Thyroglossal Duct Cyst Carcinoma Research Articles

The Papillary Carcinoma of Thyroglossal Duct Cyst with a Normal Thyroid Gland Appearance: A Case Report

The Papillary Carcinoma of Thyroglossal Duct Cyst with a Normal Thyroid Gland Appearance: A Case Report

Thyroglossal duct cyst carcinoma: Case report

Introduction: Considered the most common congenital anomaly in the development of the thyroid gland, the thyroglossal duct cyst (TDC) has an estimated prevalence of 7% of the population. Although the vast majority of these cysts are benign, around 1% of cases can become malignant. Aim: To report the history, evolution and management of a patient with a thyroglossal duct cyst that developed into a carcinoma, to review the pathophysiology of the disease and the scarce literature on the subject. Case summary: 40-year-old woman diagnosed in 2018 with TDC. She went to a head and neck surgeon in 2020 for a reassessment of the case, to whom she reported an increase in the nodule and local discomfort. Surgery was indicated to remove it. The anatomopathological examination carried out after the surgery revealed a suspicion of malignant transformation. An immunohistochemical test was carried out, which confirmed the suspicion. The patient was asked to return in 6 months and to undergo ultrasound to monitor the pathology. Discussion: The thyroglossal duct results in the thyroid descending from the base of the tongue to its final resting place in the anterior region of the neck in the midline. This tract should obliterate at the beginning of fetal life; failure in this involution can subsequently give rise to a cyst in this duct. The cyst is often noticed after an upper respiratory tract infection and, in rare cases, a carcinoma can develop from the walls of the cyst. Conclusion: CDT carcinoma cases should be discussed due to the scarcity of reports in the literature and their rare incidence in the clinical field.

Papillary Thyroid Carcinoma of a Large Thyroglossal Duct Cyst: A Case Report

Background: Thyroglossal duct cyst is the most common congenital anomaly of the thyroid gland. Carcinoma arising from it is rare which composes 1% of total cases, often diagnosed incidentally after surgical excision. Here we are reporting a case of papillary thyroid carcinoma of thyroglossal cyst in 45-year-old female with normal thyroid gland. Case Description: A 45-year-old female presented with 1 year history of swelling over midline of the neck with normal thyroid gland. FNAC suggested a benign cystic lesion, most likely thyroglossal cyst. CT scan neck showed a well-defined lobulated and septated thin-walled cystic lesion of approx. 6×4×5cm in the midline upper infrahyoid region anterosuperior to thyroid, suggestive of thyroglossal cyst. Sistrunk procedure was performed. HPE revealed papillary thyroid carcinoma of thyroglossal cyst. Conclusion: A case of thyroglossal duct cyst with normal thyroid gland and without any clinical or radiological evidence of malignancy, a possibility of underlying malignancy should be kept in mind and can be managed adequately with Sistrunk procedure only, with regular follow up.

Role of imaging in the management of thyroglossal duct cyst carcinomas (TGC-TIRADS): a single centre retrospective study over 16 years

Role of imaging in the management of thyroglossal duct cyst carcinomas (TGC-TIRADS): a single centre retrospective study over 16 years

Papillary thyroid carcinoma in thyroglossal duct cyst: a review article

Papillary thyroid carcinoma in thyroglossal duct cyst: a review article

SAT517 Papillary Thyroid Cancer in Thyroglossal Duct Cyst.

Abstract Disclosure: P.L. castellanos: None. S.E. Meek: None. A.M. Chindris: None. V.J. Bernet: None. Approximately 250 cases of papillary thyroid cancer (PTC) within a thyroglossal duct cyst (TGDC) have been reported worldwide. The presence of PTC within a TGDC is rare representing less than 1 % of all TGDC cases. This report describes the case of a young male with PTC in a TGDC suspicious nodules. We present this case along with a review of the literature related to this very uncommon finding. Papillary thyroid carcinoma is a very rare disease but always should be considered when speaking of a mass at the level of the central neck. There is a considerable controversy regarding the role of thyroidectomy to treat thyroglossal duct cyst carcinoma since the treatment of choice is Sistrunk procedure and the only indications to make a thyroidectomy will be aggressive disease and more than 45 years old according to some articles but without any consensus now. With a cure rate of 95 % and recurrence rate of 3 -10 % when this cancer is treated by Sistrunk operation, it doesn’t seem necessary to do an extent surgery if there is not enough thyroid compromised. Long term follow up is necessary to exclude the development of thyroid cancer. Presentation Date: Saturday, June 17, 2023

