Endocrine Abstracts

Introduction: Cervical lymphadenopathy is a frequent reason for ENT consultation. In most cases the diagnosis is easy based on clinical, radiological and cytopathological data. However, in some situations, the diagnosis remains pending. The objective of this work is to study the possible difficulties face to a chronic cystic cervical lymphadenopathy.

Materials and methods: It is a retrospective study bringing 4 cases of cervical cystic lymphadenopathy revealing thyroid papillary carcinoma collected over a period of 17 years (from 2000 to 2016).

Results: Our study focused on 4 cases. The sex ratio was 1 with an average age of 49 years. The reason for consultation was cervical swelling in all cases evolving for an average of 6 years. The swelling was supraclavicular in 2 cases, jugulo-carotid in one case and subdigastric in one case. Its size varied between 3 and 15 cm. The swelling was relapsing in all cases, associated with a palpable thyroid nodule in one case and multiple lymphadenopathies in one case. Cervical ultrasound, done in all patients, wrongly led to the diagnosis of a branchial cyst in 2 cases. All patients had a cervicotomy with an extemporaneous examination, suggesting a metastasis of a thyroid papillary carcinoma in 2 cases. Which examination carried the diagnosis of branchial cyst in the 2 other patients. The metastatic nature of lymphadenopathy was not confirmed until the final histological examination. It was a metastasis of papillary micro carcinoma in 3 cases and of a branchial cyst invaded by an adjacent metastatic lymphadenopathy of a thyroid papillary carcinoma in one case. The cystic nature was confirmed after immunohistochemical study.

Conclusion: Cystic cervical lymphadenopathy may be the only telltale sign of papillary carcinoma of the thyroid, hence the need to invoke this diagnosis before any cystic cervical mass.