Primary papillary carcinoma in thyroglossal cysts. Case reports and literature review

Papillary Carcinoma Within Thyroglossal Duct Cyst: A Rare Midline Coexistence

Thyroglossal duct cysts (TDCs) develop papillary carcinomas in very rare cases. Mostly, in such cases, the diagnosis is established after the excision of a clinically benign TDC. An anterior neck mass was found in a 43-year-old man with papillary carcinoma arising in a TDC. Clinical, radiological, and analytical controls are necessary for the management of papillary carcinoma in the TDC. There is no need for thyroidectomy unless there are palpable abnormalities in the gland or significant changes on an ultrasound. The outcome of the papillary carcinoma does not seem to be significantly impacted by routinely performed thyroidectomy.

Papillary thyroid carcinoma from a thyroglossal cyst: case series

Papillary carcinoma originating from a thyroglossal cyst represents an infrequent finding, which occurs in ~1% of cases of thyroglossal cyst and its presentation is usually the same as that of a benign cyst, which represents the most frequent benign congenital lesion of the neck. The diagnosis is usually presented as a finding on the histopathological examination. Two cases of a thyroglossal cyst with later development of malignancy are presented. The first, a 30-year-old female, and the second, a 32-year-old male. Both began their condition after presenting an increase in volume in the neck, the female presented a right sub-mental triangle of 1 year of evolution, and the male on the anterior side of the neck. In both cases, the diagnosis of thyroglossal cyst was made by the physical examination and findings of cervical ultrasound and computed axial tomography. Surgical management consisted of the Sistrunk procedure with a definitive histopathological result for papillary thyroid carcinoma originating from thyroglossal cyst. In the case of the male patient, the Sistrunk procedure was performed along a total thyroidectomy, although in the female patient, a total thyroidectomy was performed in a second stage. Patients were then discharged and referred to the endocrinology service for further medical treatment. The management of these cases continues to be controversial due to the limited number of reported cases, so the multidisciplinary management and individualization of each case plays a fundamental role in the management of this rare condition.

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

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Thyroglossal duct cyst carcinoma concurrent with another thyroid gland carcinoma as two separate tumours are rare.

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Ultrasound scan and ultrasound-guided fine needle aspiration and cytology are useful for diagnosis and for follow up.

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Excision of thyroglossal duct cyst carcinoma and total thyroidectomy is ideal treatment option to facilitate future radioactive iodine ablation if required.

Introduction

Malignancy of thyroglossal duct cyst (TGDC) is rare, usually as papillary carcinoma, and less frequently as squamous cell or follicular carcinoma. TGDC carcinoma can present as a mass arising from the neck, with or without compression symptoms. Papillary carcinoma in TGDC concomitant with another papillary carcinoma in the thyroid gland is extremely rare.

Presentation of case

: 31 years old female with a neck lump since 2 years, slowly increasing in size, with mild pain while drinking fluids, and no change of voice. No past history of neck irradiation or family history of thyroid cancers. Ultrasonography of the neck showed TGDC and right thyroid nodule. Ultrasound guided fine needle aspiration and cytology of the TGDC showed TGDC papillary carcinoma. The patient underwent Sistrunk’s procedure and total thyroidectomy.

Discussion

Rare case of classic papillary carcinoma arising in TGDC, concomitant with another papillary carcinoma in the right thyroid nodule. Preoperative work up included US and fine needle aspiration and cytology (FNAC). Post-operative histopathology showed papillary carcinoma in the TGDC; and another in the right thyroid lobe that was a papillary carcinoma with follicular patterns.

Conclusions

TGDC carcinoma concurrent with another carcinoma in the right thyroid lobe as two separate tumours are extremely rare. All patients should undergo Sistrunk’s procedure, and total thyroidectomy for the thyroid tumour. Follow-up requires thyroxine replacement therapy to treat hypothyroidism and to suppress TSH in order to prevent recurrence; and neck ultrasound and thyroglobulin tumour marker to detect recurrence if present.

Follicular thyroid carcinoma within a thyroglossal duct cyst in adult

Thyroglossal duct cyst carcinoma is a rare malignancy, with an incidence of 0.7% to 1.6%. Most cases of thyroglossal duct cyst carcinoma are papillary carcinoma, with follicular carcinoma having been rarely reported. In this study, a 33-year-old man presented with a typical thyroglossal duct cyst and underwent surgical resection of the cyst, which was determined to be follicular carcinoma. We have reported this rare case to increase the awareness of such entities within the general otolaryngology and the community of head and neck surgeons, as well as among endocrine surgeons.

SIMILAR CASES PUBLISHED

10.