SAT574 Thyroglossal Duct Papillary Thyroid Cancer With Normal Eutopic Thyroid Gland: A Management Dilemma

Abstract Disclosure: H. Belal: None. J.T. Batch: None. G.Y. Gandhi: None. Background: The incidence of thyroglossal duct cyst carcinomas is less than 1%, the majority being papillary thyroid cancer. One-third arise de novo from the thyroglossal duct. The rest are direct metastasis of eutopic papillary thyroid cancer. Management in the setting of a normal eutopic thyroid gland is challenging. Clinical Case: A 35-year-old female presented with transient right facial paresthesia. CT angiogram revealed an incidental 2.3 cm thyroglossal duct cyst with internal ectopic thyroidal tissue and micro-calcifications. She denied any compressive symptoms, radiation exposure, or family history of thyroid cancer and was euthyroid. Ultrasound noted a normal thyroid gland and complex solid-cystic mass measuring 2.3 x 2.0 x 1.5 cm superior to the isthmus. Satisfactory fine needle aspiration of the mass revealed benign-appearing epithelial cells, macrophage, and colloid-like material. Due to new anterior neck pain, a Sistrunk Procedure (SP) was performed. Pathology revealed a 1.2 cm papillary thyroid carcinoma, conventional type (confirmed by TTF-1 and thyroglobulin stains), arising within the thyroglossal duct cyst. Surgical margins were free of cancer, and there was no lymphovascular invasion. A thyroid ultrasound seven months after the procedure revealed heterogenous thyroid tissue, no thyroid nodules, and several small benign-appearing reniform-shaped cervical lymph nodes in zones 1 and 2. The patient was offered yearly thyroid ultrasound surveillance versus prophylactic thyroidectomy. She elected to proceed with thyroidectomy due to concerns about disease recurrence. Final pathology results revealed right lobe 2 mm papillary microcarcinoma limited to the thyroid. Conclusion: Fine needle aspiration of thyroglossal duct cysts can have a high false negative rate, as in our patient. There is currently no consensus on treatment of thyroid carcinomas arising from thyroglossal duct cysts. There are four possible surgical strategies: 1) SP alone 2) SP with concurrent thyroid lobectomy or pyramidal lobe resection 3) SP with total or near total thyroidectomy in all patients and 4) SP and selective addition of total or near total thyroidectomy in high-risk patients. The role of radio-iodine ablation and levothyroxine suppression after SP is also unclear. Management recommendations are Grade C, relying on case reports, case series, and expert opinion. Whether or not to proceed with total thyroidectomy, especially in the setting of a normal thyroid gland, remains highly controversial. Some experts even argue for an early aggressive surgical approach with SP, total thyroidectomy, and level I lymph node sampling in all patients to provide accurate staging and allow for the use of thyroglobulin and whole-body scintigraphy in surveillance. Multisite comparative data on the long-term outcomes of patients who receive early aggressive versus conservative management is needed. Presentation: Saturday, June 17, 2023

Clinical Observation and Analysis of Thyroglossal Duct Cyst Carcinoma: A Report of 5 Cases.

Thyroglossal duct cyst carcinoma (TGDCCa) is a rare condition with only approximately 300 cases reported to date. There is a lack of comprehensive reporting on its clinical manifestations, ultrasound, contrast-enhanced computed tomography, magnetic resonance imaging (MRI) features, immunophenotyping, procedure, and prognosis following modified Sistrunk's procedure. This study aimed to address these gaps by analyzing and summarizing the clinical features of 5 cases of papillary carcinoma arising in thyroglossal duct cysts (TGDC).Five patients with papillary carcinoma in TGDC treated by modified Sistrunk's procedure were included. Their clinical manifestation, physical examination findings, iconography, pathological findings, treatment, and outcomes were analyzed in aiding the diagnosis and treatment of TGDCCa. Immunohistochemistry was used to confirm the papillary carcinoma subtype. The BRAFV600E mutation was detected in 2 patients. No evidence of cancer recurrence, distant metastases, and malignant changes in the thyroid was found after a mean follow-up of 29.8 months.The management of TGDCCa with papillary carcinoma in low-risk patients can be accomplished by performing a modified Sistrunk's procedure along with a regular follow-up imaging of the thyroid and neck. Although postoperative pathological diagnosis is the gold standard for diagnosis, it is equally crucial to comprehend the clinical manifestations and auxiliary diagnostic techniques before surgical intervention.

