Abstract

Background: Patients having papillary thyroid malignancy along with lymph adenopathy may cause diagnostic dilemmas. It is important to characterize these lymph nodes as metastasic or concomitant lymphoproliferative disease. The development of papillary thyroid carcinoma (PTC) as the second malignancy has been reported frequently after neck irradiation for lymphoma treatment but their coexistence in patients without any history of radiotherapy is very unusual and has been reported only in a few cases.
Case Presentation: We present a 56-year-old female patient having thyroid nodule and cervical lymphadenopathy. The patient did not have significant past medical history, or history of neck irradiation but have intermittent signs of compression, including dysphagia and dysphonia. A neck ultrasound revealed a 3 cm solid hypoechoic nodule with suspicious features in the right lobe of the thyroid gland along with bilateral jugulodigastric and left supraclavicular lymphadenopathy. Ultrasound-guided fine-needle aspiration biopsy of the right-sided thyroid nodule revealed PTC, while supraclavicular lymph node biopsy surprisingly revealed classical Hodgkin’s lymphoma with nodular sclerosis.
Conclusion: Although in patients with cervical lymphadenopathy and concomitant thyroid carcinoma, lymphatic metastasis is the most common diagnosis, but the possibility of synchronous thyroid cancer and lymphoma should not be ignored to optimize the management.

Key words: Papillary thyroid carcinoma, synchronous, Hodgkin’s lymphoma, chemotherapy, radioiodine therapy, 18F-FDG PET-CT.