Objective | To discuss the clinical, radiologic, and cytopathologic features of papillary thyroid carcinoma (PTC) presenting as an isolated lateral cervical cyst. Methods | Retrospective case series of five adult patients presenting with isolated lateral cervical cysts that were eventually found to represent cystic metastases from PTC. Results | All but one patient were younger than 40 years of age (range 19 - 62). Three of the 5 were asymptomatic at presentation, and 2 presented with complaints of local discomfort or pain. Fine-needle aspiration (FNA) of the lesions was grossly abnormal in all patients, findings ranged from greenish-black, to dark-brown, to scant but hemorrhagic fluid. In three cases attention was directed towards the thyroid gland only after excisional biopsy and intraoperative histopathological examination revealed cystic lymph node metastasis from an occult PTC. In the other two cases permanent histopathological diagnosis revealed PTC and the patients were subsequently treated. Conclusion | Although the majority of isolated (occurring in the absence of a localizing primary lesion) lateral cervical cysts are benign, distinguishing these masses from metastatic carcinoma within a lymph node that has undergone cystic degeneration can be difficult. Head and neck surgeons should be mindful of the potential for malignancy in their approach to these lesions, as they often mimic benign cysts. Surgical management for definitive treatment should be dictated by the results of preoperative diagnostic imaging, FNA, and frozen-section analysis at the time of excisional biopsy. Appropriate contingency consent should be obtained in cases where preoperative workup suggests the possibility of occult malignancy.
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