Introduction: The incidental finding of thyroid cancer in cervical lymph nodes in neck dissection specimens of head and neck cancer patients is rare. It is often challenging to differentiate findings from benign thyroid heterotopia and decide on apropriate therapy.

Methods: We present four cases in which thyroid tissue was histologically detected in cervical lymph nodes of patients with squamous cell carcinoma of the head and neck after neck dissection.

Case presentation: Histologic examination of four neck dissection preparations revealed the presence of thyroid tissue in one to three lymph nodes. All patients then underwent thyreoidectomy. Histologic analysis showed no evidence of thyroid primary in two of the cases. In the third case, a papillary microcarcinoma measuring 1 mm was found on the contralateral side only after extensive re-examination. The fourth thyroid contained a microcarcinoma measuring 4 mm on the ipsilateral side.

Discussion: Our results emphasize the importance of an accurate re-evaluation and follow-up of patients with incidental occult metastases for detection of a primary thyroid tumor. In the literature, histologic examination of the thyroid fails to detect a primary carcinoma in up to 25 % in comparison to 50% of our small cohort. The choice of treatment in patients with differentiated thyroid cancer metastasis and a coexisting head and neck cancer diagnosis - characterized by poor prognosis - is difficult. A thyreoidectomy should be carefully considered against an active surveillance plan, especially in the absence of suspicion in thyroid ultrasonography and possible thyroid heterotopia.

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