Head and Neck ImagingPapillary thyroid carcinoma
well-differentiated
thyroid carcinoma, being the most common
thyroid malignancy (about 60%). It is characterized by slow growth. Histologically, the
lesion is often multifocally present within the
thyroid gland. Extension through the
thyroid capsule is unusual at presentation. Half of patients have gross lymphatic spread at presentation; the
lymph nodes at risk are within the tracheo-oesophageal groove, lower neck and upper mediastinum. Distant
metastasis is rare. If adequately treated, the long-term prognosis is good.
The imaging findings with regard to the primary tumour are often nonspecific. If confined to the gland, CT and MRI cannot distinguish between benign and malignant thyroid lesions. Ultrasonography with fine needle aspiration is the most helpful diagnostic tool.
Papillary thyroid carcinoma commonly presents with neck adenopathies. These often appear partially or completely cystic, and may contain calcifications. The imaging appearance of the neck adenopathies and their position should raise the suspicion of a thyroid carcinoma; the primary tumour may still be very small. (Fig.1) (Fig.2).
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Axial CT-images in a 31 year-old patient presenting with swelling of right neck. Enlarged, inhomogenously enhancing lymph node mid-parajugular (arrow, a); enlarged lymph node in the right tracheo-oesophageal groove (arrow, b). Nodular mass in the right thyroid lobe (arrowhead). Histologically, the thyroid gland was diffusely infiltrated by carcinoma, and multiple lymph nodes in the right neck contained metastatic deposits.
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Papillary thyroid carcinoma, Fig.1 (a) | | Papillary thyroid carcinoma, Fig.1 (b) | | Papillary thyroid carcinoma, Fig.2 (a) |
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Papillary thyroid carcinoma, Fig.2 (b) | |