Carcinoma arising in median ectopic thyroid (including thyroglossal duct tissue)

Thyroglossal duct cyst with papillary carcinoma: what must be done?

OBJECTIVE

To present a report series of five cases, compare their clinical evolution, and establish the appropriate treatment.

METHODS

A retrospective study was performed with the clinical records from three health institutions in Mexico City, Mexico, in order to search for patients with histologic diagnosis of thyroglossal duct carcinoma and were classified by different risk stratifications to compare their outcome.

RESULTS

We found five patients, three females and two males, mean age 49 years. Four were treated by Sistrunk's procedure, total thyroidectomy, radioiodine ablation, and thyroxine suppression; one patient underwent Sistrunk's procedure only. Four patients were classified in the low- and median-risk group and had good outcome; one patient was in the high-risk group and had poor outcome.

CONCLUSIONS

The thyroglossal duct cyst must be studied in the adult population through fine-needle aspiration biopsy (FNAB) and a frozen section in cases in which FNAB is inconclusive or unavailable. When a diagnosis of a thyroglossal cyst carcinoma is made, an evaluation of the thyroid gland during surgery must be done as well as a careful examination to identify suspicious lymph nodes and neck dissection should be reserved for confirmed adenopathies. When an thyroglossal duct cyst has been excised using Sistrunk's procedure and the definitive histologic analysis reports malignancy, the thyroid gland must be studied. The extension of the surgery must be handled according to the criteria established for differentiated thyroid cancer.

Thyroglossal duct carcinoma

PURPOSE OF REVIEW

The purpose of this paper is to review the presentation and management of thyroglossal duct carcinoma.

RECENT FINDINGS

Recent articles have analyzed the value of preoperative investigation and have addressed some of the controversies in the management of such tumors; in particular, the optimal surgical management of the thyroid gland, as well as optimal management of lymph node metastases, the role of thyroid suppression therapy, and radioactive iodine therapy.

SUMMARY

Thyroglossal duct carcinoma is uncommon, occurring in approximately 1% of all thyroglossal duct cysts. It is often diagnosed incidentally after surgical excision. Ninety-four percent of carcinomas are of thyroid origin, with most being papillary in nature, and 6% are of squamous cell origin. 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. Those patients with more advanced disease require more aggressive treatment. This may include a total thyroidectomy with or without neck dissection in addition to the Sistrunk operation, followed by radioactive iodine therapy and thyroid-stimulating hormone suppression. The prognosis is generally excellent with adequately treated disease.

Extent of surgery in thyroglossal duct carcinoma: reflections on a series of eighteen cases

The occurrence of carcinoma of the thyroglossal duct remnant (TDRCa) is reported to be less than 1%. We retrospectively analyzed 18 cases (14 females, 4 males; mean age, 38.17 years) of TDRCa who underwent surgery in our department, to evaluate the correct workup for diagnosis and treatment. Nine patients underwent a total thyroidectomy and a Sistrunk procedure (SP) whereas 8 underwent a completion total thyroidectomy after a postoperative diagnosis of TDRCa. One patient was diagnosed with TDRCa several years after total thyroidectomy for goiter. Postoperatively all patients were given radioiodide and levothyroxine therapy. Mean follow-up was 85 months. No patient died of tumor-related disease. Thyroglossal duct neoplasms were represented by papillary carcinoma in 16 cases; thyroid histology demonstrated papillary carcinoma in 6 cases (33.3%). Three patients demonstrated single regional node metastasis and only one of them demonstrated the presence of malignant thyroid disease. When clinical diagnosis of thyroglossal duct cyst is made, the workup should be completed by ultrasound (US) scan and fine-needle aspiration cytology (FNAC) in order to plan the correct surgery for a possible TDRCa. Total thyroidectomy should always be considered with SP to permit the correct treatment and follow-up in those patients. Long-term survival of patients with cTDRCa is excellent.

