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Hou T, Liu Z, Gan Q, Debnam JM, Krishnamurthy S. Clinical and cytopathological features of suspected thyroglossal duct cysts and neoplasms arising from them: A large series from a referral cancer center. Cancer Cytopathol 2021; 130:72-79. [PMID: 34529338 DOI: 10.1002/cncy.22511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Thyroglossal duct cysts (TGDCs) are the most common congenital midline cystic lesions in the neck, and they are often evaluated by fine-needle aspiration. Recognizing the cytomorphologic features of TGDCs and their mimics is important for clinical management. METHODS This study examined the clinical, radiological, and cytopathological features of 86 ultrasonography-guided fine-needle aspiration (US-FNA) specimens from clinically suspected TGDCs or malignancies arising from TGDCs and correlated the findings with surgical follow-up and/or imaging studies. RESULTS According to ultrasound examinations of 66 lesions, 17 (25.8%) were cystic, 8 (12.1%) were cystic with septations, 21 (31.8%) were cystic with solid nodules, and 20 (30.3%) were solid or cystic with internal debris. Cytopathologically, 81 lesions (94%) were categorized as benign, 2 (2%) were categorized as atypical, and 3 (3%) were categorized as malignant. In benign lesions, proteinaceous material (63%), histiocytes (63%), colloid (37%), squamous cells (35%), columnar cells (32%), follicular cells (15%), inflammatory cells (9%), and multinucleated giant cells (9%) were noted. Diagnoses in the benign category included TGDC in 64 patients (75%), TGDC or mimics (colloid nodule/epidermoid cyst) in 14 patients (17%), a colloid nodule in 1 patient, and thyroiditis in 1 patient. Surgical resection, performed in 23 patients, confirmed TGDCs in 12, benign mimics in 7, and carcinoma in 4. CONCLUSIONS Cytopathological features, in conjunction with imaging, allowed a definite diagnosis of TGDC in most patients (75%). The presence of mature squamous cells, thyroid follicular cells, with or without colloid and/or lymphocytes alone allowed a differential diagnosis of TGDC and its mimics in 17%. US-FNA findings could not distinguish primary carcinomas arising from TGDCs from metastatic tumors.
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Affiliation(s)
- Tieying Hou
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zhonghua Liu
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Qiong Gan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J Matthew Debnam
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Savitri Krishnamurthy
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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2
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Papillary carcinoma of the thyroglossal duct cyst: Is thyroidectomy necessary? JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.755373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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3
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Han ZN, Liu Z, Wang J. Impact of thyroid ultrasonography combined ultrasound-guided fine-needle aspiration biopsy in detection thyroid microcarcinoma: A protocol of systematic review. Medicine (Baltimore) 2020; 99:e21712. [PMID: 32872050 PMCID: PMC7437749 DOI: 10.1097/md.0000000000021712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study aims to explore the accuracy of thyroid ultrasonography (TUS) combined ultrasound-guided fine-needle aspiration biopsy (UGFNAB) for detection of thyroid microcarcinoma (TMC). METHODS A comprehensive search in PUBMED, EMBASE, Cochrane Library, Web of Science, Scopus, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from the beginning to the June 1, 2020 without language and publication status limitations. Two authors will independently perform articles identification, data extraction and assessment of study quality. Any disagreements will be resolved by discussion with a third author. We will carry out study quality evaluation using Quality Assessment of Diagnostic Accuracy Studies tool, and will employ statistical analysis using RevMan V.5.3 and Stata V.12.0 softwares. RESULTS We will summarize current evidence to investigate the accuracy of TUS combined UGFNAB in detection of TMC. CONCLUSION The findings of this study may provide helpful evidence of TUS combined UGFNAB in detection of TMC. STUDY REGISTRATION INPLASY202070048.
