Paridhi ., Shalini Bahadur , Bhuvan Adhlakha , Shivani Kalhan , Hukam Singh ,
Volume 20, Issue 1 (1-2026)
Abstract
Background: The incidental discovery of papillary thyroid carcinoma (PTC) in cervical lymph nodes during neck dissection for tongue squamous cell carcinoma (SCC) is an exceedingly rare finding, reported in approximately 0.3 - 1.6% of head and neck squamous cell carcinoma (HNSCC) cases. Differentiating between metastatic PTC and papillary carcinoma arising in aberrant thyroid tissue poses a diagnostic challenge, especially in the absence of a detectable thyroid mass.
Case Presentation: A 35-year-old male presented with a rapidly growing ulcero-proliferative lesion on the lateral border of the tongue for four months. Biopsy revealed moderately differentiated SCC. The patient underwent hemiglossectomy with supraomohyoid neck dissection. Histopathology confirmed SCC with clear margins and no nodal metastasis; however, one cervical lymph node revealed thyroid follicles with cells showing optically clear nuclei. Immunohistochemistry was positive for TTF1 and HBME-1, confirming metastatic PTC. No palpable thyroid nodule was identified, and computed tomography demonstrated only hypodense colloid nodules. Thyroid function tests were normal, and the patient remains disease-free on follow-up without thyroid surgery.
Conclusion: The coexistence of tongue SCC and metastatic PTC in cervical lymph nodes is exceptionally uncommon. The absence of a primary thyroid lesion raises questions regarding the origin - occult metastasis versus transformation in aberrant thyroid tissue. The literature supports conservative management with vigilant follow-up when thyroid imaging shows no evidence of malignancy. Meticulous histopathological examination of neck dissection specimens in HNSCC is vital. Management should be individualized, balancing surgical intervention and surveillance based on clinic radiologic findings.
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