Papillary carcinoma in an isthmic thyroglossal duct cyst: clinical considerations

Cancer in a thyroglossal duct cyst is uncommon (incidence: approximately 1%). There are about 250 reported cases in the literature, most of which are papillary cancers or, less frequently, squamous or follicular carcinomas. The preoperative diagnosis of thyroglossal duct cyst carcinoma may be facilitated by an ultrasound neck examination or fine needle aspiration cytology (FNAc). As reported in the literature, however, the diagnosis is often obtained only at histopathological examination. We describe a case of a 43-year-old male patient with a papillary carcinoma in an isthmic thyroglossal duct cyst. Ultrasound of the neck demonstrated a nodular hypo-anechogenic cystic neoformation of the isthmus of the thyroid, while Fnac was not diagnostic. An isthmectomy of the thyroid was initially performed. Frozen examination of the cystic lesion revealed a papillary carcinoma in the thyroglossal duct cyst. A total thyroidectomy with central lymphectomy was therefore performed. Carcinoma in the thyroglossal duct has a low mortality (5-year mortality: < 2%), but a long-term follow-up is mandatory, due to the low, short-and medium-term recurrence rate.     

Papillary carcinoma of the thyroglossal duct cyst: a case report

The thyroglossal duct cyst is the most common anomaly in thyroid development. To date, approximately 250 cases have been reported, the majority being papillary thyroid carcinomas. In most cases the diagnosis is established only after excision of a clinically benign thyroglossal duct cyst. Controversies exist in relation to a rational and effective therapeutic approach. A further case of thyroglossal duct papillary carcinoma affecting a 52 years-old man is presented to highlight the clinicopathological features of this condition. FNAC resulted false negative. Surgery consisted in a Sistrunk procedure, followed by total thyroidectomy and central lymphectomy after definitive histological diagnosis. In view of the prolonged course of papillary carcinoma, long-term follow-up is mandatory.     

Thyroid Carcinomas Arising in Thyroglossal Ducts

Six cases of thyroid carcinoma arising in a thyroglossal duct cyst are described and combined with previously reported cases to provide a total of 66 cases for retrospective analysis. Most presented as benign thyroglossal duct cyst, and the malignant nature of the lesion was not recognized until the permanent pathology sections were reviewed. Eight of 10 patients with metastatic disease in retrospect had preoperative indications of malignancy as manifest by clinically suspicious nodes or a thyroglossal cyst larger than the mean for the series. The primary cell type in all cases was papillary thyroid carcinoma. Local resection by the Sistrunk method and suppressive doses of thyroid are recommended for the patient with papillary thyroid carcinoma arising in a thyroglossal duct cyst when there is no evidence of extension of the malignancy beyond the confines of the cyst. The patient presenting with metastatic carcinoma should, of course, be treated with appropriate local resection, hormonal manipulation, thyroid ablation, and lymphadenectomy as indicated by his age and sex, the cell type of the tumor, and the extent of local and metastatic disease.     

Adenosquamous carcinoma arising in a thyroglossal duct cyst: Report of a case

A 61-year-old Japanese woman had an 11-year history of an enlarging anterior neck mass that was diagnosed otolaryngologically as a thyroglossal duct cyst. Preoperatively, fine-needle aspiration cytology suggested a neoplastic lesion, but no obvious malignancy was clinically evident. Sistrunk’s operation was performed. An adenosquamous carcinoma arising in a thyroglossal duct cyst was found on pathological examination. Carcinoma arising in a thyroglossal duct cyst is rare, and only approximately 200 cases have been reported, most of which were papillary carcinoma. Only 21 cases of squamous cell carcinoma arising in a thyroglossal duct cyst have been reported. The present case is the first report of adenosquamous carcinoma arising in a thyroglossal duct cyst.     

Papillary thyroid carcinoma in thyroglossal duct cyst: case reports and literature review

Although thyroglossal duct cysts represent a common developmental abnormality of the thyroid gland, malignant transformation is rare and occurs in only 1% of cases. This article describes four clinical cases observed at the Surgical Science Department of "La Sapienza" University of Rome between 1996 and 2000. Histologic examination indicated two pure papillary carcinomas, a sclerosing papillary carcinoma, and a follicular variant of papillary carcinoma. In all cases, treatment involved removal of the body of the hyoid bone and total thyroidectomy, which we associated with removal of the thyroglossal duct cyst. In one case, laterocervical lymphectomy was performed. Carcinoma multifocality was found in one patient. We recommend associating total thyroidectomy with removal of the tumor of the thyroglossal duct and of the body of the hyoid bone, because the carcinoma may be multifocal and there may be lymphatic invasion of the thyroid and to ensure a correct follow-up.     