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Affiliation(s)
- Zhuan-Ning Han
- Department of Ultrasound, The Second Affiliated Hospital of Xi’an Medical College, Xi’an
| | | | - Jing Wang
- Department of Endocrine and Metabolism, Yanan University Affiliated Hospital, Yan’an, China
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4
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Thyroglossal Duct Carcinoma Originating in the Hyoid Bone. Case Rep Radiol 2019; 2019:3067346. [PMID: 31355039 PMCID: PMC6633968 DOI: 10.1155/2019/3067346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 06/10/2019] [Indexed: 11/17/2022] Open
Abstract
Thyroglossal duct (TGD) carcinoma is a rare malignant tumor arising from remnants of thyroid tissue or the wall of the duct and generally occurs along the anatomic course of the TGD. TGD carcinoma originating in the hyoid bone is extremely rare but can occur since the TGD penetrates the hyoid bone on rare occasions. This report describes the case of a 30-year-old man with TGD carcinoma originating in the hyoid bone. Computed tomography demonstrated a mass in the hyoid bone that expanded the cortical bone of the hyoid. The mass had a central solid component with calcification and a marginal cystic component. When we encounter a calcified mass in the hyoid bone, we should consider TGD carcinoma among the differential diagnoses.
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Verma R, Patro SK, Damodharan N, Sood A, Bal A. Papillary carcinoma thyroid in a thyroglossal cyst: A management dilemma. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2017. [DOI: 10.1080/23772484.2016.1270166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Roshan Verma
- Department of Otolaryngology, Head and Neck surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sourabha Kumar Patro
- Department of Otolaryngology, Head and Neck surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Niveditha Damodharan
- Department of Otolaryngology, Head and Neck surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashwini Sood
- Nuclear medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Thyroglossal Duct Cyst Carcinomas: A Clinicopathologic Series of 22 Cases with Staging Recommendations. Head Neck Pathol 2016; 11:175-185. [PMID: 27704385 PMCID: PMC5429280 DOI: 10.1007/s12105-016-0757-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 09/21/2016] [Indexed: 10/20/2022]
Abstract
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.
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7
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Abstract
Thyroglossal duct cyst is a frequent event; however, papillary carcinoma within a thyroglossal duct cyst is rare, particularly in children. A 17-year-old girl presented with an asymptomatic mid-submental mass for the last 2 months. The diagnosis of thyroglossal duct cyst was made based on physical examination and computed tomography finding. After performance of Sistrunk procedure, an incidental papillary carcinoma within the thyroglossal duct cyst was observed on pathology. We reviewed the pediatric cases of thyroglossal duct carcinoma, and then decided not to perform a concurrent thyroidectomy. We will continue close follow-up for future thyroid involvement.
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AIUM practice guideline for the performance of ultrasound examinations of the head and neck. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:366-382. [PMID: 24449746 DOI: 10.7863/ultra.33.2.366] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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9
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Pfeiffer MS, Kim GH, Krishnan M. Thyroglossal duct papillary carcinoma in a 15-year old female and review of pediatric cases of thyroglossal duct carcinoma. Int J Pediatr Otorhinolaryngol 2014; 78:135-8. [PMID: 24238995 DOI: 10.1016/j.ijporl.2013.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 10/16/2013] [Accepted: 10/19/2013] [Indexed: 11/17/2022]
Abstract
Thyroglossal duct carcinoma is rare, occurring in approximately 1% of thyroglossal duct cysts. Excluding this case report there have been 25 cases of adolescent thyroglossal duct carcinoma reported in the English literature thus far. Most of the pathology reported has been papillary or follicular carcinoma, leading to the question of whether or not to perform concurrent thyroidectomy. Based on our review of the pediatric cases of thyroglossal duct carcinoma we elected not to perform a concurrent thyroidectomy and recommend close follow-up to monitor for signs of future thyroid involvement.
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Affiliation(s)
- Michael S Pfeiffer
- Department of Otolaryngology - Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, PA, USA.
| | - Grace H Kim
- Department of Otolaryngology - Head and Neck Surgery, Loma Linda University School of Medicine, 11234 Anderson Street, Loma Linda, CA 92354, USA.
| | - Miguel Krishnan
- Department of Otolaryngology - Head and Neck Surgery, Loma Linda University School of Medicine, 11234 Anderson Street, Loma Linda, CA 92354, USA.
