Differential Diagnosis for a 32 y.o Woman with a Right Neck Lump and Normal Follicular Thyroid Cells on Histopathology
- Single most likely diagnosis:
- Ectopic thyroid: This is the most likely diagnosis given the presence of normal follicular thyroid cells in a cervical lymph node. Ectopic thyroid tissue can be found in various locations, including the neck, and can be mistaken for a metastatic thyroid cancer.
- Other Likely diagnoses:
- Papillary thyroid cancer (Follicular variants; 40%): Although the histopathology report shows normal follicular thyroid cells, it's possible that the sample missed the malignant cells. Papillary thyroid cancer can have a follicular variant, and metastasis to cervical lymph nodes is common.
- Follicular thyroid cancer: Similar to papillary thyroid cancer, follicular thyroid cancer can also metastasize to cervical lymph nodes. However, the presence of normal follicular cells on histopathology makes this diagnosis less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Metastatic thyroid cancer (any type): It's crucial to rule out metastatic thyroid cancer, as it can have a significant impact on treatment and prognosis. Although the histopathology report shows normal cells, further evaluation, such as imaging studies and additional biopsies, may be necessary to confirm the diagnosis.
- Rare diagnoses:
- Thyroglossal cyst: This is a rare diagnosis, as thyroglossal duct cysts typically present in the midline of the neck and are often associated with thyroid abnormalities. However, it's possible for a thyroglossal cyst to be located laterally and contain thyroid tissue.