LATE CERVICAL NODAL TUBERCULOSIS RECURRENCE MIMICKING METASTASIS OF PAPILLARY THYROID CARCINOMA. A CASE REPORT

Although papillary thyroid carcinoma (PTC) represents the most usual form of thyroid neoplasia the association with cervical tuberculous lymphadenitis (CTL) is rare and diagnosis remains a challenge. Case report: We report the case of a 78-years-old female patient with personal history of cervical fistulizing tuberculous gumma diagnosed with right lateral cervical mass and Hashimoto nodular thyroiditis. The neck ultrasound and CT exam revealed an enlarged right thyroid lobe containing a nodule of 2/2 cm and right later cervical multiple masses resembling lymphadenopathies. The patient underwent to surgical treatment which consisted in total thyroidectomy and modified neck dissection with resection of internal right jugular vein adherent to the lymph node mass. Results: The final pathology report demonstrated a pT3mN0LV1Pn0 right lobe papillary thyroid carcinoma on Hashimoto thyroiditis while lymph nodes presented giant epithelioid granulomas with giant multinuclear Langhans cells and central necrosis consistent with the diagnosis of tuberculous adenitis. The postoperative course was uneventful and the patient was referred to both TB and endocrinology specialist. Conclusions: Cervical tuberculous lymphadenitis can mimic metastatic adenopathy in papillary thyroid carcinoma and frequently the definitive diagnosis is achieved by excisional biopsy and histopathological examination.