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Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma

Patrick Wunderbaldinger1,2, Mukesh G. Harisinghani2, Peter F. Hahn2, Gilbert H. Daniels3, Karl Turetschek1, Joseph Simeone2, Mary J. O'Neill2 and Peter R. Mueller2

1 Department of Radiology, University of Vienna, Waehringer Guertel 18-20, A-1030 Vienna, Austria.
2 Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA 02114.
3 Thyroid Unit and Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114.



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  		Fig. 1. —26-year-old woman with known papillary thyroid carcinoma and left lateral palpable cervical mass. Sonogram of left lateral cervical region shows 1.6-cm large oval, solid mass that proved to be enlarged hyperreactive lymph node (straight arrows), and immediately next to it is 1.2-cm purely cystic thinwalled mass (curved arrows) that proved to be completely liquefied (purely cystic) lymph node metastasis at surgery.

 


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  		Fig. 2. —47-year-old man with long history of sore throat and slight dysphagia. During diagnostic workup, sonogram showed 1.3-cm large cystic mass with irregular thickened wall (arrows) and unknown thyroid mass. Histologically thickened wall consisted of fibrovascular filaments surrounded by tumor cell clusters.

 


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  		Fig. 3A. —51-year-old woman with known papillary thyroid carcinoma. Sonogram shows 1.6-cm large cystic thin-walled mass with approximately 6-mm large papillarylike internal nodule (arrow). This cystic mass in lower jugular chain proved to be cystic lymph node metastasis at surgery.

 


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  		Fig. 3B. —51-year-old woman with known papillary thyroid carcinoma. Sonogram shows another cystic mass with thickened wall and small (1- to 2-mm) internal nodules (arrows). Histologically, these nodules were caused by tumor cell clusters forming follicles along wall of cystic lymph node metastasis.

 


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  		Fig. 4A. —36-year-old woman with 5-year history of hyperthyroidism. Sonogram shows 3-cm large cystic mass near carotid bifurcation with thin internal septations (arrows) that proved to be papillary thyroid tissue-like structures on fibrovascular stalks.

 


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  		Fig. 4B. —36-year-old woman with 5-year history of hyperthyroidism. Sonogram shows another cystic mass with thickened wall and irregular, partly nodular-appearing internal septations (arrows) that corresponded histologically to remaining streaks of lymphoid tissue and connective tissue filaments in liquefied lymph node metastasis.

 


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  		Fig. 5A. —Sonograms of branchial cleft cysts. Sonogram of 14-year-old girl shows thin-walled homogeneous hypoechoic mass (arrow) on lateral aspect of neck that proved to be noninfected branchial cleft cyst at surgery.

 


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  		Fig. 5B. —Sonograms of branchial cleft cysts. Sonogram of 20-year-old man with acute neck pain and palpable mass near sternocleidomastoid muscle shows cystic mass with internal nodules (curved arrows) and internal septations (straight arrows) that proved to be inflamed branchial cleft cyst at surgery. Histologically, these internal nodules consisted of pus, debris, and hemorrhage.

 

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