Papillary thyroid cancer differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2] Sahar Memar Montazerin, M.D.[3]


Papillary thyroid cancer must be differentiated from other diseases that cause neck mass, such as branchial cleft cyst, thyroglossal duct cyst, cystic metastasis, and multiple neurofibromas.

Differentiating Papillary thyroid cancer from other Diseases

  • The differential of a cystic neck mass(es) includes:
Disease Name Age of Onset Gender Preponderance Signs/Symptoms Imaging Feature(s) Macroscopic Feature(s) Microscopic Feature(s) Laboratory Findings(s) Other Feature(s) Microscopic Appearance
Papillary Thyroid Cancer[1][2][3]
  • More common in the middle aged (30 - 50 years of age)
  • More commonly affects women
Source:Wikimedia commons
Follicular Thyroid Cancer[2][3][4]
  • More commonly affects women
Source:Wikimedia common
Medullary Thyroid Cancer[5][6][7][3]
  • Incidence increases with age
  • More common in the 3rd to 4th decades of life
  • Both genders are affected equally
  • Single non-encapsulated mass
  • Gray-tan color
Source:Wikimedia common
Anaplastic Thyroid Cancer[8][9][10]
  • More common among older individuals
  • Mean age at diagnosis is 65 years
  • More commonly affects women
    • Irregular margin
  • Imaging features are not characteristic of this cancer
Source:Wikimedia common
Follicular Adenoma[11]
  • More commonly affects individuals older than 50 years of age
  • More commonly affects women
  • Solitary nodule which may show echogenicity or not
  • Solitary, spherical, and encapsulated lesion
  • Well demarcated from the surrounding parenchyma
  • Functional adenoma:
    • Elevated T3, T4
    • Decreased TSH
  • May be considered functional or hot
  • May be considered non-functional or cold
Source:Wikimedia common
Multinodular Goiter[12]
  • Commonly affects individuals older than 60 years of age
  • More commonly affects women
Source:pathology outline, case courtesy of Dr. Swati Satturwar
Thyroid Lymphoma[13]


  • More common among women
Source:pathology outline, case courtesy of Dr. Mark R. Wick


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  2. 2.0 2.1 Schlumberger, Martin Jean (1998). "Papillary and Follicular Thyroid Carcinoma". New England Journal of Medicine. 338 (5): 297–306. doi:10.1056/NEJM199801293380506. ISSN 0028-4793.
  3. 3.0 3.1 3.2 Sipos JA (December 2009). "Advances in ultrasound for the diagnosis and management of thyroid cancer". Thyroid. 19 (12): 1363–72. doi:10.1089/thy.2009.1608. PMID 20001718.
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  6. Kebebew E, Ituarte PH, Siperstein AE, Duh QY, Clark OH (March 2000). "Medullary thyroid carcinoma: clinical characteristics, treatment, prognostic factors, and a comparison of staging systems". Cancer. 88 (5): 1139–48. doi:10.1002/(sici)1097-0142(20000301)88:5<1139::aid-cncr26>;2-z. PMID 10699905.
  7. Hofstra, Robert M. W.; Landsvater, Rudy M.; Ceccherini, Isabella; Stulp, Rein P.; Stelwagen, Tineke; Luo, Yin; Pasini, Barbara; Hoppener, Jo W. M.; van Amstel, Hans Kristian Ploos; Romeo, Giovanni; Lips, Cornells J. M.; Buys, Charles H. C. M. (1994). "A mutation in the RET proto-oncogene associated with multiple endocrine neoplasia type 2B and sporadic medullary thyroid carcinoma". Nature. 367 (6461): 375–376. doi:10.1038/367375a0. ISSN 0028-0836.
  8. Nagaiah G, Hossain A, Mooney CJ, Parmentier J, Remick SC (2011). "Anaplastic thyroid cancer: a review of epidemiology, pathogenesis, and treatment". J Oncol. 2011: 542358. doi:10.1155/2011/542358. PMC 3136148. PMID 21772843.
  9. Chang TC, Liaw KY, Kuo SH, Chang CC, Chen FW (June 1989). "Anaplastic thyroid carcinoma: review of 24 cases, with emphasis on cytodiagnosis and leukocytosis". Taiwan Yi Xue Hui Za Zhi. 88 (6): 551–6. PMID 2794956.
  10. Venkatesh YS, Ordonez NG, Schultz PN, Hickey RC, Goepfert H, Samaan NA (July 1990). "Anaplastic carcinoma of the thyroid. A clinicopathologic study of 121 cases". Cancer. 66 (2): 321–30. doi:10.1002/1097-0142(19900715)66:2<321::aid-cncr2820660221>;2-a. PMID 1695118.
  11. Mathur, Aarti; Olson, Matthew T.; Zeiger, Martha A. (2014). "Follicular Lesions of the Thyroid". Surgical Clinics of North America. 94 (3): 499–513. doi:10.1016/j.suc.2014.02.005. ISSN 0039-6109.
  12. Bronshteĭn ME, Makarov AD, Artemova AM, Bazarova EN, Kozlov GI (1994). "[Morphology of the thyroid tissue in multinodular euthyroid goiter]". Probl Endokrinol (Mosk) (in Russian). 40 (2): 36–9. PMID 8197088.
  13. Pedersen RK, Pedersen NT (January 1996). "Primary non-Hodgkin's lymphoma of the thyroid gland: a population based study". Histopathology. 28 (1): 25–32. PMID 8838117.
  14. Hyjek E, Isaacson PG (November 1988). "Primary B cell lymphoma of the thyroid and its relationship to Hashimoto's thyroiditis". Hum. Pathol. 19 (11): 1315–26. doi:10.1016/s0046-8177(88)80287-9. PMID 3141260.
  15. Tupchong L, Hughes F, Harmer CL (October 1986). "Primary lymphoma of the thyroid: clinical features, prognostic factors, and results of treatment". Int. J. Radiat. Oncol. Biol. Phys. 12 (10): 1813–21. doi:10.1016/0360-3016(86)90324-x. PMID 3759532.
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