Exophytic Papillary Thyroid Carcinoma With Anaplastic Transformation in a Cervical Lymph Node: A Case Report and Review of the Literature

Papillary thyroid carcinoma (PTC) is the most common malignant neoplasm of the thyroid and generally follows an indolent clinical course with favorable long-term survival.However, a subset of tumors may develop aggressive histological and locoregional features, including tall-cell morphology, extensive extrathyroidal extension, and anaplastic transformation.We report an unusual presentation of PTC characterized by massive exophytic cervical growth and anaplastic transformation within a metastatic cervical lymph node.A 76-year-old man presented with a progressively enlarging right lateral cervical mass over a two-year history, accompanied by hoarseness, dysphonia, and dyspnea on moderate exertion.Physical examination revealed a 15 × 15 cm exophytic cervical mass with overlying skin ulceration.Computed tomography demonstrated extensive right cervical lymphadenopathy with central necrosis, compression of the ipsilateral internal jugular vein, airway displacement, and a heterogeneous right thyroid lobe mass with internal calcifications and poorly defined margins.The patient underwent total thyroidectomy and right radical neck dissection.Intraoperatively, an extensive cervical nodal conglomerate with infiltration of the sternocleidomastoid muscle and involvement of the thyroid cartilage was identified.Histopathological examination demonstrated papillary thyroid carcinoma of the tall-cell subtype with anaplastic transformation within cervical lymph node metastasis.This case highlights an exceptionally aggressive locoregional presentation of PTC and emphasizes the importance of comprehensive clinical, radiological, surgical, and histopathological assessment in patients presenting with bulky cervical disease.Recognition of aggressive histological features and anaplastic transformation is essential for appropriate multidisciplinary management and prognostic assessment.