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10
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Hakeem AH, Hakeem IH, Pradhan SA, Hathiram B, Khattar VS. Papillary carcinoma in a thyroglossal duct cyst with concurrent thyroid micro-carcinoma and neck nodal metastases. Indian J Surg Oncol 2013; 4:229-32. [PMID: 24426727 PMCID: PMC3771041 DOI: 10.1007/s13193-013-0233-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 03/05/2013] [Indexed: 10/27/2022] Open
Affiliation(s)
| | | | - Sultan A. Pradhan
- />Prince Aly Khan Hospital, Mazagaon, Nesbit Road, Mumbai, Maharashtra 400 010 India
| | - Bachi Hathiram
- />Department of ENT, BYL Nair Hospital, Mumbai, Maharashtra India
| | - Vicky S. Khattar
- />Department of ENT, BYL Nair Hospital, Mumbai, Maharashtra India
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11
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Papillary carcinoma arising from thyroglossal duct cyst with thyroid and lateral neck metastasis. Int J Surg Case Rep 2013; 4:704-7. [PMID: 23807380 DOI: 10.1016/j.ijscr.2013.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 05/09/2013] [Accepted: 05/16/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Thyroglossal duct carcinomas (TGDC) are rare, with approximately 274 reported cases since the first report in 1915. The prevalence of carcinomas in surgically removed thyroglossal duct cyst (TGD) is less than 1%. The usual recommended treatment for this condition is the Sistrunk operation, but controversies remain regarding the need for total or partial thyroidectomy. PRESENTATION OF CASE A 28-year-old woman was admitted to our hospital with the symptoms of painless midline neck swelling and growing mass. A preoperative computed tomography (CT) showed a 4cm sized heterogeneous mass at the infrahyoid anterior neck. Ultrasonography of the neck additionally showed suspicious metastatic lymph node at right level VI, both level VI. The patient underwent a Sistrunk operation. The frozen section revealed papillary carcinoma arising from TGDC and also revealed metastatic papillary carcinoma in the right thyroid, at right level III and level VI. Total thyroidectomy, right modified radical neck dissection and central neck dissection were performed. The thyroid gland and TGD were confirmed papillary carcinoma. The dissected neck lymph nodes revealed metastatic papillary carcinoma. DISCUSSION The usual recommended treatment for TGD is the Sistrunk procedure. There is controversy regarding whether total or partial thyroidectomy should be performed. CONCLUSION Physicians should be aware of extended operation, including thyroidectomy and/or neck node dissection for TGDC with metastatic lesion of thyroid and neck node.
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12
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Choi YM, Kim TY, Song DE, Hong SJ, Jang EK, Jeon MJ, Han JM, Kim WG, Shong YK, Kim WB. Papillary thyroid carcinoma arising from a thyroglossal duct cyst: a single institution experience. Endocr J 2013; 60:665-70. [PMID: 23318645 DOI: 10.1507/endocrj.ej12-0366] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Thyroid cancers arising from a thyroglossal duct cyst (TGDC) are rarely reported. No clear consensus exists regarding optimal management. In this light, TGDC carcinomas recently treated at Asan Medical Center, as well as previously reported cases in the literature, were reviewed. There were ten patients who were diagnosed with TGDC carcinoma at our institution. All patients underwent pre-operative fine-needle aspiration biopsy (FNAB). Nine patients were suspected of having papillary carcinoma following cytology. The Sistrunk operation (SO) was performed in four patients, SO with total thyroidectomy (SO/TT) was performed in three patients, and SO/TT with neck dissection was performed in three patients. Six patients who received total thyroidectomy underwent radioactive iodine (RAI) therapy and T4 suppression. With a median follow-up period of 28.5 months, two patients showed recurrence and one of them died of the disease. We analyzed 163 cases from 1990 to 2012 with three or more cases TGDC carcinoma, including the present study. Among 48 patients who underwent FNAB, 75% had papillary thyroid carcinoma (PTC). SO, SO/TT, or SO/TT with neck dissection was performed in 27%, 41%, and 32% of patients, respectively. Among 119 patients who received total thyroidectomy, 36% had concomitant PTC in the thyroid. Among 52 patients who received neck dissection, 69% had cervical nodal involvement. The results of our review suggest that when TGDC carcinoma is suspected, ultrasonography and, if necessary, FNAB should be performed. If these tests reveal a suspected lesion in the thyroid or lymph node, SO/TT and lymph node dissection should be performed.
