Thyroid Cancer No More Surgery 101: Ethanol Ablation for Of A large Congenital Rest Branchial Cleft Cyst Causing Choking in Patient with Papillary Thyroid Cancer PTC. Not Everything in the Neck is a Recurrence of cancer and needs more radiation or surgery.
Case History: Branchial Cleft Cyst Mascarading as a Recurrent thyroid cancer
61 Y/O F with PTC 4 years before she saw me for choking sensation in the neck with a large mass that was firm to hard.She had prior 600 MCI RAI/131 and 2 thyroid surgeries for a 1 cm PTC and a neck dissection with 28 lymph nodes positive for cancer but the cyst was not removed!. She presented with the 4.3 cm cyst one year before she came to the USA to see me for non-invasive ethanol ablation.The cyst was only 1 cm when she first presented to with thyroid cancer 4 years prior. Her thyroid function tests including TSH were normal and she had low level TG of 2.1 and TGab of 3.9. She still had thyroid cancer persistence by marker testing. However, my evaluation found the cause of her choking was not recurrent cancer but a non-cancer cyst.
My FNA was difficult as I had to push hard to break the thick capsule. The fluid was viscus and dark brown black. The Cancer marker washout for thyroglobulin was negative. The cytology diagnosis was Left Neck Cyst with dense histiocyte rich mucinous material with ciliated respiratory epithelial cells consistent with a Congenital Rest Cyst. After draining the thick fluid with an #18 gauge needle under USG ethanol was injected. The cyst was ablated.
Thick Mucin seen on this first 2 slides
Ciliated tall columnar cells with a point beneath the nucleus where it attached to the basement membrane.
Comment: This patient was given 600 MCI RAI/131 to treat a small PTC cancer to rid the blood of thyroglobulin which failed.The cyst that was not related to the cancer. It had been slowly growing for years and was ignored during the cancer evaluation. After she developed local symptoms and it was visible she came to me for treatment without more surgery or radiation not knowing it was not a recurrence of her thyroid cancer.
Call me for an opinion when there is a plan for more surgery or radioiodine for your papillary thyroid cancer. Ask for Matt