Papillary carcinoma arising in lingual thyroid

Lingual thyroid is a well-known developmental abnormality, malignant transformation of which is rare. This is a case report of a papillary carcinoma located in ectopic lingual thyroid tissue, in a 28-year-old white male. A search of the literature revealed only one more such report.

Three cases of papillary carcinoma and three of adenoma in thyroglossal duct cysts: clinical-diagnostic comparison with benign thyroglossal duct cysts

The clinical and diagnostic findings of 3 cases of papillary thyroid carcinoma in thyroglossal duct cyst (TDC) were compared to those of 3 cases of adenoma in TDC and 2 cases of benign TDC. The neck masses of the subjects with benign TDC grew slowly, whereas those of 2 patients with papillary carcinoma and 1 of the patients with adenoma grew rapidly (especially those with carcinoma). On the other hand, one case of carcinoma, and two cases of adenoma in TDC were diagnosed incidentally. Benign TDC had an anechoic pattern at US, whereas the cysts containing carcinoma and adenoma showed the presence of a mural nodule at US. Microcalcifications in the mural mass were present in one patient with carcinoma. The 3 patients with carcinoma in TDC underwent total thyroidectomy. The histology was negative in all 3 patients for thyroid cancer and thyroid nodules. However, in 2 of them it revealed the carcinoma invading the cyst wall and adjacent tissues, 1 of which also exhibited 2 metastatic lymph nodes in the central neck area. The cases reported illustrate the utility of enhancing one's clinical suspicion of carcinoma in patients bearing TDC, even when incidentally discovered. In particular, rapid growth of the cystic mass, and the presence of a mural nodule on US, especially with calcifications, must raise the physician's suspicion for a cancer arising in TDC.

Management of well-differentiated thyroid carcinoma presenting within a thyroglossal duct cyst

BACKGROUND AND OBJECTIVE

Well-differentiated thyroid carcinoma (WDTC) is diagnosed in approximately 1.5% of thyroglossal duct cysts (TGDC). No clear consensus exists regarding further management after adequate excision of the cyst, especially the role of total thyroidectomy and postoperative radioactive iodine therapy. The current review was undertaken in an attempt to clarify these issues.

METHODS

Demographic, clinical, tumor, treatment, pathology, and outcome data on 57 eligible patients reported in recent literature were pooled together with 5 patients treated at our institution for this analysis.

RESULTS

A Sistrunk operation was performed for resection of the thyroglossal duct cyst in the majority (90%) of patients. Histologic examination of the tumor in the cyst revealed that papillary carcinoma was the most frequent (92%) histologic type. A total thyroidectomy was performed consequent to the diagnosis of thyroglossal duct cyst carcinoma in approximately half of the 62 patients. A malignant tumor was reported in 27% of the thyroidectomy specimens. Postoperative radioactive iodine therapy was administered in 16 (26%) patients. With a median follow-up of 71 months (range 1-456 months), the 5- and 10-year Kaplan-Meier overall survival was 100 and 95.6%, respectively. There were no disease-related deaths reported in any of the patients. Univariate analysis revealed that the only significant predictor of overall survival was the extent of primary surgery for the thyroglossal cyst. The addition of total thyroidectomy to Sistrunk operation did not have a significant impact on outcome (P = 0.1). Patients treated with postoperative radioactive iodine (RAI) fared significantly worse than those that did not need RAI, which may be explained by the fact that this modality would generally be used in patients with higher risk tumors.

CONCLUSIONS

The Sistrunk operation is adequate for most patients with incidentally diagnosed TGDC carcinoma in the presence of a clinically and radiologically normal thyroid gland. Results of adequate excision using the Sistrunk operation are excellent and the concept of risk-groups should be used to identify patients, who would benefit from more aggressive treatment.

