A 33-year-old presented with a lump in her neck. Physical examination confirmed enlarged right cervical lymph nodes with normal thyroid gland. She underwent percutaneous biopsy of... A 33-year-old presented with a lump in her neck. Physical examination confirmed enlarged right cervical lymph nodes with normal thyroid gland. She underwent percutaneous biopsy of the lymph nodes. Histopathology: Normal follicular thyroid cells. Which of the following is the most appropriate next step? A. Reassurance B. Surgical referral C. Lymph node excision D. 3 months follow up ultrasound
Understand the Problem
The question describes a clinical scenario involving a 33-year-old female with a neck lump and enlarged cervical lymph nodes. A biopsy reveals normal follicular thyroid cells. The question asks what the most appropriate next step in management is, with several options provided. We must choose the option that is most consistent with standard medical practice for evaluating and managing lymphadenopathy.
Answer
Surgical referral
The most appropriate next step is surgical referral. Although the histopathology report shows normal follicular thyroid cells, the presence of enlarged cervical lymph nodes necessitates further investigation to rule out malignancy or other potential causes. Surgical referral allows for a more comprehensive evaluation and potential excision of the lymph node for further pathological analysis.
Answer for screen readers
The most appropriate next step is surgical referral. Although the histopathology report shows normal follicular thyroid cells, the presence of enlarged cervical lymph nodes necessitates further investigation to rule out malignancy or other potential causes. Surgical referral allows for a more comprehensive evaluation and potential excision of the lymph node for further pathological analysis.
More Information
The presence of normal follicular thyroid cells in the lymph node biopsy is unusual and requires further investigation to exclude thyroid cancer spread or other benign thyroid inclusions in the lymph nodes.
Tips
A common mistake is to reassure the patient based on the initial biopsy results without considering the possibility of other underlying conditions or the need for further investigation.
Sources
- Fine-Needle Aspiration of the Thyroid Gland - Endotext - NCBI - ncbi.nlm.nih.gov
- Lymph node metastasis in cancer progression - Nature - nature.com
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