Inaccurate Examination of Neck Lump as Regional Metastasis of Papillary Thyroid Carcinoma in Children: A Case Report

Background: Malignancy of the thyroid in children was a rare finding and the most pathological finding was papillary thyroid carcinoma. Thyroid carcinoma in children can present with neck lumps or enlarged neck lymph nodes. However, enlarged neck lymph nodes can be a mark of disruption immune system or lymph nodes’ malignancy or metastases from another organ. Case: An eight-year-old girl came to surgical oncology policlinic Prof. Dr. I.G.N.G. Ngoerah general hospital with a tumor on her right neck below the ear lobe and a scar from surgery on her right neck. Previously, she was done surgery on the right neck lump without cytomorphological examination at a regional hospital and it was a papillary thyroid carcinoma. She was referred to Prof. Dr. I.G.N.G. Ngoerah general hospital. She had done total thyroidectomy and right radical neck dissection with sternocleidomastoid muscle removal. The pathological examination was papillary thyroid carcinoma with four metastasis lymph nodes from nine lymph nodes. She had done radioactive iodine and take levothyroxine daily for hormonal suppression. After radioactive iodine therapy, she did not have any malignancy in the surgical field. Conclusion: In children, enlarged neck lymph nodes must be considered as a metastasis lesion of the thyroid. Although thyroid carcinoma is rare in children, we can do fine needle aspiration biopsy to evaluate the origin of enlargement. It can reduce the increase in cancer staging and the risk of metastasis.