Abstract

A rare case of metastatic papillary thyroid carcinoma, incidentally, found within a branchial cyst was reported in a teaching hospital, Kalutara, Sri-Lanka. A 37-year-old female presented with left side lateral neck lump of 4 years duration. Physical examination revealed a solitary, palpable, painless movable neck lump. Both ultrasound scan and fine needle aspiration cytology were suggestive of a branchial cyst. Excisional biopsy revealed that it was a papillary thyroid carcinoma metastatic to/ arising from a branchial cyst. Thyroid Fine needle aspiration biopsy confirmed a left thyroid nodule with suspicious smears (Thy 4/Bethesda). Patient underwent total thyroidectomy histopathology confirmed presence of Papillary Thyroid carcinoma. Branchial cysts are the most common lateral neck masses. Although it is a benign lesion, rarely, it is possible to find unexpected malignancy within it. During the diagnostic phase, it should be kept in mind that this could be a metastatic lesion from a distant primary or an occult thyroid primary cancer within the branchial cyst. A thorough investigation would help identification of such malignancy and early intervention gives less trouble to both patient and clinician.

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