Utilization of three-dimensional computed tomography for papillary thyroid carcinoma arising in the thyroglossal duct remnant: Report of a case

Abstract

This report presents a rare and interesting case of papillary thyroid carcinoma arising in a thyroglossal duct remnant (TDR) that was diagnosed by three-dimensional computed tomography (3DCT). The patient, a 61-year-old woman, presented with a painless mass in the anterior suprahyoid region that had gradually enlarged over a 2-year period. Three-dimensional CT successfully revealed the thyroglossal duct (TD) descending from the tumor to the isthmus of the thyroid. An ultrasonography-guided fine-needle aspiration biopsy of the tumor was positive for carcinoma. A total thyroidectomy was performed in addition to the Sistrunk procedure. The histological findings indicated papillary thyroid carcinoma arising in the TDR and thyroid papillary microcarcinoma in the left thyroid lobe. The patient underwent radioactive iodine ablation and thyroid suppression therapy. This is apparently the first reported case of papillary thyroid carcinoma arising in a TDR evaluated using 3DCT. Three-dimensional CT was able to clarify the relative locations of the tumor, TD, and thyroid in the present case, and visualization of the TD allowed a definitive preoperative diagnosis that would not otherwise have been possible using conventional imaging techniques. This case suggests that 3DCT may therefore play an important role in providing definitive information on patients with anterior neck masses that are difficult to diagnose.

Two separate tumours—Concomitant papillary carcinoma in thyroglossal duct cyst and right thyroid lobe: Case report and review of the literature

“…CT of the neck is not standard at our institution for uncomplicated cases, and is undertaken in suspected cases as mentioned above. This is in line with the literature, as Table 1 shows that within the published cases, US scan was undertaken for 4 out of the 5 cases including the current case [ 13 , 14 , 18 ], while CT of the neck was done in a minority (2 out of 5) of cases [ 14 , 19 ]. FNAC or core needle biopsy are safe, well-tolerated, and cost-effective for diagnosing thyroglossal duct lesions and are recommended [ 11 ].…”

“…Table 1 shows that the current patient was the youngest in the reported cases of concomitant TGDC carcinoma and thyroid carcinoma. The female gender of our patient also supports the fact that more females are affected with TGDC carcinoma than males [ 10 ], and our review ( Table 1 ) illustrates that concomitant papillary carcinoma in TGDC and in the thyroid could be twice more likely among females than males [ 13 , 14 ]. In addition, our patient was from the Philippines, where Filipinos are known to have higher prevalence of thyroid cancers that display more aggressive behaviour [ 15 ].…”

“…Some surgeons recommend that total thyroidectomy should be performed in all cases of TGDC carcinoma [ 7 ], because of the high incidence of the presence of concomitant thyroid malignancy in the main thyroid gland as a pathophysiology; or to facilitate radioactive iodine therapy and adjuvant treatment therapy [ 2 ]. Table 1 shows a case treated by Sistrunk’s operation as the primary surgery, and then after the histopathology results, the patient underwent secondary total thyroidectomy [ 13 ], compared with the rest of the cases in Table 1 that underwent total thyroidectomy in addition with compartmental dissection [ 14 , 18 , 19 ]. In our patient, despite her low risk (young patient, no past medical illnesses, no family history), a high measure of care was taken (Sistrunk's operation and total thyroidectomy undertaken together) because of the potential high risk of thyroid malignancy among individuals from the Philippines [ 15 ], and the possibility of carcinoma arising in the identified thyroid nodule.…”

Internal Spreading of Papillary Thyroid Carcinoma: A Case Report and Systemic Review

“…US is the common method for thyroid cancer diagnosis with high sensitivity within 1 mm. CT is a useful complement for US in judging the invasion of adjacent tissues, and the involved lymph node in some areas [ 9 – 11 ]. Why were the multiple low-density tubercle shadows found by CT but not by US in our case?…”

Papillary thyroid carcinoma arising from a thyroglossal duct cyst

“…[2,15] Ogawa et al, have suggested a possible utilization of three-dimensional CT in providing accurate pre-operative diagnosis of papillary thyroid carcinoma in a TGDC. [16] The diagnosis, however, is often made postoperatively on pathological examination of the resected specimen. The common surgical procedure used for a TGDC is Sistrunk procedure.…”