Lingual thyroid carcinoma: a case report and review of the literature

Ectopic thyroid tissue may reside anywhere along its embryologic path of descent. Most ectopias manifest as simple thyroglossal duct cysts in conjunction with a normally developed thyroid gland in its usual thyroid cervical bed. Lingual thyroid is a rare developmental abnormality characterized by the failure of the thyroid gland, or remnants, to descend from its embryologic site of origin at the foramen cecum to its usual pretracheal position. Carcinoma arising in a lingual thyroid is even more unusual with fewer than 30 cases reported in the literature. We report the second case of lingual papillary thyroid carcinoma and review the clinical features, natural history, diagnosis, and treatment of lingual thyroid carcinoma.

Papillary carcinoma in thyroglossal duct cyst

OBJECTIVE

To report the management and outcome of three cases of papillary carcinoma (PC) in thyroglossal duct cysts (TGCs).

METHODS

We present case reports of one female and two male patients between the ages of 22 and 46 years who had TGCs. In addition, we discuss the theories about the pathogenesis of TGC carcinoma (de novo versus metastatic lesions).

RESULTS

In all three patients, we found a TGC that contained a vegetating mass. Subsequent pathologic examination revealed the presence of a PC. All patients underwent total thyroidectomy, and two of them concurrently had PC in the thyroid gland. Besides the PC in the TGC, the first patient had a "cold" scintigraphic thyroid nodule that was also a PC, whereas the second patient had a thyroid microcarcinoma that had not been detected before surgical intervention. The third patient did not have carcinoma of the thyroid, but the histologic pattern of the gland resembled that observed in de Quervain's disease. We interpreted this finding as "palpation thyroiditis." The patients received postoperative 131I and suppressive therapy with levothyroxine. During a follow-up period of 2 to 12 years (mean, 5.8), we found no recurrence of the disease, and serum thyroglobulin remained undetectable in all cases.

CONCLUSION

Although use of total thyroidectomy followed by radioiodine therapy and suppressive treatment with levothyroxine is a matter of debate in patients with PC in TGCs, we conclude that this approach yields a favorable outcome in most cases, especially when the thyroid is also involved by the PC, and allows a better postoperative follow-up.

Papillary carcinoma in a thyroglossal cyst: report of a case and review of literature

A 29-years old male presenting with a midline neck swelling four centimetres in diameter of one years duration was diagnosed to have a thyroglossal cyst. He underwent a Sistrunk's operation. Histological examination of the specimen revealed a papillary thyroid carcinoma limited to the cyst wall. The thyroid scan was normal indicating no further need for surgery. The patient has been on suppressive therapy with thyroxin for one year and is currently disease-free. A review of literature is also presented.

Thyroid papillary carcinoma arising in ectopic thyroid tissue within a branchial cleft cyst

A case of papillary carcinoma arising in ectopic thyroid tissue within a branchial cleft cyst is described. A 46-year-old woman presented with a 2.0 x 2.0 cm mass in her left lateral neck. The excised mass showed a cystic lesion with a thyroid papillary carcinoma. Following a lateral cervical cystectomy, subsequent thyroid gland and lymph nodes dissections were performed. Pathological examination showed an adenomatous goiter and no primary carcinoma in the thyroid gland, as well as metastatic papillary carcinoma in the lymph nodes. Two cases of thyroid papillary carcinoma arising in ectopic thyroid tissue within a branchial cyst have been reported previously, but no lymph node metastases were recognized. The first case of papillary carcinoma arising in ectopic thyroid tissue within a branchial cleft cyst, and accompanied by lymph node metastasis is presented.

Congenital cystic masses of the neck: radiologic-pathologic correlation

Cervical congenital cystic masses constitute an uncommon group of lesions usually diagnosed in infancy and childhood. The most common congenital neck mass is the thyroglossal duct cyst. The diagnosis is easily established from the presence of a cystic lesion in the anterior midline portion of the neck. The vast majority of branchial cleft cysts arise from the second branchial cleft. They can occur anywhere from the oropharyngeal tonsillar fossa to the supraclavicular region of the neck. Cystic hygroma is the most common form of lymphangioma. In the neck, cystic hygromas are most commonly found in the posterior cervical space. They typically extend into adjacent structures without respecting the fascial planes. Dermoid and epidermoid cysts result from sequestration of ectodermal tissue. The floor of the mouth is the most common location in the neck. Cervical thymic cysts are very uncommon lesions and are found anywhere from the angle of the mandible down to the sternum. Laryngoceles are classified into internal, external, and mixed types and have a frequent association with laryngeal carcinoma.