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Affiliation(s)
- Yun Mi Choi
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
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Gomi K, Kitagawa N, Usui Y, Tanaka M, Yoshida M, Hirata Y, Kosaka T, Honda S, Take H, Shinkai M, Shishikura A, Aida N, Ohhama Y, Tanaka Y. Papillary carcinoma with extensive squamous metaplasia arising from thyroglossal duct cyst in an 11-year-old girl: significance of differentiation from squamous cell carcinoma: a case report. J Pediatr Surg 2011; 46:e1-e4. [PMID: 21496518 DOI: 10.1016/j.jpedsurg.2010.10.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 10/28/2010] [Accepted: 10/31/2010] [Indexed: 11/16/2022]
Abstract
We report a case of papillary carcinoma (PC) with extensive squamous metaplasia arising from a thyroglossal duct cyst (TDC) that required differential diagnosis from squamous cell carcinoma (SCC). An 11-year-old Japanese girl presented with a 9-month history of an anterior-midline neck mass that was clinically diagnosed as TDC. Open neck biopsy revealed nested proliferation of atypical squamous cells within the cystic structures, and SCC arising from TDC was initially suspected. Further examination, however, including immunohistochemistry, revealed the tumor to be of thyroid cell origin. The patient underwent wide local resection of the thyroglossal duct carcinoma by Sistrunk procedure and cervical lymph node dissection. Microscopically, the diagnosis was of PC with extensive squamous metaplasia and metastasis to the medial submandibular lymph node. Distinction of squamous metaplasia in PC from SCC is sometimes difficult, but has a significant effect on postoperative management.
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Affiliation(s)
- Kiyoshi Gomi
- Division of Pathology, Kanagawa Children's Medical Center, Yokohama City, Kanagawa Prefecture 232-8555, Japan.
| | - Norihiko Kitagawa
- Division of Surgery, Kanagawa Children's Medical Center, Yokohama City, Kanagawa Prefecture 232-8555, Japan
| | - Yoshiko Usui
- Division of Surgery, Kanagawa Children's Medical Center, Yokohama City, Kanagawa Prefecture 232-8555, Japan
| | - Mio Tanaka
- Division of Pathology, Kanagawa Children's Medical Center, Yokohama City, Kanagawa Prefecture 232-8555, Japan
| | - Mariko Yoshida
- Division of Pathology, Kanagawa Children's Medical Center, Yokohama City, Kanagawa Prefecture 232-8555, Japan
| | - Yoshihiro Hirata
- Division of Surgery, Kanagawa Children's Medical Center, Yokohama City, Kanagawa Prefecture 232-8555, Japan
| | - Taiichiro Kosaka
- Division of Surgery, Kanagawa Children's Medical Center, Yokohama City, Kanagawa Prefecture 232-8555, Japan
| | - Shohei Honda
- Division of Surgery, Kanagawa Children's Medical Center, Yokohama City, Kanagawa Prefecture 232-8555, Japan
| | - Hiroshi Take
- Division of Surgery, Kanagawa Children's Medical Center, Yokohama City, Kanagawa Prefecture 232-8555, Japan
| | - Masato Shinkai
- Division of Surgery, Kanagawa Children's Medical Center, Yokohama City, Kanagawa Prefecture 232-8555, Japan
| | - Ayako Shishikura
- Division of Radiology, Kanagawa Children's Medical Center, Yokohama City, Kanagawa Prefecture 232-8555, Japan
| | - Noriko Aida
- Division of Radiology, Kanagawa Children's Medical Center, Yokohama City, Kanagawa Prefecture 232-8555, Japan
| | - Youkatsu Ohhama
- Division of Surgery, Kanagawa Children's Medical Center, Yokohama City, Kanagawa Prefecture 232-8555, Japan
| | - Yukichi Tanaka
- Division of Pathology, Kanagawa Children's Medical Center, Yokohama City, Kanagawa Prefecture 232-8555, Japan
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Park MH, Yoon JH, Jegal YJ, Lee JS. Papillary thyroglossal duct cyst carcinoma with synchronous occult papillary thyroid microcarcinoma. Yonsei Med J 2010; 51:609-11. [PMID: 20499433 PMCID: PMC2880280 DOI: 10.3349/ymj.2010.51.4.609] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This is a case report on papillary thyroglossal duct cyst (TGDC) carcinoma along with synchronous occult papillary thyroid microcarcinoma. A 46-year-old woman visited our hospital because she had an anterior midline neck mass below her hyoid bone. Preoperative ultrasound-guided fine-needle aspiration cytology revealed signs of papillary TGDC carcinoma. We performed a Sistrunk operation and a total thyroidectomy. Histopathological examination of the specimen revealed papillary carcinoma arising in the TGDC and papillary microcarcinoma of the thyroid gland without extrathyroidal extension. Surgeons should be aware of TGDC carcinoma during surgical planning and postoperative treatment and should differentiate this carcinoma from an anterior midline neck mass.
