|Year : 2016 | Volume
| Issue : 2 | Page : 95-96
Papillary carcinoma arising in a thyroglossal duct cyst
Arijit Roy, Tamal Kanti Choudhury, Pallab Ghosh, Aryapriyo Chatterjee
Department of Surgery, KPC Medical College and Hospital, Kolkata, West Bengal, India
|Date of Web Publication||8-Jun-2016|
Department of Surgery, KPC Medical College and Hospital, 1F, Raja Subodh Chandra Mullick Road, Jadavpur, Kolkata - 700 032, West Bengal
Source of Support: None, Conflict of Interest: None
Papillary thyroid carcinoma within the thyroglossal duct (TGD) cyst is a very rare finding and its presentation is similar to benign TGD cyst. We report a case of a 47-year-old female with a thyroglossal duct cyst with papillary thyroid carcinoma. Following a standard Sistrunk operation, the histopathological examination reported a possibility of carcinoma.
Keywords: Papillary thyroid carcinoma, Sistrunk operation, thyroglossal duct cyst
|How to cite this article:|
Roy A, Choudhury TK, Ghosh P, Chatterjee A. Papillary carcinoma arising in a thyroglossal duct cyst. Saudi Surg J 2016;4:95-6
| Introduction|| |
Thyroglossal duct (TGD) remnants are the most common midline neck mass usually located at the level of the thyrohyoid membrane.  The possibility of malignancy within the TGD remnants is 1-2%.  In most of the cases, the diagnosis of the thyroglossal duct carcinoma is made after the histopathological examination of the surgical specimen of a routine Sistrunk procedure.  The literature is not unanimous about the further course of action after the diagnosis is made. It is difficult to decide whether the Sistrunk operation was enough for the treatment or some other kinds of treatment should also be implemented. A scar excision is considered enough for a squamous cell carcinoma, but the controversy remains regarding the differentiated thyroid cancers. In this particular case, it was a papillary carcinoma.
| Case Report|| |
A 47-year-old female patient presenting with a lump in front of the neck for 4 months was admitted in ESI Hospital. The lump was mobile on deglutition and protrusion of tongue. It located in the midline on the front of the neck. She complained of occasional pain on deglutition. There were no associated problems and no significant history. She was diagnosed of TGD cyst and was transferred to K. P. C. Medical College and Hospital for further treatment and management. Physical examination revealed a midline cervical mass of 2.2 cm × 1.4 cm at the level of the thyrohyoid membrane. The mass was mobile on deglutition and tongue protrusion. The mass was nontender and smooth. There were no other palpable lymph nodes, and the thyroid gland was nonpalpable. Her routine blood investigations showed no abnormality. Thyroid hormone levels were within normal limits. The patient underwent a standard Sistrunk procedure. In the procedure, the cyst was identified and the cyst along with the tract was excised up to the foramen cecum [Figure 1]. The central part of the hyoid bone was excised and the tract was ligated. The specimen was then sent for histopathological examination (HPE) [Figure 2].
|Figure 2: The cyst along with the entire thyroglossal tract dissected up to foramen cecum|
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The HPE reports showed microscopic finding sections showing cystic space lined by stratified cells containing colloid material. The surrounding tissue contains thyroid follicles. The lining follicular cells show at places crowding of nuclei and ground grass appearance of nuclei. They reported a possibility of TGD cyst with malignant transformation (papillary carcinoma) in the tissue [Figure 3].
| Discussion|| |
A study by Luna-Ortiz et al. concluded that the extension of the surgery of thyroglossal cyst carcinoma should be handled according to the same criteria established for differentiated thyroid cancer.  A study by Balalaa et al. concluded that the Sistrunk operation alone is sufficient for squamous carcinoma, but total thyroidectomy is recommended for differentiated thyroid carcinoma.  On the other hand, some authors believe that cancer of a TGD cyst is expected to behave in a manner similar to that of thyroid cancer, a slow-growing tumor that may take more than 20 years to progress. Because of this prolonged course, long-term follow-up is advisable.  In a particular study, there was a discussion of two such similar cases where the first patient was treated with total thyroidectomy followed by routine thyroxine supplementation and the second patient was kept under close observation. In both cases, on regular follow-up, there was no sign of recurrence. 
| Conclusion|| |
Malignancy within a TGD cyst is very rare but should be included in the differential diagnosis of a neck mass. This condition is rarely diagnosed preoperatively. Once diagnosed, therapy includes surgery, radioactive iodine, and thyroid suppression as it is the case for differentiated thyroid cancers. For this particular case, we have decided to follow-up the patient bimonthly clinically and by thyroid scans for any signs of recurrence.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Allard RH. The thyroglossal cyst. Head Neck Surg 1982;5:134-46.
Datar S, Patanakar T, Armao D, Mukherji SK. Papillary carcinoma in a giant thyroglossal duct cyst. Clin Imaging 2000;24:75-7.
Plaza CP, López ME, Carrasco CE, Meseguer LM, Perucho Ade L. 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.
Luna-Ortiz K, Hurtado-Lopez LM, Valderrama-Landaeta JL, Ruiz-Vega A. Thyroglossal duct cyst with papillary carcinoma: What must be done? Thyroid 2004;14:363-6.
Balalaa N, Megahed M, Ashari MA, Branicki F. Thyroglossal duct cyst papillary carcinoma. Case Rep Oncol 2011;4:39-43.
Weiss SD, Orlich CC. Primary papillary carcinoma of a thyroglossal duct cyst: Report of a case and literature review. Br J Surg 1991;78:87-9.
Banerjee P, Ray L, Ray S, Das S, Sinha R. Papillary carcinoma of thyroglossal cyst. Indian J Otolaryngol Head Neck Surg 2007;59:377-9.
[Figure 1], [Figure 2], [Figure 3]