Papilläres Schilddrüsenkarzinom in einer medianen Halszyste

A rare presentation of ectopic thyroid tissue in the submandibular region: a case report

Ectopic thyroid tissue in the lateral neck is a rare finding, especially in the submandibular region. This case report presents a 38-year-old female patient with swelling in the lateral cervical neck. Due to a thyroid goitre, right hemithyroidectomy was performed in the past. However, a persistent high thyroglobulin level was detected after surgery. Regarding the suspected tumour in the submental region, a cervical magnetic resonance imaging (MRI) was performed, which revealed a suspicious looking mass. The patient underwent complete surgical excision and the histopathological report concluded that the tumour was ectopic thyroid tissue. Her thyroglobulin level decreased back to a normal level after excision of the submandibular mass. These results show that ectopic thyroid tissue must be considered a differential diagnosis for patients with unclear swelling in the submental region.

[Suspected rare manifestation of a thyroglossal and lateral cervical cyst-a diagnostic and therapeutic approach]

A 34-year-old female patient presented to our department with a 1.5 cm midline cystic lesion of the neck. A second cystic mass was found in level 2 of the left lateral neck. Following complete resection, histopathological examination revealed the diagnosis of a dystopic papillary thyroid carcinoma. Total thyroidectomy and bilateral neck dissection were performed. The patient developed transient postoperative hypoparathyroidism. The specimen showed four intraparenchymal parathyroid glands. Treatment with radioactive iodine was conducted.

Papillary-Type Carcinoma of the Thyroglossal Duct Cyst: The Case for Conservative Management

Objectives:

Thyroglossal duct cyst (TGDC) is the most common congenital neck mass, presenting in up to 7% of the population. TGDC carcinoma is much less common, occurring in roughly 1% of patients diagnosed with TGDC. The vast majority of these tumors are papillary-type thyroid cancer. Given its rarity, there is wide variation in management recommendations for this disease. Extent of surgical management and need for adjuvant therapy including radioactive iodine ablation (RAI) are particularly debated, with some authors arguing aggressive therapy including RAI for any patients who undergo concurrent thyroidectomy with the Sistrunk procedure for TGDC carcinoma. We present a series of patients treated for TGDC carcinoma at our institutions and discuss our management algorithm.

Methods:

This is a retrospective chart review of patients with TGDC treated at 2 separate institutions. Factors reviewed included patient age, sex, preoperative diagnosis, preoperative work-up, extent of therapy, and use of adjuvant therapy.

Results:

Six patients who were treated for TGDC carcinoma at our institutions were identified. One patient was excluded because the patient had been treated at an outside facility prior to referral. All patients had papillary-type thyroid cancer. One patient underwent the Sistrunk procedure alone, and the remaining 4 underwent the Sistrunk procedure plus total thyroidectomy. Two of 4 patients were noted to have malignancy in the thyroid. Two of 4 patients who underwent thyroidectomy additionally received adjuvant RAI.

Conclusion:

Thyroglossal duct cyst carcinoma is uncommon and management is controversial. In low-risk patients (single tumor focus, negative margins, normal preoperative neck/thyroid imaging, no extension of TGDC carcinoma beyond the cyst wall), the Sistrunk procedure alone with observation of the thyroid may be sufficient. In this patient population, RAI is unlikely to be of any substantial benefit.

Thyroglossal Duct Cyst Carcinoma: A Systematic Review of Clinical Features and Outcomes

Objective

Although thyroglossal duct cysts (TGDCs) are relatively common, malignancies within these lesions are infrequent. As a result, there are no large-scale series describing clinical characteristics. Our objectives were to perform a systematic review of the literature evaluating patient demographics, pathology, management, and prognosis of these patients.

Data Sources

PubMed, Embase, Cochrane reviews, and Google Scholar were searched for relevant articles. Articles meeting inclusion criteria were reviewed for data detailing epidemiology, treatment, and outcomes.

Review Methods

Inclusion criteria included English-language articles with original reports on human subjects. Two investigators independently reviewed all articles for the data collected, including epidemiology, treatment, and outcomes.

Results

Ninety-eight articles comprising 164 patients were included in the final analysis. The mean age at presentation was 39.5 years (9-83 years); 68.3% of patients were female. In total, 73.3% of cases were found on final pathologic analysis. The most common pathology was papillary cancer (92.1%). Of the patients, 98.9% underwent a Sistrunk procedure and 61.0% underwent total thyroidectomy. There was a 4.3% recurrence rate with a mean time to recurrence of 42.1 months from initial treatment. One patient died of TGDC carcinoma, while all other patients were disease free at the time of last follow-up (mean follow-up was 46.1 months).

Conclusion

TGDC carcinoma is typically diagnosed on final pathology. While management encompasses a Sistrunk procedure, further consideration should be given to thyroidectomy among patients ≥45 years of age and individuals with aggressive disease. TGDC carcinoma harbors an exceedingly low rate of mortality.