Presentation
Coincidental finding on CT neck.
Patient Data
The right thyroid lobe shows irregular hypoechoic solid lesion with punctate echogenic foci inside (representing psammoma bodies (microcalcifications)). The lesion shows posterior extracapsular extension.
Few (about three) ipsilateral mid and lower jugular chain suspicious lymph nodes also noted with cavitation and multiple punctate echogenic foci inside.
Case Discussion
This lesion shows most of the hallmarks suggestive of a malignant thyroid lesion:
- absent lucent "halo" around the lesion
- the lesion infiltrates the surrounding thyroid tissue
- benign lesions typically have a hypoechoic well defined "halo" around them
- visible microcalcifications
- the lesion is hypoechoic compared to the normal parenchyma.
Ipsilateral jugular chain lymph nodes noted have very similar appearance of the thyroid lesion. This emphasizes the fact of being metastatic nodes.
Papillary thyroid carcinoma has a tendency to metastasize early to local lymph nodes, with about 50% of patients having nodal involvement at presentation. These metastases are usually to the ipsilateral jugular chain (87.8%) and are commonly confined to the mid and lower lymph node levels, level III and IV (73.2%).