PMC5824529_01
A cystic, nonlobulated swelling predominantly involving the left upper neck and crossing midline
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F1
Thyroid gland was normal by palpation [Figure 1].
X-ray neck lateral view showed a soft-tissue swelling in the upper neck
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F2
There was no abnormality detected on X-ray chest posteroanterior view; however, the X-ray neck lat view showed a soft-tissue swelling in upper neck [Figure 2].
Ultrasound scan showed an evidence of large lobulated cystic mass noted in the left submandibular region. Fluid shows internal echoes and calcification within
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F3
Fluid shows internal echoes and calcification within [Figure 3].
(a and b) Sistrunk's procedure (intermediate pictures)
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F4
Intraoperative diagnosis was TDC [Figure 4a and b].
Gross specimen received was a paramedian neck swelling measuring 11.3 cm x 6 cm x 4.9 cm. External surface is multinodular and well capsulated. Cut section is multilocular, cystic and filled with yellow-brown fluid. The solid areas are gray yellow with areas of calcification and focal papillary excrescence measuring 2.2 cm x 1.6 cm x 1cm
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F5
The solid areas were gray yellow with the areas of calcification and focal papillary excrescence measuring 2.2 cm x 1.6 cm x 1 cm [Figure 5].
(a and b) Microscopic examination showed a multiloculated cyst focally lined by pseudostratified ciliated epithelium. The wall shows thyroid follicles, lymphoid aggregates and foci of cholesterol clefts and calcification. In areas, the cyst wall shows papillary carcinoma of thyroid exhibiting nuclear grooves and overlapping
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F6
Adjacent two lymph nodes show reactive hyperplasia [Figure 6a and b].
Postoperative follow-up
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F7
Postoperatively, the patient was absolutely alright and symptomatically relieved [Figure 7].