Papillary Thyroid Cancer, Nodal Metastases
Findings:
Multiple axial contrast enhanced neck CT images demonstrate multiple thin rim enhancing cystic lesions within the left posterior cervical nodal chain, Some of which demonstrate enhancing mural nodules. A much smaller lesion with similar characteristics involves the left thyroid lobe.
Differential Diagnosis:
The differential diagnosis for a cystic neck mass in a young adult includes a type 2 branchial cleft cyst (wrong location), thyroglossal duct cyst (expected at midline), lymphangioma/cystic hygroma, and nodal mets from thyroid cancer.
Discussion:
In young adults, the presence of painless complex cystic neck masses with enhancing rims and nodularity should raise concern for metastatic occult thyroid cancer, even if long standing. Most well differentiated thyroid cancers have a very slow growth rate and an excellent prognosis. Undifferentiated/anaplastic thyroid cancers are seen in the elderly and have a poor prognosis.