Papillary thyroid carcinoma (PTC) is the most prevalent endocrine malignancy, typically presenting as a solid thyroid nodule. While cervical lymph node metastases are common, purely cystic nodal metastases involving the upper cervical lymph nodes are uncommon. Furthermore, the involvement of a thyroglossal duct cyst (TGDC) by PTC is also infrequent. We present the case of a 35-year-old male who presented with a long-standing, painless right submandibular swelling. Imaging revealed a complex cystic picture involving both upper cervical lymph nodes and a TGDC, alongside a suspicious thyroid nodule. Following surgical intervention, histopathology confirmed a classic variant of PTC with extensive cystic nodal metastases and TGDC involvement. The patient was successfully managed with high-dose Iodine-131 therapy and is doing well with suppressive thyroxine therapy. This case highlights the initial presentation of cystic neck mass in PTC in adults and highlights the pivotal role of nuclear medicine in the comprehensive management of differentiated thyroid carcinoma.
Balgi et al. (Wed,) studied this question.