Thyroglossal duct carcinoma: presentation and management, including eight cases reports

Although thyroglossal duct cysts represent a common developmental abnormality of the thyroid gland, malignant transformation is rare and occurs in only 1%. This article describes eight patients who were referred to the Royal Marsden Hospital between 1956 and 1991. There were five males and three females, aged from 14 to 71 years (mean 44.6). There were seven papillary carcinomas and one follicular carcinoma. Patients were followed for between 6 and 41 years (mean 16.5). Management comprised: surgical excision only in four patients; surgical excision plus thyroidectomy followed by radioiodine in three; and radioiodine following only biopsy in one patient with lingual thyroid carcinoma. Multifocal carcinoma of the thyroid was found in one patient and a single focus of carcinoma in the thyroid gland in another; lymph node metastases were found in only one patient. There was no history of previous exposure to ionizing radiation.

Thyroglossal duct carcinoma: a rational approach to management

OBJECTIVE

To discuss the authors' experience with thyroglossal duct carcinoma and present a rational approach to the management of this entity.

STUDY DESIGN AND METHODS

A retrospective review of the cytopathology and pathology records of all patients with the diagnosis of a thyroglossal duct remnant from 1965 to 1997 was performed.

RESULTS

Three cases of papillary thyroglossal duct carcinoma were identified, with one suspected squamous cell carcinoma by needle aspiration. The papillary carcinomas are discussed in detail to illustrate the difficulty encountered in managing the thyroid gland in the setting of a thyroglossal duct carcinoma. Fine-needle aspiration proved effective in making the diagnosis preoperatively.

CONCLUSIONS

The authors recommend that a thyroglossal duct cyst with a microscopic focus of papillary carcinoma, without cyst wall invasion, be managed with a Sistrunk procedure. Treatment of all other thyroglossal duct papillary carcinomas should include removal of all thyroid tissue followed by radioactive iodine treatment.

Thyroglossal duct cyst with papillary carcinoma in an 11-year-old girl

A case of primary papillary carcinoma arising in a thyroglossal duct cyst is reported in a young girl. This is a rare finding, with only five pediatric cases in the total of 115 cases reported in the literature. Subsequent management is described, including the role of scintigraphy and radioiodine ablation.

Squamous cell carcinoma arising from thyroglossal duct remnants: report of a case and results of immunohistochemical studies

We report on the case of a 57-year-old male found to have squamous cell carcinoma (SCC) arising from thyroglossal duct remnants. The patient presented with an asymptomatic tumor in his anterior neck which was immovable on palpation. Aspiration biopsy cytology revealed class V malignancy with many atypical clusters and marked keratinization. After preoperative radiation, a radical operation employing Sistrunk's procedure with bilateral neck dissection was performed. Histopathological examination confirmed a diagnosis of moderately differentiated SCC, but revealed ciliated columnar epithelium in the walls of the cyst without a normal layer of squamous cells. Furthermore, immunohistochemical studies demonstrated the tumor to be negative for thyroglobulin staining, but positive for cytokeratin and carcinoembryonic antigen. These histopathological findings proved attributable to squamous metaplasia occurring in the ciliated columnar epithelium of the thyroglossal duct. Thus, SCC might originate in the metaplastic portion of the thyroglossal duct remnants. Although the prognosis associated with SCC in the thyroglossal duct is not as optimistic as that associated with papillary carcinoma, no evidence of recurrence has been observed in this patient in the 7 years since his operation. This suggests the effectiveness of our therapeutic approach for this unusual disease.

