Adenoma thyroid with supraclavicular tuberculous lymphadenitis Masquerading as malignancy thyroid with Metastasis - Diagnostic dilemma

Abstract: Thyroid swelling or goitre is one of the commonest presentations among female patients more than males attending ENT out patients. The clinical importance of thyroid swelling is related to evaluating their functional status and assess,whether it is benign,malignant ,hypo or hyper active.Even if benign should look for pressure symptoms which justifies surgery.Tuberculous lymphadenitis is the most common form of extrapulmonary tuberculosis.Coexistence of thyroid swelling with supraclavicular lymph node mimicking malignancy with metastatic deposit is unusual and always to be evaluated. We report a case of a 45-year female,who on outside initial evaluation was diagnosed as follicular carcinoma of thyroid. However clinical examination revealed a palpable supraclavicular lymph node. Thus subjected to a repeat FNA (fine needle aspiration) from thyroid which revealed benign thyroid follicular adenoma and FNA from supraclavicular lymph node revealed tuberculous lymphadenitis, which was further confirmed by histological sections post operatively. This case emphasizes the need for thorough clinical examination and utility of image guided FNA to rule out the biological nature of these lesion