A rare case of incidentally diagnosed primary papillary carcinoma of thyroglossal duct cyst

Thyroglossal duct cysts are the most common congenital abnormality of thyroid development. Seventy percent of thyroglossal duct cysts are diagnosed during childhood and 7% are diagnosed in adulthood. Less than 1% of these cases are malignant with most being papillary in nature. It is often diagnosed incidentally after surgical excision. Incidentally discovered, well-differentiated thyroid carcinoma of the thyroglossal duct, in the presence of a clinically and radiologically normal thyroid gland, can be managed adequately by the Sistrunk operation. We present a rare case of primary papillary carcinoma of thyroglossal duct cyst, with normal thyroid gland, in a 28-year-old female that was diagnosed incidentally on histopathological examination. A Sistrunk procedure was performed on the patient to remove the thyroglossal duct cyst and patient is doing well at regular follow up.     

Management of papillary carcinoma arising in thyroglossal-duct anlage.

Cysts of the thyroglossal duct are common congenital abnormalities. They present as asymptomatic midline cervical swellings. The risk of malignant change is low; only 103 cases have been reported in the world literature, 85% of which were papillary adenocarcinomas. The appropriate treatment for this condition remains controversial. The authors describe three patients who had papillary carcinoma contained within a thyroglossal-duct rest. All were treated by cyst resection and thyroid suppression, but without thyroidectomy and radioactive thyroid ablation. Postoperatively, all patients remained disease free, with no recurrence at follow-up ranging from 10 to 29 years. Isolated papillary carcinomas arising from primitive thyroid remnants, associated with a palpably normal thyroid gland at surgery and a negative thyroid scan, can be treated adequately by excising the thyroglossal mass.     

Thyroglossal Duct Cyst—More Than Just an Embryological Remnant

Thyroglossal duct cyst is a congenital malformation that occurs due to incomplete closure of the thyroglossal duct. Apart from being a quiescent embryological remnant, it presents itself clinically at any age and often requires surgical excision. Twenty four patients were encountered at Sri Ramachandra Medical College and Research Institute between June 2004 and June 2009 with thyroglossal duct cyst. The purpose of the study was to analyse their presentation, associated complications including malignancy and the approach to their management. Operative notes, histopathology files and medical records were used for the retrospective analysis of the patients with thyroglossal duct cyst. Thyroid profile and Radioisotope scan were performed on all the patients to document the position of the thyroid gland. Further, these patients were subjected to Ultrasonography and Computerised Tomography neck to conclusively map the location of the cyst. Fine Needle Aspiration of the tissue was done to diagnose malignancy. It was noted that there was maximum clustering of about 62.5% in males. About 45% of them belonged to the paediatric age group. The total number of symptomatic patients was about 59%. Unlike the various studies in literature, most of the thyroglossal duct cyst patients at our hospital were symptomatic. The symptoms were pain, dyspnoea, dysphagia, discharge and recurrence. Malignancy was diagnosed in two patients who were ironically asymptomatic. Other complications were looked into and treated. Thyroglossal duct cyst is a cervical anomaly that is usually found as an asymptomatic painless cystic swelling. However, most of our patients had a symptomatic presentation. Association with malignancy was noted. Surgical intervention was the cure for all the patients.     

Follicular carcinoma in a thyroglossal duct.

The case of a 24-year-old woman with follicular carcinoma arising de novo in a thyroglossal duct is reported. A review of the literature disclosed seven case reports of thyroglossal duct carcinoma with a mixed papillary-follicular pattern. There are three criteria for the diagnosis of follicular carcinoma of a thyroglossal duct: presence of a thyroglossal duct, absence of carcinoma within the thyroid gland and angioinvasion. A plan of treatment, based on the literature survey, should include Sistrunk excision of the tumour if possible, and subtotal thyroidectomy should be performed to eliminate the presence of a primary thyroid carcinoma.     

Papillary carcinoma of the thyroid arising on thyroglossal duct cysts: report of a case and review of the literature

Thyroglossal duct cysts are the most common congenital disorder of the neck. One percent of cases may degenerate and give rise to a cancer, mainly arising in the pericystic thyroid tissue. Some 250 cases have been reported in the literature to date. We report here on a 39-year-old man with a midline mass in the neck measuring 4 cm max. The patient was examined preoperatively by ultrasonography of the neck and assay of thyroid hormones, which yielded a diagnosis of a thyroglossal duct cyst. On the basis of these findings, the patient underwent surgery to remove the mass and, after an extempore histopathological examination, was submitted to total thyroidectomy owing to the presence of papillary carcinoma of the thyroid arising on the thyroglossal duct cyst with multiple foci in the context of the thyroid gland. Most thyroid cancers at the time of surgery are confined to the thyroid gland, infiltrating the adjacent structures in approximately 20% of cases and the local-regional lymph nodes in 8 to 11.5%. Thyroid papillary adenocarcinoma is multifocal in 21% of cases. The multifocal nature of the cancer makes total thyroidectomy mandatory at the same time as surgery is performed to remove the cyst.     

