Abstract
Introduction Thyroglossal duct cysts (TGDC) account for 70% of congenital neck masses.Majority (70%) is diagnosed during childhood and only 7% in adulthood. Only 1% of thyroid carcinomas evolve from a TGDC. It’s essential to differentiate primary papillary carcinoma in a TGDC from a metastatic papillary carcinoma of thyroid. Objective A 23 year old girl presented with a painless lump over the anterior neck for one month. Examination revealed a non-tender firm midline neck lump just above the hyoid bone with no palpable thyroid nodules or cervical lymphadenopathy. Ultrasound revealed a suprahyoid TGDC and a sub-centimeter solitary thyroid nodule (STN) in right lobe with no cervical lymphadenopathy. FNAC of TGDC showed a benign cystic neoplasm. Ultrasound guided FNAC of the STN showed benign cells only. Thyroid functions were normal. A Sistrunk operation was performed. Histology revealed a papillary carcinoma (with CTF1 nuclear and CK19 positivity in cells lining the papillae). A Total Thyroidectomy was performed after an oncological consultation to exclude a possible primary focus in the STN and to facilitate adjuvant treatment. Histology of the STN was a papillomatous focus likely to be hyperplastic (CK19 negative) and rest of the thyroid normal Conclusion De novo papillary carcinoma in a TGDC is rare. The diagnosis in most cases is incidental after surgical resection. Total thyroidectomy would be indicated, if the carcinomatous component is > 1 cm or <1 cm but with enlarged cervical lymph nodes, tumour invasion of the cyst wall or an abnormal thyroid gland
Highlights
Thyroglossal duct cysts (TGDC) account for 70% of congenital neck masses[1]
Diagnosis and management Ultrasound (USS) of the neck revealed a suprahyoid thyroglossal cyst and a sub-centimetre solitary thyroid nodule (STN) in the right lobe with no cervical lymphadenopathy
Histology of the TGDC revealed a papillary carcinoma confirmed by immunohistochemical studies as CTF1 nuclear and CK19 positivity in cells lining the papillae
Summary
Thyroglossal duct cysts (TGDC) account for 70% of congenital neck masses[1]. Majority (70%) present during childhood and 7% in adulthood[2]. Case presentation A 23 year old girl presented with a painless lump over the anterior neck for one month. The lump was gradually enlarging in size with no recent rapid enlargement. There were no symptoms suggestive of hyper or hypothyroidism. There was no family history of thyroid malignancies.
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