Primary papillary carcinoma in a thyroglossal duct cyst: A case report

Background: Thyroglossal duct cyst(TDC)is the most common congenital disorder of the thyroid gland. Seventy five percent of midline neck masses in children are (TDC). Occurrence of malignancy in (TDC) is very rare event, and include 1% of all cases of (TDC). Here in this report, we describe a rare case of primary papillary carcinoma which arises in a (TDC). Case report: Our case is a 42-year-old woman who presented with a hard painless solid and cystic mass in front of the neck above of thyroid cartilage. After initial physical examination and ultrasonography, the mass identified. Radiologist performed a core needle biopsy of the cyst and mass which show a papillary cell carcinoma. The patient underwent near total thyroidectomy, excision of lymph node and surgical excision of the thyroglossal duct cyst (the Sistrunk's procedure). Histopathology of the specimen revealed a thyroglossal duct cyst which showed a primary invasive papillary carcinoma that infiltrated the cyst wall. The thyroid gland was normal, cervical lymph node was not involved. Conclusions: Primary papillary carcinoma of thyroglossal duct cyst is a rare disease which presents in patients with cystic midline neck masses. Surgery and radical excision is the optimal patient management with radioactive iodine therapy which improve the survival.

Thyroglossal duct cyst carcinoma case series—Management strategy and outcomes

ObjectiveTo review the clinical presentation, diagnosis, pathology and management strategies in a modern cohort of patients with thyroglossal duct cyst carcinoma. Study designRetrospective case series following PROCESS Guidelines. SettingComprehensive cancer centre. MethodsData recorded included: gender, age at diagnosis, clinical presentation, thyroid function, diagnostic investigations, cytological results, final histology, staging and follow up status. The risk of malignancy in cytological analysis was stratified according to the Royal College of Pathologists classification in United Kingdom. ResultsTwelve patients were included. The majority of patients (66.7%) presented with an isolated thyroglossal duct cyst. Only 4 patients had preoperative cytological suspicion of carcinoma (sensitivity: 33.3%). At the time of presentation all patients were euthyroid. Following diagnosis of malignancy, a total thyroidectomy was performed in all patients, with the exception of 2, who had a thyroglossal duct cyst carcinoma of less than 10mm. Among the 10 patients who underwent total thyroidectomy, 7 (70%) patients had proven carcinoma in the thyroid gland, 3 with deposits of less than 10mm. The average size of the thyroid cancer deposits was 7.2mm (1–20mm). With a mean follow-up of is 44 months (5–120), all patients were alive and free of recurrence at the end of the study period. ConclusionThyroglossal duct cyst carcinoma is a rare condition and its management should be discussed in a multidisciplinary meeting. As with differentiated thyroid cancer originating in the thyroid gland, it bears extraordinary survival rates. Accordingly, the management of these cancers has shifted towards a more conservative approach although its peculiarities must be taken into account: ease of extracystic invasion and possible different lymph node invasion.

'Lateral Aberrant Thyroid Carcinoma' or 'Thyroglossal Duct Cyst Carcinoma Metastasizing to Neck Node': Can we Decide in this Interesting Case Report?

Lateral aberrant thyroid(LAT) belongs to subset of ectopic thyroid, mostly presenting as asymptomatic lateral neck swelling and are challenging to diagnose without histopathological examination. Malignant transformation in LAT is even rare and is best managed by surgical excision. Here, we report a case of papillary carcinoma of LAT, but with an unusual post-operative finding, revealing papillary carcinoma of thyroglossal duct cyst.

