Clinical Case Database / Category: Case Based Discussion

Lumps in the neck

Publication details

Darryl Ramoutar MA MBBChir, Charis Costopoulos MA MBBChir
Foundation Years Journal, volume 2, issue 2, p.66 (123Doc Education, London, February 2008)

Abstract

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 ‘Orphan Annie’ 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?

Access the Clinical Cases Database

A subscription is required to read the full article. Please subscribe using one of the options below.

Authors

Darryl Ramoutar MA MBBChir (Corresponding author)

FY2 in A&E/Trauma and Orthopaedics
Hinchingbrooke Hospital
Hinchingbrooke Park
Huntingdon
PE29 6NS

Charis Costopoulos MA MBBChir

FY2 in Academic Medicine
Addenbrooke’s Hospital

References

1. Quinn MJ, Babb P, Brock A, Kirby L, Jones J. Cancer trends in England and Wales 1950–1999. Studies on medical and population subjects no. 66, London. The Stationery Office 2001: Appendix B4.
2. Department of Health Referral Guidelines for Suspected Cancer.
3. National Institute for Clinical Excellence Guidance on Cancer Services: Improving Outcomes in Head and Neck Cancers, The Manual.
4. Vowles RH, Ghiacy S, Jefferis AF. A clinic for the rapid processing of patients with neck masses. Journal of Laryngology and Otology 1998; 112: 1061–1064.
5. Guidelines for the management of thyroid cancer in adults. Royal College of Physicians of London, 2002.
6. Pisani T, Bononi M, Nagar C. Fine needle aspiration and core needle biopsy techniques in the diagnosis of nodular thyroid pathologies. Anticancer Research 2000; 20: 3843–3847.

Disclaimers

Conflict Of Interest

The Journal requires that authors disclose any potential conflict of interest that they may have. This is clearly stated in the Journal’s published “Guidelines for Authors”. The Journal follows the Guidelines against Conflict of Interest published in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (http://www.icmje.org/urm_full.pdf).

Financial Statement

The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.

Patient Consent statement

All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts (http://www.icmje.org/urm_full.pdf). The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.

Animal & Human Rights

When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.

About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.