Neck lesions mimicking thyroid pathology.
BACKGROUND
Nodular lesions within the neck may origin from several structures. A misdiagnosed origin may expose the surgeon to inappropriate procedures. These lesions are paradoxically frequent in high specialised centre for endocrine surgery.


METHODS
In the year 2006, three patients were first admitted to our department with a diagnosis of thyroid nodule (1) or lymphatic metastases of thyroid carcinoma (2). The first patient had ultrasound (US) and Tc-99-m scan orienting for thyroid nodule. The two other patients, presented with lateral neck lesion in ipsilateral sincronous and previous diagnosis of papillary thyroid carcinoma, respectively, with US and computed tomography scan confirmed lesion but with a FNA cytology negative for tumoural cells.


RESULTS
All three patients underwent surgical exploration. In the first two cases, a whitish tender nodule (4 and 4.5cm), cleavable from surrounding structures, was removed with final histology of Schwannoma and Paraganglioma, respectively. Both patients experienced Bernard Horner Syndrome. In the last patients, a firm grey nodule of 5cm strictly adherent to muscular planes was removed with diagnosis of Castleman's Disease.


CONCLUSIONS
Nodular neck lesions mimicking a thyroid pathology (thyroid nodules or metastatic lymph nodes) are rare but can represent a tough challenge for surgeons who might fall into incorrect surgical approaches, resulting in high morbidity. Pre-operative work-up would help the surgeon to obtain the correct diagnosis, thus, to follow the better surgical approach. Nevertheless, a careful approach would be used for that neurogenic tumour amenable of resection without jeopardising nervous structures.
Donatini
G
G
Department of Surgery, University of Pisa, Pisa, Italy. giacko76@hotmail.com
Iacconi
P
P
De Bartolomeis
C
C
Iacconi
C
C
Fattori
S
S
Pucci
A
A
Puccini
M
M
Miccoli
P
P
D000328:Adult; D005871:Castleman Disease / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D005260:Female; D005729:Ganglioneuroma / Q000175:diagnosis* / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D009442:Neurilemmoma / Q000175:diagnosis* / Q000601:surgery; D016606:Thyroid Nodule / Q000175:diagnosis