Pyramidal lobe‐dominant papillary thyroid carcinoma—A rare entity with important clinical implications

AbstractPapillary thyroid carcinoma (PTC) primarily located in the pyramidal lobe of the thyroid gland is extremely rare, therefore the clinical and pathological features are not well understood. The authors describe a case of PTC of the pyramidal lobe, in a 77‐year‐old woman who underwent en bloc total thyroidectomy with pyramidal lobe, hyoid bone and cervical lymph node excision. In line with the present case, current literature reports a greater presence of worse prognostic factors, namely extrathyroidal extension, advanced T stage or presence of cervical lymph node metastasis. Recently, a new classification has been suggested—Upper Neck Papillary Thyroid Cancer (UPTC)—which encompasses these carcinomas, Delphi ganglion metastases and thyroglossal duct cyst carcinomas, with potential clinical and therapeutic implications, particularly the need for orthotopic thyroidectomy. Also, the complete excision of the pyramidal lobe during thyroidectomy may influence the success of radioactive iodine therapy and the patient's follow‐up surveillance.

AB175. SOH23ABS_026. An unusual case of thyroglossal duct cyst carcinoma presenting in the sublingual space, and its multidisciplinary management

Background: Thyroglossal duct cysts (TGDCs) are the most common congenital anomaly of thyroid gland development, with a <1% risk of malignancy occurring within them. It's rare for a TGDC to be located in floor of the mouth region or the sublingual space since both these areas are not part of the typical embryological migration route of the thyroid gland.

Papillary carcinoma affecting a lateral thyroglossal cyst duct and thyroid: a case report

Thyroglossal duct cyst is the most common congenital benign cervical lesion in the population; the presence of thyroglossal duct cyst carcinoma is very rare; added to this, its association with papillary thyroid carcinoma is even more rare. Treatment is usually surgical and associated with a partial or total thyroidectomy according to each case.

Thyroglossal Duct Cyst Carcinoma: Lessons from a 20-Case Series.

Thyroglossal duct cyst (TDC) is a common congenital cyst with an incidence of about 7%. Thyroglossal duct cyst carcinoma (TDCC) is a rare sequel which arises from TDC and has an incidence of about 1%. As these are rare, they do not have well-defined management guidelines. The aim of this study was to analyse the clinical profile and pathological characteristics of patients with thyroglossal duct cyst carcinoma and to propose a protocol for their treatment and follow-up. A retrospective study was done from January 2000 to December 2019. All the clinical details, imaging characteristics, treatment and histopathology were analysed. The mean age group in our study was 37.9years with a female preponderance. The clinical features like rapid increase in size, fixity of the lump and lymph node metastasis were not very common. Seventy-five percent of our patients who underwent imaging had suspicious characteristics. Fifty-six percent of our patients had FNAC suggestive of TDCC. Fifty percent of our patients had concomitant thyroid carcinoma. None of our patients had distant metastasis at follow-up. TDCC is rare and a disease of young adulthood and usually has good prognosis. It may be a clinical surprise or a small lesion which can be detected with ultrasound and targeted FNAC. There is high rate of concomitant thyroid carcinoma and hence needs careful assessment. Sistrunk's procedure with total thyroidectomy either staged or simultaneously has good outcome and permits adjuvant treatment.

Papillary Thyroid Carcinoma Arising in Thyroglossal Duct Cyst and Locally Infiltrated to Hyoid Bone: Issue of Individualized Management