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Affiliation(s)
- Min-Ho Park
- Department of General Surgery, Chonnam National University Hwasun Hospital, Hwasun-eup, Hwasun, Korea.
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15
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Abstract
The range of pathology seen in the head and neck region is truly amazing and to a large extent probably mirrors the complex signaling pathways and careful orchestration of events that occurs between the primordial germ layers during the development of this region. As is true in general for the entire discipline of pediatric pathology, the head and neck pathology within this age group is as diverse and different as its adult counterpart. Cases that come across the pediatric head and neck surgical pathology bench are more heavily weighted toward developmental and congenital lesions such as branchial cleft anomalies, thyroglossal duct cysts, ectopias, heterotopias, choristomas, and primitive tumors. Many congenital "benign" lesions can cause significant morbidity and even mortality if they compress the airway or other vital structures. Exciting investigations into the molecular embryology of craniofacial development have begun to shed light on the pathogenesis of craniofacial developmental lesions and syndromes. Much more investigation is needed, however, to intertwine aberrations in the molecular ontogeny and development of the head and neck regions to the represented pathology. This review will integrate traditional morphologic embryology with some of the recent advances in the molecular pathways of head and neck development followed by a discussion of a variety of developmental lesions finishing with tumors presumed to be derived from pluripotent/progenitor cells and tumors that show anomalous or aborted development.
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Hofmann V, Kösling S, Thanh PN, Holzhausen HJ, Bloching M. Papilläres Schilddrüsenkarzinom in einer medianen Halszyste. HNO 2009; 57:719-24. [PMID: 17431562 DOI: 10.1007/s00106-007-1569-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Thyroglossal duct cysts are the most common anomaly in thyroid development. The occurrence of carcinoma in a cyst is reported to be about 1% of cases. Histopathological examinations reveal a papillary thyroid carcinoma in about 94% of these. We report the case of 38-year-old female having a massive, cervical cystic mass over a period of 18 months. An ectopic papillary thyroid carcinoma was diagnosed. A total thyoidectomy and bilateral neck dissection were performed. This revealed a small thyroid carcinoma and three positive lymphatic nodes. Whether the cystic carcinoma is the primary or a metastasis of the thyroid carcinomais discussed.
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Affiliation(s)
- V Hofmann
- Klinik und Poliklinik für Hals-, Nasen-, Ohren-Heilkunde, Kopf- und Halschirurgie, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Germany.
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17
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Chaabouni AM, Intidhar Labidi S, Kraiem T, Gammoudi A, Ladgham A, Ben Slimane F. Carcinome vesiculo-papillaire sur thyroïde linguale. ACTA ACUST UNITED AC 2006; 123:199-202. [PMID: 17088708 DOI: 10.1016/s0003-438x(06)76666-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The management of diagnosis, treatment and outcome of malignant neoplasm arising in a lingual thyroid. MATERIAL AND METHODS We report a case of papillary-follicular carcinoma arising in a lingual thyroid. RESULTS Lingual carcinoma causes dysphagia and pain due to oropharyngeal obstruction. Surgical pharyngotomy with a trans-hyoid approach provides good access to the lesions. Therefore, the eutopic thyroid was present, in pretracheal position, without neoplastic proliferation. CONCLUSIONS Carcinoma arising in lingual thyroid is an extreme rare entity. Its diagnosis is histologic. Its treatment is surgical associated with radio-iodine therapy.
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Abstract
Thyroglossal duct anomalies and dermoid cysts comprise the vast majority of congenital midline cervical masses seen in children. Unusual lesions of the midline neck include ranulae and midline cervical clefts. Workup and management is lesion-dependent, and an accurate preoperative diagnosis is essential for planning and performing an appropriate surgical procedure. This discussion presents an overview of the relevant embryology, pathophysiology, and diagnostic modalities for these congenital midline cervical anomalies. Additionally, the current principles of surgical management are described.
