title: Incidental findings of thyroid tissue in cervical lymph nodes: old controversy not yet resolved?
abstract: The clinical significance of papillary or follicular thyroid tissue incidentally discovered in cervical lymph nodes during pathological assessment of neck dissections for non-thyroid cancers of the upper aero-digestive tract is critically reviewed. Special emphasis is given to controversies over normal-looking, nodal, thyroid follicles. Arguments for and against the benign nature of these follicles are considered together with processes that could be involved in their formation. The admittedly limited evidence suggests that benign, thyroid follicular inclusions rarely occur in cervical lymph nodes. Histological criteria that could be helpful in recognizing the inclusions, which include assessing their extent in conjunction with the size of the node, are discussed. Finally, an algorithm based on collaboration between specialists, correlating histological findings with imaging and loco-regional control of the upper aero-digestive tract cancer, is suggested for the management of patients with incidentally discovered, nodal thyroid tissue.
authors.affiliation: Oral and Maxillofacial Pathology, School of Dentistry, University of Liverpool and Pathology Department, Liverpool Clinical Laboratories, Liverpool, UK.
authors.forename: Asterios
authors.initials: A
authors.lastname: Triantafyllou
authors.affiliation: Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Williams
authors.affiliation: Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Angelos
authors.affiliation: Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
authors.affiliation: Departments of Pathology and Otolaryngology-Head and Neck Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: William H
authors.initials: WH
authors.lastname: Westra
authors.affiliation: Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Hunt
authors.affiliation: Department of Pathology, Allegiance Health, Jackson, MI, USA.
authors.forename: Kenneth O
authors.initials: KO
authors.lastname: Devaney
authors.affiliation: University of Udine School of Medicine, Udine, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Rinaldo
authors.affiliation: Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Slootweg
authors.affiliation: University Pathologists, Providence, RI and Fall River, MA, USA.
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Gnepp
authors.affiliation: Departments of Surgery and Otolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Carl
authors.initials: C
authors.lastname: Silver
authors.affiliation: Coordinator of the International Head and Neck Scientific Group, Padua, Italy. a.ferlito@uniud.it.
authors.forename: Alfio
authors.initials: A
authors.lastname: Ferlito
mesh_terms: D000328:Adult; D000465:Algorithms; D002291:Carcinoma, Papillary / Q000556:secondary; D002828:Choristoma / Q000473:pathology*; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D000072281:Lymphadenopathy / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck; D037981:Neck Dissection; D013961:Thyroid Gland; D013964:Thyroid Neoplasms / Q000473:pathology; D013965:Thyroidectomy
keywords: Heterotopia; Lymph nodes; Metastasis; Neck dissection; Pathology; Thyroid