Clinical Case Database / Category: Case Based Discussion
Lumps in the neck
Darryl Ramoutar MA MBBChir, Charis Costopoulos MA MBBChir
Foundation Years Journal, volume 2, issue 2, p.66 (123Doc Education, London, February 2008)
Miss X, a 30-year-old secretary, presented to a GP clinic with a lump in her neck just to the right of the midline. She said she had noticed the lump for several months and it had been very gradually increasing in size, so she decided to have it checked as it was now in her opinion cosmetically unfavourable and catching on some of her clothing. She was otherwise asymptomatic and had no significant family history. On examination, a 2 cm firm lump was palpated in the anterior triangle just to the right of the midline. It moved with swallowing, was not fixed to the skin and had a smooth surface with a regular, well-circumscribed border. It was non-tender and did not transilluminate. A small palpable superior cervical lymph node was also discovered on the same side. Thyroid function tests were requested which were normal and she was thus referred to the rapid-access neck lump clinic as an urgent referral (2 weeks). There she had ultrasound guided fine-needle aspiration biopsy of the lump. The histopathologist reported cells with pale, empty looking â€˜Orphan Annieâ€™ nuclei and psammoma calcification. She was referred to an endocrine surgeon. What do you think was the likely diagnosis and how do you think it was treated?
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Darryl Ramoutar MA MBBChir (Corresponding author)
FY2 in A&E/Trauma and Orthopaedics
Charis Costopoulos MA MBBChir
FY2 in Academic Medicine
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