Carcinoma of the thyroglossal duct

Seven patients with carcinoma in a thyroglossal duct cyst have received treatment over a 15 year period. Findings in all of these patients reflect the likelihood of carcinoma arising within thyroglossal duct tissue. In each patient there was sufficient histologic evidence of the presence of a thyroglossal duct cyst and carcinoma arising within an intimate admixture of normal thyroid tissue in the cyst wall. In the absence of a history of irradiation and with separation of the carcinoma from the pyramidal lobe of the thyroid, excision of the thyroglossal cyst alone by traditional means seems appropriate. Our experience as well as a review of reported cases to date indicate that distant metastases are extremely rare and the prognosis excellent.     

Double cervical cyst derived from a single thyroglossal duct tract

Thyroglossal duct cysts are one of the most common congenital cervical pathologic findings in children. This type of cyst can be located anywhere between the base of the tongue and the sternal manubrium. We report the case of a patient with a double thyroglossal cyst, one located in the hyoid region and the other in the thyroid gland. The 2 cysts were connected by a permeable tract, which confirms that an involution failure of the embryonic remains of the thyroglossal duct was responsible for the development of the cyst. Intrathyroid cysts of the thyroglossal duct, though uncommon, should be included in the differential diagnosis of thyroid cysts in children.     

Ultrasonographic findings of thyroglossal duct papillary carcinoma: A case report

IntroductionReports on thyroglossal duct cyst carcinoma (TGDCCa) are rare, occurring in approximately 1% of thyroglossal duct cyst (TGDC) cases. The origin and treatment of carcinoma arising in TGDC are controversy.Presentation of caseA 38-year-old woman presented with a midline neck mass at the thyrohyoid level for 3 years. Ultrasound revealed a 2.4 cm cystic mass with a solid mural component and microcalcification. A small right thyroid nodule was also detected. Sistrunk’s operation was performed and the pathology was a primary carcinoma arising in the TGDC with a close surgical margin. Total thyroidectomy was done and revealed a 4 mm papillary carcinoma with partial invasion through the thyroid capsule of the right lobe with a 1 mm papillary carcinoma at the isthmus. The diagnosis was a primary TGDCCa with multifocal papillary thyroid carcinoma.DiscussionSistrunk’s operation is an accepted procedure for the treatment of both TGDC and TGDCCa. Additional total thyroidectomy has been proposed but still controversial. The aims of preoperative ultrasound and ultrasound-guided fine needle aspiration biopsy (FNAB) are differential diagnosis of the possible diseases and operative planning. The results which suggest a carcinoma arising in the TGDC, synchronous thyroid malignancy and metastatic cervical lymph nodes are helpful in determining the magnitude of the operation.ConclusionUltrasound and FNAB of the TGDC, thyroid gland and cervical lymph nodes are the useful preoperative evaluations leading to the accurate diagnosis. The definitive treatment is Sistrunk’s operation with the possible addition of total thyroidectomy and neck dissection when indicated.     

Redefining Anatomy in a Case of Midline Subhyoid Ectopic Thyroid

Ectopic thyroid is an uncommon embryological aberration of the thyroid descent. Subhyoid median ectopic thyroid gland is a result of incomplete descent of the thyroid anlage and is characterized by a cosmetically unacceptable ovoid mass of thyroid tissue in the midline overlying the thyroid cartilage and thyrohyoid membrane. A normally placed thyroid gland is not detectable and in most cases all functioning thyroid tissue is located within the mass. Most of the ectopic thyroids are usually mistaken for a thyroglossal cyst and excised. Severe myxedema follows removal. Many cases have been reported in the literature, none of which was recognized prior to operation. All patients were operated upon for removal of a thyroglossal duct cyst. The diagnosis was missed at operation and in these cases severe myxedema was universal. The cause of the myxedema was not always immediately recognized. Therefore, many diagnostic tests including thyroid function test, ultrasound of the neck, and thyroid scanning had been recommended in the preoperative evaluation of a thyroglossal cyst. Here, we present a case of ectopic thyroid mass which was the only thyroid tissue present in the neck. So, division and repositioning of the thyroid mass thereby redefining the anatomy was done with good cosmetic results.     