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

Patient: Female, 27

Final Diagnosis: Invasive thyroglossal duct cyst papillary carcinoma

Symptoms: Painless cervical enlargement

Medication: —

Clinical Procedure: Sistrunk’s procedure

Specialty: Surgery

Thyroglossal Duct Cyst Carcinomas in Pediatric Patients: Report of Two Cases with a Comprehensive Literature Review

Thyroglossal duct cyst (TGDC) carcinomas are rarely encountered in the pediatric population. The clinical behavior of these tumors in the pediatric setting is unclear and management is not well defined. Two cases of pediatric thyroglossal duct cyst carcinoma were identified in a review of all thyroglossal duct cysts diagnosed over a ten year period. These two cases were analyzed along with 57 cases of thyroglossal duct cyst carcinoma affecting patients less than 21 years of age compiled from the English literature. Fifty-nine patients (36 females, 23 males) aged 6-20 years (mean 15.0 years) were identified. All presented with an anterior midline neck mass, which was typically mobile and non-tender. The average tumor size was 2.6 cm. Histologically, all tumors were papillary thyroid carcinomas arising in a background of a thyroglossal duct cyst. The tumors exhibited a papillary, follicular, or mixed architecture with classical papillary thyroid carcinoma nuclear features. Soft tissue extension was present in 16 cases. All patients were managed surgically with a Sistrunk procedure, with additional thyroidectomy performed in 29 patients, combined with a lymph node dissection (n = 15), or a Sistrunk and lymph node dissection (n = 5). All patients were stage I at presentation, with 11 showing lymph node metastases. Postoperative radioactive iodine was employed in 20 patients. A papillary carcinoma of the thyroid gland was reported in four of the patients who had concurrent/subsequent thyroidectomies. Recurrences were reported in four patients, with distant metastases in one patient, who died of disease (13 months). Follow up data was available for 45 patients, with an overall mean follow-up of 54.5 months. All patients were alive, with the exception of one who died with disease. TGDC carcinomas in pediatric patients is associated with a good overall prognosis, best managed by Sistrunk procedure alone, with selected lymph node dissection if clinically indicated.

Thyroglossal Duct Cyst Carcinomas: A Clinicopathologic Series of 22 Cases with Staging Recommendations

Carcinomas arising from thyroglossal duct remnant cysts (TGDCs) are rare, without well-defined management and staging criteria. All TGDCs (n = 685) diagnosed between 2005 and 2015 were retrospectively reviewed, with 22 carcinomas identified (3.2 % incidence). Twenty-two patients (17 females, 5 males), aged 12-64 years (mean 39.9 years; median 39 years) were identified. An anterior, superior midline neck mass was the presenting symptom in all patients. A cancer diagnosis [all papillary thyroid carcinoma (PTC)] was made after the Sistrunk procedure (SP), with a Bethesda Category V or VI classification preoperatively by fine needle aspiration in 5 of 12 cases tested. A SP was performed in all patients, with total thyroidectomy concurrently (n = 4) or subsequently (n = 12). A selected neck dissection was performed in 5 patients, with metastases found in 3. Of the patients who had a thyroidectomy, synchronous PTC was identified in 6 (thus, 6 of 22 patients had synchronous thyroid gland primaries). This supports an origin from extra-thyroidal remnants (cyst origin) rather than metastatic tumor from a thyroid gland primary. Follow-up radioactive iodine therapy was performed in 13 patients. Metastatic disease to local lymph nodes 57 months after presentation was seen in 1 patient, with all others alive and disease free (mean 3.8 years; range 0.4-10.8 years). The TGDCs ranged from 0.8 to 5 cm (mean 2.3 cm), while the PTCs ranged from 0.1 to 3.8 cm (mean 1.4 cm). All of the tumors were classical PTC, showing a sclerotic and infiltrative pattern, with a capsule present in 11. Lymphovascular invasion was detected in 11; margins were positive in 6. Using currently defined criteria, the patients were separated into AJCC stage group I (n = 21) or II (n = 1). However, if extension into the adipose tissue (n = 11), skeletal muscle (n = 10), or perineural/perivascular tissues (n = 10) were used to stage the patients, interpreted to represent the equivalent of "extrathyroidal extension" (n = 13) as defined for thyroid gland primaries, there would be 15 group I and 7 group III cases. All seven group III patients were ≥45 years. Three of four patients with lymph node metastasis also showed soft tissue extension. In conclusion, TGDC carcinomas (TGDCCa) are uncommon, with all classical PTC. For "microcarcinomas" (≤1 cm), conservative management can be used for patients <45 years (i.e., Sistrunk procedure only); for >1 cm tumors, and due to the high incidence of concurrent papillary carcinoma and higher stage at presentation in older patients, completion thyroidectomy is recommended for patients ≥45 years. Thus, even though a good prognosis can be expected for PTC developing in TGDCs, staging is advocated to more appropriately match therapeutic interventions.