Painfull Cervical Lymphadenopathy as the First Clinical Manifestation of Thyroid Carcinoma [Article in Bosnian]

Introduction – An enlarged lymph node is the most common neck mass in children. The usual causes of enlargement are infections such as bacterial and viral adenitis, pharyngitis, an infectious diseases and Hodgkin disease. However, sometimes enlarged lymph nodes can be found in thyroid carcinoma as the first manifestation of the disease.  Case report – Here we report on 11- year old girl with painful cervical lymphadenopathy. An ultrasound and cytological examination followed by fine-needle aspiration cytology from the thyroid gland revealed a papillary carcinoma. A total thyroidectomy with lymph nodes dissection was performed. The postoperative diagnosis confirmed thyroid carcinoma metastaticum in the lymph nodes. With a view to implementing the further diagnostic and therapeutic protocol a whole body scintigraphy was performed and it revealed a radioiodine collection in the area of the remaining thyroid tissue. As a result radioiodine therapy i.e. 100 mCi (370 MBq) was administered. Substitution therapy was administered. A year later the whole body scan showed a focus of increased uptake in the neck indicating that there was a need to repeat radioiodine therapy. This time a dose of 100 mCi was administered (total dose of radioiodine ablation amounts to 200 mCi). Since the surgery was performed five years ago there have not been any signs of local recurrence or metastasis.  Conclusion – Enlarged lymph nodes are a serious clinical problem. Therefore, lymphadenopathy regardless of its occurrence demands detailed clinical testing. Priority should be given in this pathology diagnostics to ultrasound examination in combination with fine-needle aspiration cytology, which can reveal the cause of the disease in good time and reliably.