(1026) Pediatric papillary thyroid carcinoma presenting as lateral neck mass: case series and literature review

Introduction: Papillary thyroid cancer (PTC) is rare in children and more often presents with nodal and distant metastasis than in adults. While most pediatric lateral neck masses carry low suspicion for malignancy, diagnostic and therapeutic evaluation remains individualized. This study characterizes the clinical course of children with atypical PTC presentations using cases from a single academic center and the published literature.

Methods: A retrospective electronic health record review identified patients aged ≤18 years diagnosed with PTC between 2012 and 2025 at a single academic center who presented with a lateral neck mass and low initial suspicion for thyroid malignancy. A literature review through 2025 was performed using PubMed, Google Scholar, and Scopus to identify similar cases. Demographics, family history, imaging characteristics, diagnostic workup, pathology, treatment, and oncologic outcomes were analyzed.

Results: Among 34 pediatric patients with PTC at our institution, three presented with a lateral neck mass. Combined with the literature, 10 cases were included. Mean age at presentation was 12.9 ± 5.0 years; seven patients were male, and two reported a family history of thyroid malignancy. Median time to presentation was 16 weeks. Mean mass size was 3.4 ± 2.1 cm, with right-sided predominance and cystic features in half of cases. Diagnosis was established by fine needle aspiration (FNA) in five patients and excisional biopsy in four. One FNA was indeterminate with postoperative confirmation. All patients underwent total thyroidectomy, with eight receiving concurrent lymph node dissection (6 central, 5 lateral, 1 unspecified). Nodal metastasis was present in seven patients and pulmonary metastasis in two. At a median follow-up of 48 months, two patients developed local recurrence.

Conclusions: This series highlights the variability in presentation of advanced pediatric PTC. While FNA is valuable in select cases, definitive diagnosis often requires excision. Larger case-control studies are needed to identify lateral neck mass features associated with increased risk of thyroid malignancy.