A case of papillary carcinoma in a thyroglossal cyst without a carcinoma in the thyroid gland

Abstract

The thyroglossal duct cyst is the most common developmental anomaly of the thyroid gland. We present a patient with a papillary thyroid carcinoma diagnosed after surgical resection of a thyroglossal cyst. The 39-year-old patient reported to our hospital due to a swelling of this throat. The results of the ultrasonography were reported as showing multiple nodules in both thyroid lobes, and an ~3-cm diameter image in the submental area, in keeping with lymphadenomegalia. In the fine-needle aspiration cytology (FNAC) evaluation from the nodules in the thyroid, it was observed that the thyrocites with uniform nuclei made up single-layer groups. FNAC from the thyroglossal cyst, a few histiocytes were observed on a ground with a large number of erythrocytes. The patient was subjected to a total thyroidectomy, pyramidal lobe excision, and total excision of the 3-cm diameter soft mass, starting at the tip of the pyramidal lobe. The case was diagnosed as papillary thyroid carcinoma in thyroglossal duct cyst with histopathological and immunohistochemical findings. If the thyroglossal channel cyst had been diagnosed preoperatively, total thyroidectomy and a Sistrunk operation would have been performed. For this reason, repeated FNAC, particularly, if performed under ultrasound guidance, may improve the diagnostic value of FNAC. Thus, in such patients, throat ultrasonography must be carried out in expert hands, thin-needle aspiration biopsy, computerized tomography, and thyroid scintigraphy must be done if necessary, and the necessary treatment protocols carried out after a definite diagnosis.

Thyroglossal Duct Cyst Carcinomas in Pediatric Patients: Report of Two Cases with a Comprehensive Literature Review

“…Ultrasound examination was most common, with lesions having a nonspecific cystic appearance. Computed tomography (CT) findings reported to be of value in identifying malignancy within a TGDC, include the presence of a solid component, mural nodule, or calcifications [3,19,42,43,50,[55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72]. However, these particular imaging findings were only of assistance in a few cases [4,38,48,55].…”

Papillary Thyroid Cancer Arising From a Thyroglossal Duct Cyst

“…However, even in the presence of malignancy, the Sistrunk procedure will suffice for non-metastatic disease and for medically high risk patients [5]. Fortunately, following this procedure when papillary thyroglossal duct cyst carcinoma is present, the overall survival rate is at approximately 95.6% over a period of 10 years postoperatively [4].…”

“…However, as discussed in a review of literature by Yang et al, a preoperative FNAC has shown to have poor true-and false-negative rates, at 53% and 47%, respectively [4,5]. In contrast, according to Miccoli et al, patients that underwent a repeat FNAC resulted in 100% sensitivity and specificity in a group of nine patients subjected to this procedure, especially when performed under ultrasound guidance.…”

“…In contrast, according to Miccoli et al, patients that underwent a repeat FNAC resulted in 100% sensitivity and specificity in a group of nine patients subjected to this procedure, especially when performed under ultrasound guidance. Furthermore, other diagnostic techniques are typically unable to make a preoperative diagnosis (CT, ultrasound, scintigraphy) [4,6]. Thus, based on these previous studies, workups of these midline masses benefit from an ultrasound-guided FNAC.…”

“…Although the incidence of carcinoma within a thyroglossal duct cyst is quite rare, there have been numerous efforts to characterize and understand more regarding the etiology, histopathology, and treatment of this malignancy considering its variable development and presentation. As discussed in previous studies, carcinomas of a thyroglossal duct cyst have a frequent association (approximately 11-33%) with carcinomas in the thyroid gland (most frequently, papillary thyroid carcinoma) [1][2][3][4][5][6][7]. As a result of this association, efforts must be taken to determine whether these tumors are metastasis from a primary thyroid cancer or whether this is a primary papillary carcinoma within a thyroglossal duct cyst.…”