Endocrine Abstracts

Introduction: Sarcoidosis is a systemic inflammatory disease characterized by noncaseating granulomas. Its pseudo-tumor manifestation in certain organs such as the thyroid can mimic thyroid carcinoma and lead to erroneous therapeutic decisions. We report a case of sarcoidosis with cervical adenopathy initially considered as a cervical metastasis of thyroid cancer.

Observation: A 61-year-old woman, with a history of spontaneous subacute subdural hematoma operated in 2010, Followed at our level in consultation since 1991, for postoperative hypothyroidism, the patient underwent a left lobo-isthmectomy of a thyroid nodule suspect whose pathological study came back benign. She presents suddenly in consultation for a left cervical tumefaction on the bed of thyroid remnant which appeared recently and quickly in two months. It is a left basi-cervical mass of 4 cm, mobile and painless, without inflammatory or compressive signs, without palpable cervical lymphadenopathy, or signs of dysthyroidism,. The initial exploration made of a thyroid ultrasound showed a large mass occupying the suspicious left thyroid compartment with doubtful cervical lymphadenopathy, followed by a fine needle aspiration returned Bethesda IV. Not operated given the disappearance of the mass following a course of corticosteroids for an idiopathic thrombocytopenia discovered in parallel. This event made it possible to rectify the diagnosis thanks to a new exploration. Ultrasound found a free left thyroid compartment with bilateral cervical lymph node formations and a large suspect right supraclavicular lymphadenopathy, a dosage of thyroglobulin in needle aspiration biopsy fine was realized returning negative eliminating the thyroid origin and cytopuncture found granulomatous adenitis without caseous necrosis compatible with sarcoidosis. Biologically, the converting enzyme was twice normal and there was high calciuria. The CT scan shows a diffuse interstitial pneumopathy associated with cervical and mediastino-pulmonary lymphadenopathy concluding in an aspect of stage 3 sarcoidosis. The presumptive diagnosis was confirmed histologically by a bronchial biopsy.

Conclusion: The etiological diagnosis of a cervical mass or cervical lymphadenopathy, can represent a real challenge for the clinician. On a ground of thyroid pathology, the elimination of a neoplastic cause is a priority, sarcoidosis with these systemic and heterogeneous manifestations can constitute a diagnostic trap to be taken into consideration.