PDF(Pubmed)
Abstract：
BACKGROUND: Occult thyroid papillary carcinoma (OTPC) is typically characterized by initial presentation with cervical lymph node metastasis and can be detected through ultrasound. However, the initial and sole manifestation was a submandibular solid-cystic mass. High-frequency ultrasound, enhanced multislice computed tomography (CT) scan, and thyroid function tests revealed no abnormalities, which is relatively uncommon.
METHODS: A 24-year-old Chinese female, who studied at a university in Shandong Province, presented to the clinic in June 2019 with a right submandibular mass that she had noticed 2 mo earlier. Clinical examination revealed a 2-cm, nontender, movable solid-cystic mass in the submandibular region, with no palpable thyroid mass observed. Ultrasonography revealed a 2.0 cm × 1.1 cm solid-cystic mass in the right submandibular region, and the thyroid gland showed no abnormalities. CT scan and 131I whole body follow-up scan showed that there were no abnormalities in the thyroid. However, cytology and pathology showed papillary tumor cell clusters, consistent with papillary thyroid carcinoma. Thus, we performed total thyroidectomy and right neck lymph node dissection. The pathology revealed the thyroid was detected as classical thyroid micropapillary carcinoma, and lymph nodes of levels VI central and levels II, III, IV, V on the right side showed no tumor metastasis. The patient was followed up for 2 years without significant recurrence.
CONCLUSIONS: The presentation of a submandibular solid-cystic mass as the primary and solitary indication of OTPC is relatively uncommon. Fine needle aspiration is advised for evaluating neck masses.
METHODS: A 24-year-old Chinese female, who studied at a university in Shandong Province, presented to the clinic in June 2019 with a right submandibular mass that she had noticed 2 mo earlier. Clinical examination revealed a 2-cm, nontender, movable solid-cystic mass in the submandibular region, with no palpable thyroid mass observed. Ultrasonography revealed a 2.0 cm × 1.1 cm solid-cystic mass in the right submandibular region, and the thyroid gland showed no abnormalities. CT scan and 131I whole body follow-up scan showed that there were no abnormalities in the thyroid. However, cytology and pathology showed papillary tumor cell clusters, consistent with papillary thyroid carcinoma. Thus, we performed total thyroidectomy and right neck lymph node dissection. The pathology revealed the thyroid was detected as classical thyroid micropapillary carcinoma, and lymph nodes of levels VI central and levels II, III, IV, V on the right side showed no tumor metastasis. The patient was followed up for 2 years without significant recurrence.
CONCLUSIONS: The presentation of a submandibular solid-cystic mass as the primary and solitary indication of OTPC is relatively uncommon. Fine needle aspiration is advised for evaluating neck masses.
摘要：
背景：隐匿性甲状腺乳头状癌（OTPC）的典型特征是最初表现为颈淋巴结转移，可以通过超声检测。然而,最初和唯一的表现是下颌下实性囊性肿块。高频超声,多层螺旋CT增强扫描,甲状腺功能检查没有异常,这是相对罕见的。
方法：一位24岁的中国女性，他在山东省的一所大学学习，2019年6月，她在2个月前注意到了右颌下肿块。临床检查显示2厘米，nontender,下颌下区可移动的实性囊性肿块，没有明显的甲状腺肿块。超声检查发现右侧颌下区有2.0cm×1.1cm实性囊性肿块，甲状腺未见异常.CT扫描及131I全身随访扫描显示甲状腺未见异常。然而,细胞学和病理显示乳头状肿瘤细胞簇，符合甲状腺乳头状癌。因此，我们进行了甲状腺全切除术和右颈淋巴结清扫术。病理提示甲状腺为经典甲状腺微乳头状癌，中央VI级和II级淋巴结，III,IV,右侧V显示无肿瘤转移。患者随访2年，无明显复发。
结论：下颌下实性囊性肿块作为OTPC的主要和孤立指征相对少见。建议细针抽吸术用于评估颈部肿块。
方法：一位24岁的中国女性，他在山东省的一所大学学习，2019年6月，她在2个月前注意到了右颌下肿块。临床检查显示2厘米，nontender,下颌下区可移动的实性囊性肿块，没有明显的甲状腺肿块。超声检查发现右侧颌下区有2.0cm×1.1cm实性囊性肿块，甲状腺未见异常.CT扫描及131I全身随访扫描显示甲状腺未见异常。然而,细胞学和病理显示乳头状肿瘤细胞簇，符合甲状腺乳头状癌。因此，我们进行了甲状腺全切除术和右颈淋巴结清扫术。病理提示甲状腺为经典甲状腺微乳头状癌，中央VI级和II级淋巴结，III,IV,右侧V显示无肿瘤转移。患者随访2年，无明显复发。
结论：下颌下实性囊性肿块作为OTPC的主要和孤立指征相对少见。建议细针抽吸术用于评估颈部肿块。
