Occult medullary carcinoma of thyroid with lymph node metastases: a case report.
BACKGROUND
Occult thyroid malignancies presenting with secondary neck masses as the first clinical manifestation is well known. Although rare, medullary carcinoma serves a potential source for lymph node metastases. The characteristic cytomorphology of medullary thyroid carcinoma (MTC) should clinch the diagnosis. Further, fine needle aspiration cytology (FNAC) of the ultrasonography-detected occult nodules in thyroid serves as a useful preoperative diagnostic tool.


METHODS
A 22-year-old man presented with left-sided neck masses of 1 year duration. FNAC smears of the neck masses revealed cytomorphology characteristic of MTC. Ultrasonography of the thyroid led to ruling out the presence of an occult nodule and detected an 8-mm nodule in the left thyroid lobe. Ultrasound-guided FNAC of the nodule showed features similar to those with FNAC of the neck masses. Surgical resection of thyroid and neck masses further confirmed the diagnosis of a primary occult MTC with lymph node metastases.


CONCLUSIONS
FNAC smears of lymph node masses showing the distinct cytomorphology of MTC should prompt suspicion for occult primary in thyroid. Ultrasound-guided FNAC of these occult nodules, if detected, further serves a diagnostic tool for accurate preoperative diagnosis when metastasis presents as the first clinical manifestation of an occult primary.
Kini
Sangeeta
S
Departmentof Pathology, BYL Nair Hospital and TN Medical College, Mumbai, India. sangukini@yahoo.co.in
Saraf
Chinmay K
CK
Naik
Leena P
LP
Shah
Vimla B
VB
Puranik
Gururaj V
GV
Vartakvi
Prema K
PK
D000328:Adult; D044963:Biopsy, Fine-Needle; D018276:Carcinoma, Medullary / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000473:pathology