Carcinoma of the Thyroglossal Duct Case Reports and a Literature Review

Abstract

Carcinoma of the thyroglossal tract is a rare entity. Three patients with thyroglossal cyst carcinomas are presented and the features of the disease, as reported in the literature, are discussed. Epidemiologically, females are more often affected than males and the average age of the patients described lies in the fourth decade. The aetiology is obscure, although previous irradiation is a possible risk factor, Carcinoma of the thyroglossal tract should also be suspected in patients with irregular masses. Pre‐operative evaluation may include a thyroid scan and fine needle aspiration cytological examination of the cyst fluid. These tests, if positive, may alter the basic approach of the Sistrunk procedure to encompass thyroidectomy or wider margins. Neck dissection is preferred for cervical nodal disease. Adjuvant radiotherapy or radio‐iodine is added if indicated by the histology, and the patient receives suppressive thyroxine therapy thereafter.

Thyroglossal duct remnant carcinoma: Beyond the Sistrunk procedure

“…Cervical lymph node metastases have a prevalence of 7.7 to 15% [17, 47, 48, 55] and the presence of lymph node metastases warrants the addition of neck compartment dissection. Usually only the central compartment (level VI) requires dissection; however, lateral lymph node dissection may be required if involvement is proven on biopsy or pathology [3, 54, 59]. The role of prophylactic elective lymph node dissection was not investigated in TGDR carcinomas and therefore routine prophylactic central lymph node dissection cannot be recommended.…”

“…The histopathologic type and extent of disease are used to tailor surveillance to the individual patient. Patients taking thyroid hormone supplementation should be followed, to maintain appropriate TSH suppression [59]. …”

Fine Needle Aspiration Cytology of Squamous Cell Carcinoma Arising in a Thyroglossal Duct Cyst

“…16 From a histologic angle, the most common types are papillary, 82-87%; mixed papillary and follicular, 6.9%; and squamous, 5.2% (Table I). 17 The average age of patients at the time of diagnosis for all types is 39.2 years, while for the squamous type alone it is 55.9 years (Table II). 18 In papillary carcinoma a metastatic diffusion to the regional lymph nodes has been found in about 11% of cases.…”

“…1 However, squamous cell carcinomas also show marked local invasion and tend to recur, even many years later, 19 with a much worse prognosis. 17 Given the locally aggressive nature of squamous cell carcinoma, it is extremely important to obtain a firm diagnosis at the preoperative stage so that treatment of the neoplasm can be planned, with preference for extensive surgical intervention with exploration of the neighboring structures and drainage of lymph node areas. …”

Cytologic Findings in Thyroglossal Duct Carcinoma

“…Reports of follicular, Hurthle, and anaplastic, but not medullary carcinomas have been rare. 2 With the advent of fine-needle aspiration (FNA), it is possible to make the diagnosis of TDCa preoperatively, thus reducing patient morbidity and hospital costs. 3 Rare case reports describing the FNA findings in these neoplasms have been published.…”