Usha Patel, Nanda Jagrit, Shubham Panchal, Ankita Kacha, Rujuta Ravat,
Volume 16, Issue 4 (7-2022)
Abstract
Background and objectives: Lesions of the head and neck region are routinely encountered by clinicians, in patients across all age groups. Diagnoses range from reactive inflammatory conditions to malignancies. Cancer is among the leading causes of death in India. Head and neck cancers account for 23% of all cancer incidents in males and 6% of all incidents in females in India,. Fine needle aspiration cytology (FNAC) of cervical masses is an easy, effective, and relatively inexpensive technique. The aim of this study was to determine occurrence of various head and neck swellings and classify them under various categories.
Methods: The present study included 100 cases of palpable cervical swellings who had been referred to the AMC MET Medical College, Ahmedabad (India) from June 2018 to October 2020.
Results: The majority of cases were lymph node swellings (57%), followed by thyroid swellings (23%), salivary gland swellings (12%), and soft tissue swellings (8%). Among all cervical region swellings, tuberculous lymphadenitis and thyroid lesions were the most prevalent.
Conclusion: The findings suggest that lymph node swellings are most commonly observed in the cervical area, and that the majority of them are inflammatory, requiring medical treatment rather than surgery. Moreover, FNAC is a straightforward, quick, and cost-effective way to distinguish between non-neoplastic and metastatic malignant lesions, which could help timely surgical interventions.
Paridhi ., Shalini Bahadur , Bhuvan Adhlakha , Shivani Kalhan , Hukam Singh ,
Volume 20, Issue 1 (1-2026)
Abstract
Background: The incidental discovery of papillary thyroid carcinoma (PTC) in cervical lymph nodes during neck dissection for tongue squamous cell carcinoma (SCC) is an exceedingly rare finding, reported in approximately 0.3 - 1.6% of head and neck squamous cell carcinoma (HNSCC) cases. Differentiating between metastatic PTC and papillary carcinoma arising in aberrant thyroid tissue poses a diagnostic challenge, especially in the absence of a detectable thyroid mass.
Case Presentation: A 35-year-old male presented with a rapidly growing ulcero-proliferative lesion on the lateral border of the tongue for four months. Biopsy revealed moderately differentiated SCC. The patient underwent hemiglossectomy with supraomohyoid neck dissection. Histopathology confirmed SCC with clear margins and no nodal metastasis; however, one cervical lymph node revealed thyroid follicles with cells showing optically clear nuclei. Immunohistochemistry was positive for TTF1 and HBME-1, confirming metastatic PTC. No palpable thyroid nodule was identified, and computed tomography demonstrated only hypodense colloid nodules. Thyroid function tests were normal, and the patient remains disease-free on follow-up without thyroid surgery.
Conclusion: The coexistence of tongue SCC and metastatic PTC in cervical lymph nodes is exceptionally uncommon. The absence of a primary thyroid lesion raises questions regarding the origin - occult metastasis versus transformation in aberrant thyroid tissue. The literature supports conservative management with vigilant follow-up when thyroid imaging shows no evidence of malignancy. Meticulous histopathological examination of neck dissection specimens in HNSCC is vital. Management should be individualized, balancing surgical intervention and surveillance based on clinic radiologic findings.
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