Thyroglossal duct cyst (TGDC) is the most common developmental anomaly of the thyroid gland, while TGDC carcinoma with local infiltration to the hyoid bone is extremely rare. The reported case of papillary thyroid carcinoma (PTC) was diagnosed in TGDC along with local infiltration to the hyoid bone and needed individualized management. A 70-year-old male patient presented with a history of PTC arising in TGDC and locally infiltrated to the hyoid bone followed by total thyroidectomy and radical sistrunk operations and was referred to National Institute of Nuclear Medicine and Allied Sciences (NINMAS) for radioactive iodine therapy (RAIT). His post-operative ultrasound of the neck revealed an irregular shaped, fungating, grossly non-homogenous mixed echogenic mass lesion invading the hyoid bone, measuring about 25 X 28 mm. Radioactive iodine(131I) of 150 mCi was administered because the residual hyoid bone mass was inoperable and he was on thyroxine suppression therapy. The post-therapy 131I scan (RxWBS) showed two intense foci of radiotracer concentration (RTC) in the upper area (above the thyroid bed) and an intense focal RTC in the fundal region of the stomach. The activity in the stomach region was evaluated by ultrasound imaging, which revealed a soft tissue mass or thickening of the mid-region of the posterior wall of the stomach (3.3 cm X 1.6 cm). A CT scan of the chest was also performed to rule out metastasis, and it revealed multiple nodular lesions in both lung fields (most likely secondary) as well as tiny subcentric lymphnodes in the lower pre- and right paratracheal regions after nearly one month of RAIT when the patient was stable for examination. EBRT is still under consideration as adjuvant therapy. Tyrosine kinase inhibitors (TKI) may be considered in cases of refractoriness to radioiodine and disease progression. Bangladesh J. Nuclear Med. 26(1): 67-70, 2023

Clinicopathologic Study of Thyroglossal Duct Cyst: An Institutional Experience

Background: Thyroglossal duct (TGD) is a developmental anomaly in which a remnant of the thyroid anlage is left in the neck throughout its descent from the foramen cecum of tongue to ultimate peritracheal position. A persistent duct can lead to thyroglossal duct cyst (TGDC). Histologically, TGDC brings an epithelial lining of squamous or pseudostratified ciliated columnar epithelium and ectopic thyroid gland tissue in the duct wall. TGD-associated malignancy is rare, and the majority is papillary thyroid carcinoma (PTC). Objectives: The aim of the study is to assess the clinicopathologic features of thyroglossal duct cyst. Methods: This is an observational study. The study was carried out among the admitted patients of National Institute of ENT, Dhaka, Bangladesh from January 2019 to September 2022. Statistical analysis of the data was carried out using SPSS-24. Results: This study shows that according to age distribution, 30(58.8%) were &lt;20, 8(15.7%) were 21-30, 10(19.6%) were 31-40, 2(3.9%) were 41-50, none in the 51-60 and 1(2.0%) was ≥61 years age group. And according to gender (47.1%) were Male and (52.9%) were Female. According to diagnosis, 45(88.2%) were Thyroglossal Duct Cyst, 1(2%) was multinodular goiter and 5(9.8%) were Papillary thyroid carcinoma. Conclusion: TGDCs are common pathologic lesion affecting the neck. Thyroglossal duct cyst carcinomas, most commonly papillary thyroid carcinoma, is a rare condition that should be considered in patients presenting with cystic midline neck masses. Surgery is the main treatment and multidisciplinary consultation is required to improve survival. The diagnosis of malignancy is made postoperatively.

PSAT286 A Rare Case of Papillary Thyroid Cancer of the Thyroglossal Duct Cyst with Benign Thyroid

