Invasive Thyroglossal Duct Cyst Papillary Carcinoma: A Case Report and Review of the Literature

Abstract

Patient: Female, 27Final Diagnosis: Invasive thyroglossal duct cyst papillary carcinomaSymptoms: Painless cervical enlargementMedication: —Clinical Procedure: Sistrunk’s procedureSpecialty: SurgeryObjective:Rare diseaseBackground:Thyroglossal duct cyst is a common congenital anomaly of the thyroid gland, usually found centrally. The presence of malignancy occurring in a thyroglossal duct cyst is a rare condition, accounting only for 1% of all cases of thyroglossal duct cyst. This report is of a rare case of papillary carcinoma arising in a thyroglossal duct cyst and includes a review of the literature.Case Report:A 27-year-old female patient was referred to our department with a painless cystic mass in the neck. After initial physical examination and endocrinology investigations, a fine needle aspiration (FNA) of the cyst was performed. Cytology showed a papillary neoplasm. The patient underwent total thyroidectomy and surgical excision of the thyroglossal duct cyst (the Sistrunk’s procedure). Histopathology of the surgical excision specimen showed a thyroglossal duct cyst with a maximum diameter of 7.5 cm containing a primary invasive papillary carcinoma, measuring 1.5 cm in diameter that infiltrated into the cyst wall. The remaining thyroid gland was normal.Conclusions:Thyroglossal duct carcinoma, most commonly papillary carcinoma, is a rare condition that should be considered in patients presenting with cystic midline neck masses. Surgery and complete excision is the main treatment and the optimal patient management includes multidisciplinary consultation in order to improve survival. The diagnosis of malignancy is made postoperatively, as in the present case.

Thyroglossal Duct Cyst Carcinoma in a Young Female: Case Report and Review of Literature

“…Women are more likely than men to have a TGDC carcinoma at a 2.1 : 1 male-to-female ratio. The average age of presentation is in the fourth decade of life [3, 4]. The presence of calcifications within the TGDC and/or regional lymph nodes seen on ultrasound are specific markers for papillary thyroid carcinoma, and the presence of a solid component is suggestive of malignancy [6].…”

“…The role of preoperative fine-needle aspiration (FNA) is debated and has an only 53% diagnostic rate for detecting TGDC carcinoma though accuracy of diagnosis is improved by sampling the solid component if present [6]. Overall, TGDC malignancy is relatively uncommon with roughly 278 previously reported cases, the most common malignancy being papillary thyroid carcinoma in 75–80% of cases [4, 8]. Given the rarity, the optimal management is controversial.…”

“…Rapid increase in size of the mass or a mass that is firm and palpable can be indicative of malignancy [3–5]. Imaging can sometimes indicate the possibility of malignancy when certain features are present, such as a solid component within the TGDC [4]. Given the rarity of TGDC carcinoma, treatment algorithms are not clearly defined [3].…”

Occult papillary thyroid carcinoma with cystic nodal metastasis mimicking a thyroglossal duct cyst: A case report

“…Although the incidence of malignancy found within thyroglossal duct cysts is <1 % [5], we recommend the routine histopathological review of all resected specimens. Thyroglossal duct cysts are typically lined with either respiratory (columnar to stratified cuboidal) epithelium (38 %), squamous epithelium (10 %), or a combination of both types (51 %).…”

“…Issues associated with this pathology includes poor cosmesis, recurrent infections, fistula formation [4]. Additionally, there is a small (<1 %) chance of developing a thyroglossal duct carcinoma [5]. Papillary thyroid carcinoma is the most common malignancy (92 %) found in TDC, with less common variants being squamous cell carcinoma (5.2 %) and follicular carcinoma (1.7 %) [6].…”