Objective: Metastatic papillary thyroid carcinoma in the lymph nodes with no primary tumor in the thyroid gland and chronic thyroiditis on the background is rarely reported, easily missed and hardly recognized. We report the case of a 39-year-old female who was presented with no primary tumor in her both sides of thyroid gland and metastasis in the cervical lymph nodules. Case presentation: According to preoperative examination, the patient was under levothyroxine treatment with autoimmune thyroiditis. The patient underwent a total thyroidectomy and lymph nodes dissection. Metastasis of papillary thyroid carcinoma was found in the central lymph nodes although there was no primary tumor in the thyroid gland after serial deep cut sections. After 2 years of follow-up, no metastasis of the tumor was found in this patient. Result: Immunohistochemistry results showed metastatic lymph nodes were positive to thyroglobulin, galectin-3, HBME-1, cytokeratin 19 and negative for BRAFV600E, Ki-67 LI was >15%. Molecular analysis for TERT promoter mutations was negative. Conclusion: Failure in identifying primary tumor may be attributed to the small size (<3 mm) and/or the extended fibrosis of thyroid. We believe attention should be paid to lymph nodes with no primary tumor with autoimmune thyroiditis in the background so as to avoid missed diagnoses and delayed treatment.
Zhanna Mussazhanova1,2, Akbota Targynova1, Aray Mukanova3, Saya Kaidarova3, Gulzira Shalgimbayeva3, Madina Madiyeva3, Laura Pak3,4, Kuantkan Zhabagin4, Tatyana Belikhina4, Gulnaz Rakhimzhanova4, Zhanar Yeleubayeva5, Saltanat Bolsynbekova6, Zhanna Kalmatayeva1, Raushan Issayeva1, Lazzat Sarsenova1, Raushan Umirova7, Masahiro Nakashima2 1 Al-Farabi Kazakh National University, Almaty, Republic of Kazakhstan; 2 Nagasaki University, Atomic Bomb Disease Institute, Nagasaki, Japan; 3 Semey Medical University, Semey, Republic of Kazakhstan; 4 Center of Nuclear Medicine and Oncology, Semey, Republic of Kazakhstan; 5 Kazakh Institute of Oncology and Radiology, Almaty, Republic of Kazakhstan; 6 National Research Oncology Center, Nur-Sultan, Republic of Kazakhstan; 7 Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan.
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Mussazhanova Zh., Targynova A., Mukanova A., Kaidarova S., Shalgimbayeva G., Madiyeva M., Pak L., Zhabagin K., Belikhina T., Rakhimzhanova G., Yeleubayeva Zh., Bolsynbekova S., Kalmatayeva Zh., Issayeva R., Sarsenova L., Umirova R., Nakashima M. Metastatic papillary thyroid carcinoma in cervical lymph nodes with autoimmune thyroiditis and no primary tumor: challenging diagnosis and management of a rare case // Nauka i Zdravookhranenie [Science & Healthcare]. 2022, 6 (Vol.24), pp. 289-293. doi 10.34689/SH.2022.24.6.034

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