Infiltrative follicular variant papillary thyroid carcinoma with bilateral cervical nodal metastases following benign cytology: Surgical management in a resource-limited setting

Abstract:

Fine-needle aspiration cytology (FNAC) has recognized limitations in diagnosing infiltrative follicular variant papillary thyroid carcinoma (FVPTC), as follicular architecture obscures the nuclear features needed for cytological diagnosis. We report a 49-year-old euthyroid male who underwent right hemithyroidectomy for a Bethesda Category II nodule (TIRADS 3 on ultrasound, no suspicious nodes). Postoperative histopathology revealed infiltrative FVPTC with capsular and lymphovascular invasion, and an ipsilateral central nodal metastasis (1/1). Following the 2015 American Thyroid Association guidelines, the tumor board recommended completion of total thyroidectomy with bilateral modified radical neck dissection, performed after a 5-week financial delay. Final staging was pT2 pN1b cM0 (AJCC 8 ^th edition), with multifocal left-lobe disease and bilateral nodal metastases (right lateral 4/15, left lateral 4/5). We discuss FNAC limitations, the evidence for completion surgery and bilateral dissection, and the oncological and financial challenges unique to resource-limited settings.