Thyroglossal duct carcinoma: a case report

We describe a 47-year-old woman with a 13-year history of asymptomatic midline submental swelling. Cytologic examination of a fine-needle aspiration specimen from the solid mass revealed adenocarcinoma. The preoperative diagnosis was thyroglossal duct carcinoma. A Sistrunk procedure was performed and microscopic examination revealed papillary adenocarcinoma. The postoperative course was uneventful and there were no signs of local recurrence or metastasis at one year after surgery.

Follicular carcinoma in lingual thyroid presenting as a latero-cervical mass. Case report and review of the literature

A follicular carcinoma arising in a lingual thyroid and presenting as a submandibular mass is reported. The tumor showed a mixture of solid sheets of follicular cells and well-formed follicles displaying variable levels of cytological atypia. True vascular invasion was confirmed. To the best of our knowledge, this is the first example of carcinoma arising in lingual thyroid that presented as a latero-cervical mass.

Thyroid gland ectopias

Failures of descent of the medial anlage of the thyroid and incomplete obliteration of its vertical tract lead to midline or near-midline ectopias such as lingual thyroid and thyroglossal cysts. Each poses special diagnostic and therapeutic considerations. "Ectopias" of the thyroid gland lateral to the carotid artery and jugular vein, however, cannot be readily explained by current embryological information. In these instances, and especially for intranodal thyroid tissue, a metastasis from an occult thyroid primary is the mandatory first consideration.

A case report of occult thyroglossal duct carcinoma

A 50-year-old male had an occult thyroglossal duct carcinoma in the thyroglossal duct remnant attached to the upper pole of a thyroglossal duct cyst which was noticed due to extravasation of the cyst. After the patient had been struck into the thyroid cartilage with the tip of a bamboo sword while practicing Japanese fencing. The authors emphasize again that the important matter in the treatment of thyroglossal duct cysts is the removal of the whole thyroglossal duct remnant with the central portion of the hyoid bone according to Sistrunk's method in order to prevent not only recurrence of the thyroglossal duct cyst but also not to overlook any microcarcinoma.

Papillary carcinoma arising in a thyroglossal duct cyst: a case report and literature review

Papillary carcinoma arising in a thyroglossal duct cyst is a rare finding. Less than 100 cases have been reported in the English literature. In most cases the diagnosis is only established after excision of a clinically benign thyroglossal duct cyst. The aetiology of such tumours is unclear but de novo origin and spread from a primary thyroid gland tumour has been suggested. This has important implications for therapeutic approaches. A further case of thyroglossal duct carcinoma is presented and the management is discussed on the basis of the current rationale for treatment of thyroid cancer.

Squamous cell carcinoma in thyroglossal duct cyst

Although a thyroglossal duct cyst (TDC) is a common cyst occurring in the neck, carcinomas arising in the TDC are a rare event. To date, approximately 100 cases have been reported, the majority of them being papillary carcinomas. Squamous cell carcinomas (SCC) are very rare, and only nine cases have been reported so far in the literature. We present a 55-year-old female patient with a SCC in a TDC to highlight the clinical and pathological features of this condition.

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.

Carcinoma arising in thyroglossal remnants

Three patients with a papillary carcinoma arising in a thyroglossal duct cyst are presented and the literature is reviewed. This rare malignancy is seen mostly in women between the ages of 20 and 50 years. The distribution of carcinoma subtypes differs from that of thyroid carcinomas and thyroglossal duct carcinoma is recognized as a primary tumour. The diagnosis is seldom made pre-operatively though especially in older patients with midline swellings in the neck the diagnosis should be considered. Sistrunk's operation is the treatment of choice. In this operation the cyst, the middle part of the hyoid bone and the thyroglossal duct are removed in continuity.

