Carcinoma of Thyroglossal Duct Remnants

Abstract

Neoplastic transformation in thyroglossal duct (TGD) remnants is estimated to occur in about 1% of TGD cysts, with a total of 243 cases reported in the literature. Three new cases and a review of the literature are presented. All cases of TGD cysts at Indiana University Medical Center between 1981 and 1994 were examined. Of 70 cases of TGD cysts, 3 were found to have TGD carcinomas (papillary carcinoma [2] and follicular carcinoma [1]). The latter is the sixth reported case. About 80% of the reported cases were papillary thyroid carcinomas. In most cases of TGD carcinoma, the diagnosis was not clinically apparent. Few reports emphasize the role of needle aspiration and imaging procedures in the preoperative diagnosis of these tumors. The Sistrunk procedure is the standard treatment of TGD carcinoma; the need for thyroidectomy, however, remains controversial. Recommendations for management include: 1) fine needle aspiration as appropriate for presurgical evaluation; 2) the Sistrunk procedure alone when the diagnosis is papillary carcinoma and there is no clinical or radiologic evidence of thyroid gland involvement; 3) total thyroidectomy and radioactive iodine therapy for TGD follicular carcinoma; and 4) long-term thyroid hormone suppressive therapy in all cases.