Extent of Surgery in Thyroglossal Duct Carcinoma: Reflections on a Series of Eighteen Cases

Abstract

The occurrence of carcinoma of the thyroglossal duct remnant (TDRCa) is reported to be less than 1%. We retrospectively analyzed 18 cases (14 females, 4 males; mean age, 38.17 years) of TDRCa who underwent surgery in our department, to evaluate the correct workup for diagnosis and treatment. Nine patients underwent a total thyroidectomy and a Sistrunk procedure (SP) whereas 8 underwent a completion total thyroidectomy after a postoperative diagnosis of TDRCa. One patient was diagnosed with TDRCa several years after total thyroidectomy for goiter. Postoperatively all patients were given radioiodide and levothyroxine therapy. Mean follow-up was 85 months. No patient died of tumor-related disease. Thyroglossal duct neoplasms were represented by papillary carcinoma in 16 cases; thyroid histology demonstrated papillary carcinoma in 6 cases (33.3%). Three patients demonstrated single regional node metastasis and only one of them demonstrated the presence of malignant thyroid disease. When clinical diagnosis of thyroglossal duct cyst is made, the workup should be completed by ultrasound (US) scan and fine-needle aspiration cytology (FNAC) in order to plan the correct surgery for a possible TDRCa. Total thyroidectomy should always be considered with SP to permit the correct treatment and follow-up in those patients. Long-term survival of patients with cTDRCa is excellent.

Thyroglossal Duct Cyst Carcinomas: A Clinicopathologic Series of 22 Cases with Staging Recommendations

“…Following adequate excision of the lesion, there are divergent opinions regarding further clinical management of patients with TGDC malignancies [23,24]. While prior studies have concluded that the Sistrunk procedure alone represents adequate therapy for TGDCCa [18,19,21], others advocate the need for total thyroidectomy in all patients based on data reporting a potentially high risk of unsuspected thyroid gland involvement by a synchronous intrathyroidal papillary thyroid carcinoma [5,13,22,24,28,31]. Thyroidectomy also allows for the option of radio ablative iodine therapy and more effective use of serum thyroglobulin levels for clinical surveillance.…”

Papillary Carcinoma Thyroid in a Thyroglossal Cyst

“…They opine that a radioiodine thyroid scan is warranted. If there is abnormal uptake on the scan or there is cystic wall invasion by the carcinoma or if the thyroglossal duct cyst carcinoma is greater than 1.5 cm, a total / near total thyroidectomy is indicated followed by throid stimulating hormone (TSH) suppression therapy [12][13][14]. In our case the ultrasound examination showed a normal thyroid and there were no neck nodes.…”

Concurrent Papillary Carcinoma Arising in Thyroglossal Duct Cyst and Thyroid Gland: A Case Report

“…Some believe that its occurrence is de novo from islands of normal thyroid tissue found in thyroglossal duct remnants. This theory is supported by the fact that ectopic thyroid nests have been identified histologically in as many as 62% of the surgical specimens of thyroglossal duct cysts, and that carcinoma in a thyroglossal duct cyst is found without evidence of thyroid malignancy (6). Additionally, the synchronous occurrence of papillary carcinomas in a thyroglossal duct cyst and the thyroid gland can be explained as a representative of multifocal tumors.…”