Primary papillary carcinoma of the thyroglossal duct: case report and review of the literature

Primary malignancies of the thyroglossal duct are rare. Around 150 cases are described in the world literature, most of them being papillary thyroid carcinomas. Other types of tumors are squamous cell carcinomas, mixed follicular-papillary carcinomas, or adenocarcinomas. Women are affected more often than men, the ratio being 2:1. Preoperative diagnosis of primary malignancies of the thyroglossal duct is uncommon. Initial treatment of primary malignancies of the thyroglossal duct is usually sufficiently done operatively by the so-called Sistrunk's procedure which, however, was first described in 1893 by Schlange. Some patients may need further treatment such as wider excision, thyroidectomy, radioiodine therapy, or neck dissection. In this report the case of a papillary carcinoma of the thyroglossal duct in a 63-year-old man is presented. It is intended to remind the reader of this pathology which is often forgotten because of its rarity. The problems that occur during the process of evaluation regarding ideal treatment of the individual case are discussed. The literature is reviewed.

Papillary carcinoma in a thyroglossal duct remnant with normal thyroid gland

Carcinoma in the thyroglossal duct remnant is relatively uncommon. Since the first report by Uchermann (1915), more than 150 cases of carcinoma have been reported, and the majority have been papillary thyroid carcinomas (Li Volsi et al., 1974; McNicol et al., 1988). In this report, we present a case of papillary carcinoma in the thyroglossal duct with a normal thyroid gland.

Papillary carcinoma arising from ectopic thyroid gland in the wall of a thyroglossal duct cyst

A young man operated on because of a thyroglossal duct cyst, developed papillary carcinoma four years later. There was no recurrence after the second surgery.

Carcinoma of the thyroglossal duct: case reports and a literature review

Carcinoma of the thyroglossal tract is a rare entity. Three patients with thyroglossal cyst carcinomas are presented and the features of the disease, as reported in the literature, are discussed. Epidemiologically, females are more often affected than males and the average age of the patients described lies in the fourth decade. The aetiology is obscure, although previous irradiation is a possible risk factor. Carcinoma of the thyroglossal tract should also be suspected in patients with irregular masses. Pre-operative evaluation may include a thyroid scan and fine needle aspiration cytological examination of the cyst fluid. These tests, if positive, may alter the basic approach of the Sistrunk procedure to encompass thyroidectomy or wider margins. Neck dissection is preferred for cervical nodal disease. Adjuvant radiotherapy or radio-iodine is added if indicated by the histology, and the patient receives suppressive thyroxine therapy thereafter.

Hürthle cell adenoma arising in a thyroglossal duct cyst

A 18-year-old black woman was initially seen with a 1-year history of a slowly enlarging midline neck mass. On physical examination this was consistent with a thyroglossal duct cyst. Histologic examination following a Sistrunk procedure revealed a Hürthle cell adenoma arising in a thyroglossal duct cyst. This is the second reported case of a Hürthle cell adenoma arising in a thyroglossal duct cyst. Neoplasms of thyroglossal duct cysts are reviewed.

Cytology of thyroglossal cyst papillary carcinoma

The cytologic and histologic features of two cases of carcinoma arising in thyroglossal cyst are reported. The carcinoma in both cases was papillary thyroid carcinoma. The aspirated cyst fluid in one case revealed only macrophages and benign squamous epithelial cells, while in the other case the cyst fluid showed cytologic features of papillary carcinoma including psammoma bodies and epithelial cells with papillary clustering, intranuclear cytoplasmic inclusions, and positive immunohistochemical reaction to thyroglobulin.

Follicular carcinoma with clear cell change arising in lingual thyroid

A case of follicular carcinoma arising in the lingual thyroid of a 23-year-old woman is added to the 22 previous reports. The embryology and the clinical and pathologic differential diagnoses are discussed. Histologic criteria useful in diagnosing follicular malignancy in this area include local and vascular invasiveness, hypercellularity, mitotic activity, and necrosis. The use of the immunohistochemical marker thyroglobulin and electron microscopy are described for the first time and confirm a thyroid follicular cell origin.