PAPILLARY THYROID CARCINOMA ARISING IN THYROGLOSSAL DUCT CYSTS: INCIDENCE AND MANAGEMENT

The incidence and pathological features of papillary thyroid carcinoma arising in the thyroglossal duct cysts were reviewed and compared with papillary thyroid carcinoma arising elsewhere in the thyroid gland. In the 30 year period 1964 to 1993 there were 90 thyroglossal duct nodules or cysts treated surgically at the Endocrine Surgical Unit, Royal North Shore Hospital, Sydney, Australia. There were four cases of papillary thyroid carcinoma in this group (4.4%). In the same period 2814 cases presented with clinical single thyroid nodules which were treated surgically. There were 182 cancers in this group of which 121 were papillary thyroid carcinomas (4.3% of total cases). This is identical to the incidence seen in the thyroglossal duct. We conclude that the incidence of papillary thyroid carcinoma arising in the thyroglossal duct is no different to that arising elsewhere in the gland. The difference in number of carcinomas related only to the volume of follicular thyroid tissue present in the gland proper. That being the case, there is no reason to treat these cancers differently from papillary thyroid carcinoma elsewhere in the gland.     

Large thyroglossal duct cyst with laryngeal extension

Background. A thyroglossal duct cyst typically presents as a long-standing neck mass that becomes symptomatic when inflamed. Hoarseness is an uncommon complaint, and its association may suggest encroachment on and destruction of the larynx. Following removal of the cyst with the Sistrunk procedure, the larynx may need to be reconstructed. Methods. A case is reported of a patient who was initially seen with hoarseness and a long-standing midline neck mass. Computed tomography (CT) demonstrated a large cystic neck mass that eroded the thyroid cartilage and encroached on the pre-epiglottic space and right paraglottic space. Although the clinical impression was that of laryngeal neoplasm, the CT diagnosis was that of a cyst. At surgery, a thyroglossal duct cyst was found and successfully removed with the Sistrunk procedure. Because the thyrohyoid membrane and thyroid perichondrium were preserved, the glottis did not require reconstruction. This case is presented and the literature of thyroglossal duct cysts that extend into the larynx is reviewed. Conclusions. The clinical and radiographic criteria that suggest encroachment of a thyroglossal duct cyst on the larynx are reviewed. The management and indications for laryngeal reconstruction are discussed.     

Concurrent papillary and squamous carcinoma in a thyroglossal duct cyst: a case report

Carcinomas of thyroglossal duct cysts are rare. Most are papillary carcinomas; only about 5% are squamous cell carcinomas. Only one case of mixed papillary and squamous cell carcinoma of a thyroglossal duct cyst has been reported so far. The authors present a second case, that of a 38-year-old man who was first seen with a midline neck lump. It was diagnosed clinically as a thyroglossal duct cyst and was locally excised. Pathological examination showed both a concurrent papillary carcinoma and a squamous cell carcinoma. Treatment consisted of a near-total thyroidectomy, ablative radioactive iodine and adjuvant external radiation therapy. The authors review the literature and explain the rationale behind their choice of treatment.     

Differentiated thyroid cancer on the thyroglossal duct]

Over one hundred cases of carcinomas located on the thyroglossal duct have been reported worldwide. Most of these tumors originally were differentiated thyroid cancers. Their biological behavior is the same as that of tumors of the thyroid gland itself. On the basis of one case discovered in an 11-year-old girl, who presented with regional and systemic metastases, we discuss the various aspects of their origin, diagnosis and treatment. As far as the latter is concerned, we think that these tumors can not always be treated by exeresis of the thyroglossal duct. On the basis of the analysis of situations in which these tumors may be encountered, we propose a carcinological surgery, which might possibly be more aggressive, on the thyroid and cervical lymphatic tissues.     

PAPILLARY CARCINOMA ARISING IN A THYROGLOSSAL CYST

Carcinoma arising in a congenital thyroglossal cyst is rare, with less than 150 cases reported worldwide. This is a case report of a papillary carcinoma arising within a thyroglossal cyst in a 51 year old woman. Management of this condition remains controversial. Most of these tumours arise from ectopic thyroid tissue within the cyst. Prognosis is good as metastasis is uncommon. Sistrunk procedure is adequate if histology does not reveal extracystic extension.     

Papillary thyroid carcinoma in thyroglossal duct cyst

Thyroglossal duct remnants are the most common midline neck swellings, but carcinoma is found in approximately 1% of these lesions. The cysts are usually asymptomatic and the presentation of the patient with carcinoma is indistinguishable from the common cyst. Papillary adenocarcinoma comprises 75-85% of the tumors reported. A 36-year-old woman underwent Sistrunk procedure for excision of a thyroglossal cyst. No thyroid abnormality was noted pre-operatively nor during the surgical examination. The histopathological examination revealed papillary carcinoma. She has been maintained on thyroxine suppression and was doing well at 14 months' follow-up. Carcinoma of the thyroglossal duct cyst is rare. The ultrasonographic examination should be performed pre-operatively for thyroid gland study. The main question is what to do with the thyroid gland. There still is controversy about thyroid removal for a papillary carcinoma, but all the patients should receive suppressive doses of thyroid hormone. As the cure rate is 95% for the patients whose thyroid is preserved and further postoperative complications are avoided, we can consider that the optimal surgical procedure for thyroglossal duct carcinoma is the same as that for the benign cyst.