Papillary thyroid cancer nodal metastases mimicking a slow-flow lymphatic malformation

Description 

A 28-year-old Caucasian man was referred to the head and neck clinic with a 2-year history of a right-sided neck lump, which had started to cause discomfort. Physical examination revealed two discrete non-tender neck masses in the region of the right sternocleidomastoid muscle, with no bruit or palpable pulse.

CT demonstrated multiple right-sided thin-walled cystic lesions within the upper to lower jugular chain and posterior triangle (levels II–V) forming a multiloculated cystic lesion measuring 10 cm in craniocaudal dimension. Ultrasound assessment suggested a multiloculated cystic mass with thin walls and no intralesional flow, extending along the posterior margin of the right sternocleidomastoid muscle, posterolateral to the right internal jugular vein. The thyroid and major salivary glands appeared unremarkable. Fine-needle aspiration cytology (FNAC) proved inconclusive. The abnormality was presumed to be a slow-flow lymphatic malformation; however, injection sclerotherapy did not result in resolution, confirmed on an MRI scan performed...

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