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Affiliation(s)
- David S Foley
- Division of Pediatric Surgery, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky 40202, USA.
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Plaza CPR, López MED, Carrasco CEG, Meseguer LM, Perucho ADLF. 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. Ann Surg Oncol 2006; 13:745-52. [PMID: 16538412 DOI: 10.1245/aso.2006.05.022] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2005] [Accepted: 11/04/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND Thyroid carcinoma is diagnosed in approximately 1% to 2% of thyroglossal duct remnants (TGDR). No definite agreement exists concerning the management of TGDR carcinoma, especially regarding the role of total thyroidectomy and postoperative adjuvant therapy. We report five new cases of TGDR carcinoma and review relevant articles in an attempt to clarify this issue. METHODS We studied the demographic, clinical, tumor-related, treatment, pathologic, and outcome data on five patients treated at our institution for a TGDR carcinoma and compared the results with the four most important series published. RESULTS All five patients were women, and diagnosis occurred after surgery in four. The sizes of the papillary tumors were 40, 38, 25, 23, and 15 mm (mean, 28.2 mm; range, 15-40 mm). Fine-needle aspiration biopsy of the TGDR had a low sensitivity (positive for one in four). A Sistrunk procedure was performed for resection of the TGDR in four patients, and plain TGDR resection was performed for the other patient. Three patients underwent repeat surgery; total thyroidectomy was performed in all cases, and cervical bilateral node dissection was performed in one case. With a median follow-up of 123.8 months (range, 8-284 months), all the patients are alive and free of disease, with no recurrences. CONCLUSIONS TGDR carcinoma is a rare malignant tumor that is usually diagnosed after surgery; papillary carcinoma is the most common type. The currently recommended treatment is a Sistrunk procedure, with a tendency to deferred total thyroidectomy in selected cases (similar criteria exist for papillary carcinoma of the thyroid gland). The prognosis is excellent, with a good long-term survival.
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Affiliation(s)
- César P Ramírez Plaza
- Department of Digestive and General Surgery, Regional University Hospital of Málaga Carlos Haya, Avenida de Carlos Hayas/n. C.P., Málaga, 29010, Spain.
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Moran CA, Suster S, El-Naggar A, Luna MA. Carcinomas arising in multilocular thymic cysts of the neck: a clinicopathological study of three cases. Histopathology 2004; 44:64-8. [PMID: 14717671 DOI: 10.1111/j.1365-2559.2004.01767.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To report three cases of primary carcinoma of the neck arising in multilocular thymic cysts (MTC). METHODS AND RESULTS The patients were three men aged 47, 50 and 52 years who presented with a painless neck mass of several weeks' duration. The patients had no history of previous surgical procedures or of malignancy elsewhere. The tumours in all three patients were located on the right lateral side of the neck; all patients underwent complete surgical resection of the mass. Grossly, the tumours were cystic and measured between 20 and 30 mm in greatest diameter. Histologically, the tumours showed cyst walls lined by squamous epithelium. The cyst walls contained prominent germinal centres with lymphoid hyperplasia, cholesterol cleft granulomas, and scattered keratinized structures reminiscent of Hassall's corpuscles. In addition, a neoplastic cellular proliferation composed of round to oval cells arranged in sheets and originating from the lining of the cystic structures was present. The neoplastic cells showed moderate amounts of eosinophilic cytoplasm, round nuclei, and, in some areas, prominent nucleoli. Mitotic figures were easily found, and cellular pleomorphism was present in several areas. In two cases the tumours showed features of basaloid carcinoma of the thymus, while in one case the pattern was that of squamous cell carcinoma. Immunohistochemical studies for keratin showed a strong positive reaction in the tumour cells, while leucocyte common antigen strongly stained the lymphoid background. Follow-up information obtained in two patients showed them to be alive 6 months after initial diagnosis. One patient was lost to follow-up. CONCLUSION The cases described here represent an unusual variant of carcinoma arising in multilocular thymic cyst in the neck region.
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Affiliation(s)
- C A Moran
- Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA.
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21
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Abstract
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.
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Affiliation(s)
- Mehdi Motamed
- Department of Otolaryngology Head & Neck Surgery, University Hospital, Nottingham, UK.