Papillary carcinoma arising in ectopic thyroid tissue within a branchial cyst

The first case of a papillary carcinoma arising in ectopic thyroid tissue within a branchial cyst in a 34 yr old woman is presented. This also adds to the existing list of unusual sites where ectopic thyroid tissue has been described. All histological types of carcinoma have been reported in ectopic thyroid tissue, papillary carcinoma being the most common histological type, accounting for 85% of these tumors. The criteria for establishing this diagnosis of carcinoma arising in ectopic thyroid tissue within branchial cyst is discussed.

Primary papillary carcinoma of a thyroglossal duct cyst: report of a case and literature review

Thyroglossal duct cysts are the most common anomaly in thyroid development. They are twice as frequent as branchial cleft abnormalities and, in children, are second only to enlarged cervical lymph nodes as the cause of neck mass. Generally, duct cysts are benign, but 1 per cent of cases may be malignant. From the world literature, 114 cases of malignant thyroglossal cysts were available for review. With the addition of our own case, we discuss 115 instances of duct cysts. The different types of neoplasia described included thyroid papillary carcinoma in 81.7 per cent, mixed papillary-follicular carcinoma in 6.9 per cent, squamous cell carcinoma in 5.2 per cent, follicular and adenocarcinoma in 1.7 per cent each, and malignant struma, epidermoid carcinoma and anaplastic carcinoma in 0.9 per cent each. Of the 115 cases surveyed, 35 thyroid glands were examined microscopically; of these, four (11.4 per cent) contained malignant foci. Whether these are primary malignancies of the thyroglossal duct cysts or metastases is discussed.

Adenocarcinoma arising in a thyroglossal duct cyst: report of a case and literature review

A case of thyroglossal duct cyst carcinoma is presented, and the previously reported cases are reviewed. The clinical features of these midline neck masses do not suggest the presence of a carcinoma which may be localized to a single area of the cyst wall. Therefore, submission of the complete surgical specimen for histologic examination is recommended even if frozen sections during surgery fail to reveal a carcinoma.

Common lumps and bumps of the head and neck in infants and children

The majority of lesions in the neck of children will prove to be benign and of congenital origin arising from such structures as the thyroglossal duct and the branchial clefts in addition to hemangiomas and lymphangiomas. However, it is essential that lymphadenopathy be proven infectious and any asymptomatic lymph node enlargement must be considered Hodgkin's disease until proven otherwise. The occasional neuroblastoma or rhabdomyosarcoma presenting in the neck can usually be identified as solid by sonography, leading to early investigation and biopsy. Because of the abundance of important structures that course through the neck, surgery should be conducted in an operating suite with sophisticated, modern anesthetic techniques and with a surgeon experienced in dealing with the full array of lesions that occur.

Papillary-follicular carcinoma arising in a thyroglossal duct cyst in a 12-year-old child

Carcinoma of a thyroglossal duct cyst is a rare occurrence, first reported by Ucherman in 1910. Less than 100 cases have been reported. most cases have been papillary carcinoma. We report the uncommon occurrence of a mixed papillary-follicular carcinoma in thyroglossal duct cyst in a 12-year-old girl. The controversy regarding surgical management is reviewed.

Ectopic thyroid malignancy in the midline of the neck (a case report and literature review)

A 71-year-old female presented with a midline neck mass. The clinical impression was that of a thyroglossal cyst but preoperative assessment suggested a solid lesion, possibly malignant. The mass was removed surgically using the Sistrunk technique and shown pathologically to be a mixed papillary-follicular carcinoma of the thyroid with no cystic elements. Clinically and radiologically the thyroid was normal and thyroidectomy was not performed. This management is discussed along with a brief review of the relevant literature on the pathology and treatment of similar lesions.

Intratracheal thyroid

A case of intratracheal ectopic thyroid tissue in the absence of clinical symptoms is described. It was an incidental finding observed at autopsy.