Abstract Introduction While the thyroglossal duct cyst (TGDC) is the most commonly seen midline neck mass, thyroglossal duct cyst carcinoma is rare (1-2%) with only a few hundred cases published in the literature. The disease can be challenging to diagnose and treat because most TGDC carcinoma are diagnosed post-operatively and data is limited regarding the extent of surgical resection, adjuvant therapy and long-term outcomes. We report a case of papillary thyroid carcinoma arising from TGDC without any evidence of disease in the thyroid gland. Case Report A 31-year-old male presented with complaints of progressively worsening dysphagia and weight loss for 4 months. An initial CT neck with contrast revealed a soft tissue mass along the anterior aspect of the thyroid cartilage measuring 3.4×2.0×2.2 cm that extended anteriorly from the base of the tongue, favoring a thyroglossal duct cyst. The thyroid gland appeared normal on this imaging. He was given a 2-week course of antibiotics and pantoprazole with no improvement in his symptoms. He underwent a thyroid ultrasound, which showed a large hypoechoic mass, partially cystic, anterior to thyroid. FNA of the TGDC was suspicious for papillary thyroid cancer. Follow-up CT scan redemonstrated known TGDC with increased size of adjacent lymph nodes, concerning for metastasis. Given FNA results, regional lymph node involvement, and the patient's symptoms, he underwent successful Sistrunk procedure for TGDC removal. He declined to wait for intraoperative frozen pathology and opted to discuss pathology and next steps after surgery. Pathology of the TGDC confirmed papillary thyroid cancer (conventional type) with uninvolved margins and metastasis to one of four lymph nodes with the largest lymph node being 7 mm. At the tumor board conference, it was recommended he further undergo a total thyroidectomy with possible post-operative radioactive iodine (RAI) treatment. He underwent a total thyroidectomy, and pathology showed benign thyroid gland with a few colloid cysts. Post-operatively, he was started on levothyroxine. He did not have any improvement in dysphagia following both surgeries. After extensive discussion of the risks and benefits of RAI, the patient chose to defer RAI treatment until further evaluation of his dysphagia was completed. Ultimately, the decision was made to monitor with serial ultrasounds and thyroglobulin levels. Conclusion Optimal treatment of TGDC carcinoma is debatable. A Sistrunk procedure involving resection of cyst plus mid-portion of hyoid bone is universally recommended for adequate excision of the cyst. However, no clear consensus guidelines exist for further management with total thyroidectomy and/or post-operative RAI. Total thyroidectomy permits excision of unsuspected thyroid carcinomas and enables a better follow-up. However, decisions can vary based on extent of disease, tumor characteristics, demographics, and patient preferences. Management decisions should be made on an individualized basis, using a multidisciplinary and shared decision-making approach. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

PSAT252 Primary Papillary Thyroid Carcinoma Arising from a Thyroglossal Duct Cyst

Abstract Background Thyroglossal duct cysts (TGDC) are remnants of the thyroglossal duct tract that do not atrophy and disappear, instead undergoing cystic expansion and often presenting as a midline neck mass. Rarely, carcinomas of the thyroglossal duct cyst occur, either arising as a primary carcinoma or as a cystic metastasis from a primary thyroid cancer; the former are particularly rare. These thyroglossal duct cyst carcinomas most commonly present in the adult population. Case Report We present the case of a 32-year-old female without any significant past medical history who presented with a non-tender midline neck mass identified as a thyroglossal duct cyst and completely excised; pathology results were positive for a primary papillary thyroid carcinoma with a tumor measuring 1.3 cm in diameter within the TGDC. Thyroid Ultrasound also showed the presence of two nodules measuring 1.4 cm on the right and 1.2 cm on the left, respectively, with fine needle aspiration (FNA) of both the nodules confirming papillary thyroid carcinoma as well. Lymph node FNA was negative for metastatic carcinoma. The patient underwent a thyroidectomy which definitively confirmed both a classic papillary carcinoma as well as an encapsulated, non-invasive follicular variant. In keeping with the original finding of the patient having a primary thyroglossal duct cyst carcinoma, samples from the thyroidectomy had negative tumor margins, and were also negative for any angioinvasion, lymphatic invasion, or extrathyroidal extension. Conclusion While thyroglossal duct cysts are the most common type of congenital neck cyst, primary carcinomas arising from thyroglossal duct cysts are rare. Masses that occur anywhere along the thyroglossal duct tract should be investigated for malignancy, with additional investigation of the thyroid gland for either a primary or secondary thyroid cancer. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Papillary Carcinoma in Thyroglossal Duct Cyst and Thyroid Gland with Hashimoto

The ectopic thyroid gland is a rare condition. In most cases, ectopic thyroid tissue is the only functioning thyroid tissue, but it may rarely be associated with a normal thyroid gland. Ectopic thyroid carcinoma within a thyroglossal duct cyst is a very rare entity, with controversial individual approaches. This encouraged us to present the case of a 31-year- old woman, with papillary thyroid carcinoma in the thyroid gland and in the thyroid ectopic tissue within the thyroglossal duct. After suspicion of thyroid malignancy in the ultrasonography of the neck, FNA-biopsy was performed on the thyroid nodule and the thyroglossal duct cyst. Since the pathological exam revealed a papillary carcinoma in the eutopic and ectopic thyroid tissues, the Sistrunk procedure and total thyroidectomy were done, followed by radioiodine ablation.