A bulky mass in the neck

Hypervascular neck mass as the initial presentation of papillary thyroid cancer: A case report and review of current literature

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Papillary thyroid cancer can present as an unusual hypervascular neck mass.

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Metastasis to regional lymph nodes is a common mechanism of thyroid cancer.

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FNA can be inconclusive in majority of case reports.

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CT, angio and MRI can be very helpful in narrowing the diagnosis of thyroid cancer.

Background

Papillary Thyroid Carcinoma presenting initially as a hypervascular mass is exceedingly rare. The objective of this paper was to present the rare pathology along with the utilization of multimodal imaging to establish a correct diagnosis along with current management and review of literature.

Case presentation

We describe a 33 year old male who presented with a left-sided neck mass. CT with contrast of the neck revealed a hypervascular, ring enhancing, complex cystic lesion in the left sub-clavicular and supraclavicular neck deep to the SCM, with accompanying edema. The differential diagnosis was broad and difficult to achieve given the fine needle aspiration biopsy was inconclusive. Eventually, the patient underwent a total thyroidectomy with a left modified radical neck dissection, central neck dissection, and partial resection of sternocleidomastoid muscle.

Conclusion

A large hypervascular mass presenting as a papillary thyroid carcinoma is difficult to discern but with combination of ultrasonography, soft tissue CT and angiography imaging, along with fine needle aspiration, and possible use of MRI would be successful in narrowing down the differential list to the final diagnosis of papillary thyroid carcinoma, supporting the need for punctual surgical intervention.