Presentation
Left neck mass.
Patient Data
Neck ultrasound:
Solid mass in left thyroid measuring 2.1 x 2.0 x 1.9 cm, displaying heterogeneous echotexture, irregular borders, and internal flow. Between the thyroid and the left SCM muscle, a semisolid mass was demonstrated, with a diameter of up to 3.3 cm with two types of components: one measuring 2.5 in diameter, with internal flow; the other, elastic and without internal flow - thrombus? The exophytic mass displaces the cervical blood vessels medially. No sign of SCM muscle involvement.
Non-contrast and post-contrast CT neck:
Hypodense mass taking up most of left thyroid lobe and mildly enlarging it. Left neck mass measuring 4.2 x 5.0 x 6.5 cm bordering laterally on the left thyroid lobe and apparently originating from it, displacing the SCM muscle anterolaterally and stretching it. The mass's upper-peripheral part is relatively hypodense and shows a smooth border and very slight enhancement, while its inner-inferior part shows a papillary border and enhances vividly.
Non-enlarged lymph nodes with irregular borders in station 1. Tiny nodules up to 6 mm in length scattered throughout all lung lobes (not shown) - metastases, most probably.
C3 vertebral body protrudes posteriorly, moderately narrowing the spinal canal.
Nuchal lipoma measuring 6.2 x 3.5 x 4.7 cm, most of its bulk left of the midline. Disc-osteophyte complex at levels C4-C5 and C5-C6, both exerting moderate pressure on the thecal sac.
US-guided biopsy obtained from the solid, vascular part of the exophytic thyroid mass with a 18G "gun".
Case Discussion
The histopathology report stated:
Papillary carcinoma, most probably of thyroid origin.
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