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Yamada H, Katoh A, Ishinaga H. A case of bilateral cervical lymph node metastasis of thyroglossal duct cancer. Auris Nasus Larynx 2003; 30:107-11. [PMID: 12589862 DOI: 10.1016/s0385-8146(02)00099-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED We reported a case of thyroglossal duct cancer, which metastasized to the bilateral cervical lymph nodes. The cervical lymph node metastases were detected in the upper portion of the neck. According to the results obtained in the preoperative fine needle aspiration cytology, the lymph node metastases were classified as group V and a diagnosis of papillary carcinoma was made. The preoperative studies with 123I revealed no concentration in the submittal tumor. In our surgical procedure, bilateral supraomohyoid neck dissection was added to excision of the tumor. CONCLUSION In view of the fact that thyroglossal duct cancer metastasized bilaterally to cervical lymph nodes in the present case, we experienced an extremely rare case.
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Affiliation(s)
- Hiroyuki Yamada
- Department of Otorhinolaryngology, Yamada Red Cross Hospital, 810 Takabuku, Misono-Mura Watarai-Gun, Mie 516-0805, Japan
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Abstract
Cutaneous manifestations of thyroid disease are protean in nature and can be divided into specific lesions such as the thyroglossal duct cyst and cutaneous metastases from thyroid malignancy, nonspecific signs secondary to thyroid hormone imbalance, and associated dermatologic and systemic disorders. This review represents a summary and update of thyroid disease and the skin.
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Affiliation(s)
- Janie M Leonhardt
- Division of Dermatology, UMDNJ-Robert Wood Johnson Medical School at Camden, 100 Brick Road, Suite 306, Marlton, NJ 08053, USA
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Kao SY, Tu HF, Chang RCS, Yang AH, Chang KW, Lee CH. Primary ectopic thyroid papillary carcinoma in the floor of the mouth and tongue: a case report. Br J Oral Maxillofac Surg 2002; 40:213-5. [PMID: 12054711 DOI: 10.1054/bjom.2001.0686] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a rare case of papillary carcinoma in the tongue and floor of the mouth with metastasis in cervical lymph nodes. Treatment was by total thyroidectomy with right radical lymph node dissection of the neck, followed by 60 Gy of radiotherapy and 100 mCi (131)I. Pathological examination of the thyroid gland showed no primary cancer. We review publications about ectopic thyroid and the value of antithyroglobulin immunostaining for diagnosis and treatment of the tumour.
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Affiliation(s)
- S-Y Kao
- Department of Dentistry, Oral and Maxillofacial Surgery, Veterans General Hospital-Taipei and School of Dentistry, National Yang-Ming University Taipei, Taiwan, ROC.
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Patel SG, Escrig M, Shaha AR, Singh B, Shah JP. Management of well-differentiated thyroid carcinoma presenting within a thyroglossal duct cyst. J Surg Oncol 2002; 79:134-9; discussion 140-1. [PMID: 11870661 DOI: 10.1002/jso.10059] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Snehal G Patel
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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26
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Moncet D, Manavela M, Cross GE, Cazado E, Soutelo J, Elsner B, Niepomniszcze H. Papillary carcinoma in thyroglossal duct cyst. Endocr Pract 2001; 7:463-6. [PMID: 11747284 DOI: 10.4158/ep.7.6.463] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- D Moncet
- Division of Endocrinology, Hospital de Clínicas, José de San Martín School of Medicine, University of Buenos Aires, Argentina
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Falconieri G, Della Libera D, Zanella M. Papillary thyroid carcinoma of the thyroglossal duct cyst: comparative cytohistologic and immunochemical study of 2 new cases and review of the literature. Int J Surg Pathol 2001; 9:65-71. [PMID: 11469350 DOI: 10.1177/106689690100900114] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a cytohistologic and immunohistochemical study of 2 cases of papillary thyroid carcinoma occurring in a thyroglossal duct cyst. The patients were a 21-year-old woman and a 48-year-old man. Needle aspiration cytology smears were consistent with papillary thyroid carcinoma. The Sistrunk procedure was done. Papillary carcinoma was found within a thyroglossal duct cyst. In 1 case, the tumor spread outside the cyst. Follow-up was uneventful in both patients (2 and 9 years, respectively). Our results would indicate that papillary carcinoma of thyroglossal duct cyst, though indistinguishable from its thyroid homologue, has a more indolent course and could therefore be singled out as a clinicopathologic entity. Needle aspiration cytology reliably assists in planning patient management.
