papillary thyroid carcinoma.
Wunderbaldinger P, Harisinghani MG, Hahn PF, Daniels GH, Turetschek K, Simeone J, O’Neill MJ, Mueller PR.
AJR Am J Roentgenol. 2002 Mar;178(3):693-7.
PMID: 11856700

- Occult papillary thyroid carcinoma presenting as extrathyroidal solitary neck cyst.
Aytug S, Sievert R, Ross FA.
QJM. 2002 Mar;95(3):186-8. No abstract available.
PMID: 11865176

- Cervical cystic lymph node metastasis as first manifestation of occult papillary thyroid carcinoma: report of seven cases.
Verge J, Guixá J, Alejo M, Basas C, Quer X, De Castro J, Autonell J, Serra C.
Head Neck. 1999 Jul;21(4):370-4.
PMID: 10376759

- Metastatic papillary thyroid carcinoma: an important differential diagnosis for aberrant thyroglossal cyst.
Shek TW, Luk IS.
J Laryngol Otol. 1995 May;109(5):472.
PMID: 7798013

- Papillary thyroid carcinoma: occurrence and types of lymph node metastases.
Ahuja S, Ernst H, Lenz K.
J Endocrinol Invest. 1991 Jul-Aug;14(7):543-9.
PMID: 1940060