Best of five
- A. Second branchial cyst
- B. Nodal metastasis from papillary thyroid carcinoma
- C. HPV-positive oropharyngeal metastasis
- D. Cystic hygroma
- E. Parathyroid cyst
FRCS (ORL-HNS) · SECTION 1 SBA
Metastatic papillary thyroid carcinoma in a lateral cystic node
An adult has a lateral cystic neck mass. Cytology is scant, but thyroglobulin concentration in the needle washout is very high and ultrasound shows punctate echogenic foci in a thyroid nodule. What is the most likely diagnosis?
B. Nodal metastasis from papillary thyroid carcinoma
Papillary thyroid carcinoma may produce cystic cervical metastases. Thyroglobulin washout supports thyroid origin when cytology is low cellularity; thyroid and compartmental nodal mapping guide definitive surgery.
Why every option is right or wrong
A. Second branchial cyst: A new adult lateral cyst must not be assumed congenital, and high washout thyroglobulin indicates thyroid tissue.
B. Nodal metastasis from papillary thyroid carcinoma: Papillary thyroid carcinoma may produce cystic cervical metastases. Thyroglobulin washout supports thyroid origin when cytology is low cellularity; thyroid and compartmental nodal mapping guide definitive surgery.
C. HPV-positive oropharyngeal metastasis: That can be cystic but does not produce thyroglobulin.
D. Cystic hygroma: This is usually a multiloculated lymphatic malformation without thyroid markers.
E. Parathyroid cyst: Parathyroid hormone, not thyroglobulin, would be elevated in aspirate.
What if the scenario changed?
If washout parathyroid hormone were high with hypercalcaemia, a parathyroid lesion would become more likely.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
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