Management of Well-Differentiated Thyroglossal Remnant Thyroid Carcinoma: Time To Close the Debate? Report of Five New Cases and Proposal of a Definitive Algorithm for Treatment

Plaza, César Pablo Ramírez; López, Marta Esteban; Carrasco, Carmen Eloy-García; Meseguer, Luis Martínez; Perucho, Agustín de la Fuente

doi:10.1245/aso.2006.05.022

Cited by 116 publications

(175 citation statements)

References 28 publications

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“…The reported incidence of carcinoma occurring in TGDC is around 1 % [13,[28][29][30], though higher rates have been reported by tertiary or academic referral centers, ranging from 4.9 to 7.4 % [20,31,32]. In the present community practice based series, 3.2 % of TGDC contained an associated carcinoma.…”

Section: Discussionmentioning

confidence: 51%

“…Involvement of skeletal muscle may be seen, and should perhaps suggest upstaging to a pT3 tumor. Histologic examination of the thyroid in patients with thyroglossal duct cyst carcinoma may show a microscopic papillary carcinoma in approximately one-third of cases [29][30][31][32][33]. Among patients with thyroglossal duct cyst carcinoma who had a thyroidectomy in the present study, 32 % showed a synchronous papillary thyroid carcinoma.…”

Section: Discussionmentioning

confidence: 61%

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A Clinicopathologic Series of 685 Thyroglossal Duct Remnant Cysts

Thompson¹,

Herrera²,

Lau³

2016

Head and Neck Pathol

104

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The clinical features of thyroglossal duct remnant cysts (TGDC) have been well described, however the histopathologic aspects of these lesions have not been addressed in a detailed manner. In particular, there has been no large community practice based series evaluating TGDC histologically compared with management outcomes. A retrospective review of all TGDC diagnosed between 2005 and 2015 was performed. Six hundred eighty-five patients were identified (344 males; 341 females). Age at presentation was bimodal (first and fifth decades) and ranged from 0.8 to 87 years (mean 31.3 years). Males predominate in children (150:111); females in adults (230:194). Patients presented most frequently with a mobile midline neck mass in an infrahyoid location. An associated skin fistula (n = 67) was twice as common in pediatric as adult patients. The average cyst size was 2.4 cm (range 0.4-9.9 cm) by imaging studies and 2.6 cm (range 0.2-8.5 cm) by pathologic examination; pediatric patients had smaller cysts (mean 2.1 cm) than adults (mean 2.8 cm). Histologically, 257 (38 %) TGDC were lined by respiratory epithelium alone, 68 (10 %) squamous epithelium alone, 347 (51 %) exhibited both respiratory and squamous epithelium, and 13 (1 %) had no identifiable epithelial lining. Four hundred eighty-four (71 %) TGDC had associated thyroid gland tissue present within the cyst wall (n = 282), skeletal muscle (n = 71), adipose tissue (n = 34), or a combination of these sites (n = 97). The hyoid bone was identified in 647 (grossly and/or histologically), and absent in 38. Surgical management consisted of Sistrunk procedure (n = 647), cystectomy (n = 31), or thyroidectomy/thyroid lobectomy (n = 7). Treatment related complications were observed in 6 patients, which included vocal cord damage, seroma, and hematoma. Recurrences developed in 20 (3 %) patients, 14 of whom were managed initially by cystectomy. Papillary thyroid carcinoma was identified in 22 (3.2 %) TGDC. In summary, TGDC show a bimodal peak in the 1st and 5th decades, commonly presenting as a midline cervical lesion below the hyoid bone, associated with a skin fistula in 10 %. Histologically TGDC are most commonly lined by a combination of respiratory and squamous epithelium. Thyroid gland tissue is identified in 71 % of cases (0.45 cm mean size), although not limited to the cyst wall, but present in the surrounding soft tissues. Rare TGDC may harbor malignancy (3.2 %). TGDC are most effectively managed by Sistrunk procedure rather than excision, which carries low rates of complications (1 %) and recurrence (3 %).

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 61%

A Clinicopathologic Series of 685 Thyroglossal Duct Remnant Cysts

Thompson¹,

Herrera²,

Lau³

2016

Head and Neck Pathol

104

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“…It is thought that the prognosis is good and similar to that of papillary carcinoma of thyroid gland having cure rates in excess of 95%. Hence most authors consider a Sistrunk's operation to be adequate [9][10][11]. Others consider the possibility of multifocal origin and possible lymphatic spread to the thyroid, based on embryology.…”

Section: Discussionmentioning

confidence: 99%

Papillary Carcinoma Thyroid in a Thyroglossal Cyst

Chauhan

Kakkar

Gupta

2009

Medical Journal Armed Forces India

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“…They [14] also mentioned that addition of total thyroidectomy to Sistrunk procedure did not have signifi cant impact on survival especially young population below age 45 who constitutes low risk group. Plaza et al [15] recommended an algorithm for TGDC carcinoma to be treated with Sistrunk procedure without total thyroidectomy in low risk patients. They stratifi ed low risk patients as younger than 45 years, tumor less than 1.5 cm that is confi ned to the cyst, without distant metastasis and with normal thyroid gland on ultrasonography and no suspicious lymph nodes [15].…”

Section: Management Of Tgdc Carcinoma Varies and Includedmentioning

confidence: 99%

“…Plaza et al [15] recommended an algorithm for TGDC carcinoma to be treated with Sistrunk procedure without total thyroidectomy in low risk patients. They stratifi ed low risk patients as younger than 45 years, tumor less than 1.5 cm that is confi ned to the cyst, without distant metastasis and with normal thyroid gland on ultrasonography and no suspicious lymph nodes [15]. Because of the rarity of this disease, and lack of specifi c guidelines, some authors agreed with following the current guidelines for management of papillary thyroid carcinoma concluding that Sistrunk procedure is suffi cient for tumor less than 1 cm [13,16].…”

Section: Management Of Tgdc Carcinoma Varies and Includedmentioning

confidence: 99%

Dilemma in Managing Thyroglossal Duct Cyst Carcinoma

Sadia¹,

Prashant²,

E³

et al. 2016

Glob J Rare Dis

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The thyroglossal duct cyst (TGDC) is a well-known developmental abnormality encountered in the neck. It represents over 75% of childhood midline neck masses and 7% of the adult population. It typically presents as a mobile, painless mass in the anterior midline of the neck, usually in close junction to the hyoid bone. TGDCs infrequently present with signs and symptoms of secondary infection, or with evidence of a fi stula. Malignancy is rarely encountered in TGDCs approximately in 1.5% of patients. We present an interesting and rare case of elderly female who presented with an asymptomatic neck mass. CT scan of neck with contrast showed lobulated vascular enhancing mass 3.1 cm in size with no signifi cant lymphadenopathy. Fine needle aspiration of neck mass revealed papillary carcinoma. She underwent Sistrunk procedure with total thyroidectomy and central neck dissection followed by radioactive iodine (RAI) and thyroid hormone suppression. Since the incidence of TGDC carcinoma is low, controversy exists in its management in relation to type and the extent of surgery and use of RAI.

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Management of Well-Differentiated Thyroglossal Remnant Thyroid Carcinoma: Time To Close the Debate? Report of Five New Cases and Proposal of a Definitive Algorithm for Treatment

Cited by 116 publications

References 28 publications

A Clinicopathologic Series of 685 Thyroglossal Duct Remnant Cysts

A Clinicopathologic Series of 685 Thyroglossal Duct Remnant Cysts

Papillary Carcinoma Thyroid in a Thyroglossal Cyst

Dilemma in Managing Thyroglossal Duct Cyst Carcinoma

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