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Affiliation(s)
- G Falconieri
- Division of Anatomic Pathology, City Hospital, Conegliano TV, Italy
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Mulhall KJ, O'Hanlon DM, Mortimer G, Quill DS. Papillary carcinoma in a thyroglossal duct remnant--a review of thyroglossal surgery in a regional centre in the west of Ireland. Ir J Med Sci 1998; 167:212-5. [PMID: 9868856 DOI: 10.1007/bf02937414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A review of thyroglossal duct remnants presenting to a regional centre in the West of Ireland was undertaken. Over a 15 yr period, 25 patients were operated on for duct remnants. The mean age was 19.6 yr and ranged from 3 to 68 yr. There were 16 (64 per cent) males and 9 (36 per cent) females. Seventeen (68 per cent) patients were less than 20 years at the time of surgery. Four patients presented with a sinus and the remainder with a cystic lesion. Two patients experienced recurrent disease. One patient, a 41 yr old female, had a papillary carcinoma of a thyroglossal cyst. There were no clinical features distinguishing this patient from those with benign cystic remnants of the thyroglossal duct. The possibility of carcinoma in older patients, in particular females, presenting with thyroglossal cysts emphasises the importance of performing a formal Sistrunk's operation. It reduces the risk of recurrence of the cyst and may reduce the risk of recurrence of the tumour as the duct may provide a route for the spread of tumour.
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Affiliation(s)
- K J Mulhall
- Department of Surgery, University College Hospital, Galway, Ireland
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29
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Asakage T, Nara S, Yoshizumi T, Ebihara S. Thyroglossal duct carcinoma: a case report. Jpn J Clin Oncol 1997; 27:340-2. [PMID: 9390213 DOI: 10.1093/jjco/27.5.340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
- T Asakage
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan
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30
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Heshmati HM, Fatourechi V, van Heerden JA, Hay ID, Goellner JR. Thyroglossal duct carcinoma: report of 12 cases. Mayo Clin Proc 1997; 72:315-9. [PMID: 9121176 DOI: 10.4065/72.4.315] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To report the relative frequency, natural history, and optimal treatment of thyroglossal duct (TGD) carcinoma. DESIGN We retrospectively reviewed all cases of TGD carcinoma surgically treated during a 44-year period at a tertiary referral center. MATERIAL AND METHODS The computerized medical records database at Mayo Clinic Rochester was searched for patients who had the diagnosis of TGD carcinoma or TGD cyst carcinoma from 1950 through 1994. Medical records and pathologic specimens of these patients were reviewed. RESULTS Twelve patients (six male and six female patients), who were 17 to 60 years old (mean, 40), were identified. The frequency of TGD carcinoma among surgically removed TGD cysts was 0.7%. A midline upper neck mass was the initial symptom in all patients. The diagnosis of cancer was made after the Sistrunk procedure in 11 of 12 cases and preoperatively (by fine-needle aspiration biopsy) in only 1 case. All patients had papillary carcinoma. Thyroid involvement was noted in three cases. Nine patients had subtotal or near-total thyroidectomy, and three received postoperative radioactive iodine. After a mean follow-up of 13 years (range, 1 to 38), no patient had a documented local recurrence or distant metastatic involvement, and no tumor-associated mortality was observed. CONCLUSION TGD carcinoma is a rare malignant tumor that is usually diagnosed postoperatively. Papillary carcinoma is the most common pathologic finding. The recommended treatment is the Sistrunk procedure followed by near-total or total thyroidectomy by a skilled thyroid surgeon because of the possibility of intrathyroidal foci of cancer. The prognosis is excellent in patients with papillary tumor.
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Affiliation(s)
- H M Heshmati
- Division of Endocrinology, Metabolism, Nutrition and Internal Medicine, Mayo Clinic Rochester, MN 55905, USA
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Hilger AW, Thompson SD, Smallman LA, Watkinson JC. Papillary carcinoma arising in a thyroglossal duct cyst: a case report and literature review. J Laryngol Otol 1995; 109:1124-7. [PMID: 8551138 DOI: 10.1017/s0022215100132207] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
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.
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Affiliation(s)
- A W Hilger
- Department of Otolaryngology/Head and Neck Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham
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