Metastatic Papillary Thyroid Cancer in Tuberculous Lymphadenopathy: An Unfortunate Dual Pathology

  • Nornazirah Azizan Department of Pathobiology and Medical Diagnostic, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Sabah, Malaysia
  • Firdaus Hayati Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Sabah, Malaysia
  • Nor Faezan Abdul Rashid Department of General Surgery, Surgical Sciences Cluster, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
  • Shahrun Niza Abdullah Suhaimi Department of Surgery, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
Keywords: Papillary thyroid carcinoma, tuberculosis, extra-pulmonary tuberculosis, cervical lymphadenopathy, metastatic carcinoma


Papillary thyroid carcinoma usually spreads through lymphatic route, presents as regional lymphadenopathy similar to extra-pulmonary tuberculosis of the cervical regions. We report the case of a 77-year-old woman with synchronous coexistence of tuberculosis and metastatic carcinoma in dissected lymph nodes. Total thyroidectomy is the standard care of treatment with additional neck dissection in clinically positive neck nodes. In the endemic areas and previous history of tuberculosis contact, the possibility of synchronous co-occurrence of these two pathologies should be considered thus anti-tuberculous treatment can be initiated concurrently.


Schlumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med 1998;338:297-306

Choi EC, Moon WJ, Lim YC. Tuberculous cervical lymphadenitis mimicking metastatic lymph nodes from papillary thyroid carcinoma. Br J Radiol 2009;82:e208-11

Swarma NY. A review of tuberculosis research in Malaysia. Med J Malaysia 2014;69:88-102

Sultan MAH, Hayati F, Azizan N, et al. Various presentations of breast tuberculosis and tuberculous lymphadenopathy: A case series of surgical rarity. Med Med J 2017;32:33-41

Özkan Z, Akyiğit A, Sakallioğlu Ö, et al. Diagnostic challenge in papillary thyroid carcinoma with cervical lymphadenopathy, metastasis, or tuberculous lymphadenitis. J Craniofac Surg 2013;24:2200-3

Kim SM, Jun HH, Chang HJ, et al. Tuberculosis cervical lymphadenopathy mimics lateral neck metastasis from papillary thyroid carcinoma. ANZ J Surg 2016;86:495-8

Meng L, Hu S, Huang L, et al. Papillary thyroid cancer coexisting with thyroid tuberculosis: A case report. Oncol Lett 2014;7:1563-5

Swathanthra N, Jyothi C, Premalatha P, et al. Papillary carcinoma of thyroid with an unusual coexistence of metastatic deposits and tuberculosis in the cervical lymph nodes. Med J DY Patil Univ 2014;7:59-61

Kadafar MT, Mi̇ryaguboğlu AM, Deği̇rmenci̇oğlu G, et al. Unexpected finding in the neck dissection specimen of papillary thyroid carcinoma: Concurrence of metastatic deposits and tuberculosis: Case report. Turkiye Klinikleri J Case Rep 2017;25:42-6

Ito T, Saito H, Kishine N, et al. Preoperatively diagnosed case with co-existence of papillary thyroid carcinoma and cervical tuberculous lymphadenitis. Int J Surg Case Rep 2015;15:74-7

Chao SS, Loh KS, Tan KK, et al. Tuberculous and non-tuberculous cervical lymphadenitis: a clinical review. Otolaryngol Head Neck Surg 2002;126:176-9

Yu MG, Atun JM. Tuberculous lymphadenitis mimicking nodal metastasis in follicular variant papillary thyroid carcinoma. Case Reports in Medicine 2016;5623104:3