Thryroid malignancy

Mr X presented with a swelling rt side of neck for 4 to 5 yrs gradually increasing in size No associated complaints O/E A mass felt in the rt posterior triangle of neck approx 5×3×3 cm cystic in consistency,surface smooth,margin well defined, mobile with no fixity to underlying and adjacent structures Investigations USG neck and thyroid Cystic sol 6×2.5 cm with soft tissue component and septations are noted in the lower part of rt side of neck Thyroid Rt normal in shape and size Few hypoechoic and cystic sol of 16×10 mm S/O adenoma/ colloidal cysts Lt normal in shape and size An oval shaped mildly echogenic sol 14×10 mm noted S/O adenoma/ colloid cyst CT neck with contrast Well defined lobulated solid cystic lesion 41×30 mm seen in rt side of neck abutting anteromedially the sternomastoid muscle Solid component shows homogeneous enhancement suggestive of ? Neoplastic Desmond tumour ? Inflammatory Xray chest w n l FNAC No evidence of malignancy D/D Metastatic secondary Lymphoma Kochs Operative notes Mass rt posterior triangle of neck excised Post OP uneventful Sutures removed wound dry Histopathological report Consistent with metastatic secondary papillary carcinoma of thyroid Final diagnosis Stage 4a papillary carcinoma of thyroid Uicc stage T2 N1b M0 Plan Total Thyroidectomy Central node clearance Modified radical neck dissection Followed 6 to 12 wks PO RAI treatment in Hypothyroid state