A man who had lived with a large lump in his neck for more than a decade finally tried to have it removed, but received a surprising diagnosis of cancer – despite never having had any symptoms.
At around age 31, an anonymous Pole noticed a small, firm, painless lump on the front of his neck.
He continued with his life working at a military museum as a night guard, but the lump continued to grow. After 15 years, he noticed that the mass had grown enough to prevent him from shaving.
Finally, he went to the hospital of the Military Institute of Aeronautical Medicine in Warsaw.
There, doctors discovered that the man had a mass in his neck almost 2 inches in size, about the size of a stamp. They assumed it was a harmless growth called a thyroglossal duct cyst (TGDC) that usually forms in the uterus.
However, tests later revealed that he was among only one percent of patients with this growth who had cancer cells within otherwise normal tissue. The patient was then diagnosed with thyroid cancer.
Researchers at the Military Institute of Aeronautical Medicine are raising awareness about this rare disease. Given the unusual presentation of cancer, physicians must be vigilant, especially in their elderly patients.
Most of these cysts are found in children under the age of ten. In this case study, the man did not notice the growth until he was thirty years old.
TGDC is a relatively common neck abnormality and is found in 70 percent of children with neck lumps. As people age, they become less common and only affect about seven percent of Americans per year.
These form in the womb, when genetic abnormalities cause excess thyroid tissue to form into sacs that fill with fluid.
There, TGDCs can go undetected for years.
Someone usually realizes they have one when they notice a subtle swelling in the front of their neck or develop problems swallowing or keeping their tongue in their mouth.
This is most often diagnosed in children before age 10, according to Cleveland Clinic.
Most patients experience no pain and the vast majority of them are harmless, but in about one percent of cases they contain cancer cells that can spread.
In the Pole’s situation, doctors say it is unusual for someone to live to be 30 and not realize they have this type of growth.
That was the case of the anonymous 46-year-old man, whose story was published in the American Journal of Case Reports.
After doing initial scans, doctors predicted she had TGDC, but not cancer. Still, to prevent the lump from growing and making the man uncomfortable, they chose to remove it through surgery. It is unclear when this occurred.
The surgery, they wrote, was uneventful. They were able to remove the entire growth and it only took two days for the man to recover in the hospital. However, routine cell testing later discovered a cluster of cancer cells inside the lump.
The arrow shows the lump in the throat of the 46-year-old patient. Doctors decided to remove it before suspecting it might have cancer.
She was diagnosed with primary papillary thyroid cancer. Fortunately, doctors caught it when it was still a stage 1 cancer, before it grew further or spread to the patient’s bones, blood or lymph nodes.
After further testing to ensure it had not spread, doctors concluded that the patient’s cancer had already been removed. Six months later, he was still cancer-free.
In the rare cases where this type of neck lump is cancerous, the best form of treatment is surgery, the study authors said. Sometimes this means that people must also have part of their thyroid or neck bones removed.
In addition to surgery, people with this type of thyroid cancer, which affects about 44,000 Americans a year, may also benefit from hormone therapy, radiation, or chemotherapy.
If caught early, as in the case study, this type of cancer is incredibly treatable. Between 99 and 100 percent of patients with this condition are declared cancer-free five years after being diagnosed and treated.
Although it is rare for these types of cysts to develop into cancerous tumors, the case study researchers recommend that doctors who find them in people over 40 take special precautions to look for cancer.
They said: “Suspicion of malignancy should be increased in elderly patients with TGDC, due to the rarity of this condition in that age group.”