Laterocervical lymph node metastases from suspected thyroidal primary site that turned out to be metastases of lung cancer: A case report

Key Clinical MessageIncidental sonographic discovery of thyroid nodules is an increasingly common event in clinical practice. Less frequently, patients with cytological benign thyroid nodules have suspicious cervical lymph nodes detected by ultrasound examination or by cytological exam. Here, we discuss an intriguing case of cervical lymph node metastasis with a probable thyroid origin in a 65-year-old asymptomatic male smoker. He underwent thyroidectomy and unilateral cervical lymphadenectomy. Despite a negative chest X-ray, the postoperative histological examination revealed that the lymph node metastasis was actually from a lung carcinoma. Metastatic lesions in cervical lymph nodes from non-thyroidal origins must be excluded when evaluating lesions in the region, especially when thyroid nodules subjected to fine needle aspiration biopsy yield negative results, or lymph node cytological evaluations are inconsistent with thyroid cytological findings and sonographic features. Thyroid and lung adenocarcinomas share some epithelial and mesenchymal markers. Thyroglobulin helps differentiate primary thyroid tumors from lung ones, but in cases of poor differentiation, distinguishing metastatic lesions in the thyroid gland can be challenging. Lung cancer (LC) is the leading cause of cancer mortality worldwide, and survival rates have only marginally improved over the last several decades. The ongoing clinical challenge is detecting LC at earlier stages of the disease.

Automated summary

Incidental sonographic discovery of thyroid nodules is common in clinical practice. Suspicious cervical lymph nodes may be detected in patients with cytological benign thyroid nodules. We discuss a case of cervical lymph node metastasis from a lung carcinoma in a 65-year-old asymptomatic male smoker. Differentiating metastatic lesions in the thyroid gland can be challenging, especially when evaluating lesions in the region and when fine needle aspiration biopsy yields negative results or cytological evaluations are inconsistent with thyroid cytological findings and sonographic features. Detecting lung cancer at earlier stages remains a clinical challenge, as it is the leading cause of cancer mortality worldwide.