RESUMO
The 8-year-old boy with 13 months history of enlargement of right cervical lymph nodes is described in this paper. Infectious lymphadenopathy was initially diagnosed. He was treated with antibiotics without success. Fine-needle aspiration biopsy in one of the enlarged lymph nodes showed the cells of normal thyroid gland without any signs of atypical growth. USG and scintigraphy revealed normal thyroid gland without nodules; no extra thyroid glands were detected. In 13th month of the disease two enlarged (about 5 ml each), painful, rather hard cervical nodules were present. The thyroid gland was no enlarged and without any palpable nodules. Chest X-ray and second thyroid scintigraphy were normal. Ultrasound imaging of thyroid gland revealed hypoechogenic lesion 11 x 9 x 12 in diameter in the upper part of right thyroid lobe. The morphological findings of removed nodules allowed to make a diagnosis of carcinoma papillare psammomatosum glandulae thyroideae. Total thyroidectomy with removal of cervical ipsilateral lymph nodes was performed. The operation is to be followed by radioactive iodine ablation and thyroid hormone suppression. The authors analyzed the causes and difficulties in diagnosis.
