Papillary-Type Carcinoma of the Thyroglossal Duct Cyst: The Case for Conservative Management

Abstract

Thyroglossal duct cyst carcinoma is uncommon and management is controversial. In low-risk patients (single tumor focus, negative margins, normal preoperative neck/thyroid imaging, no extension of TGDC carcinoma beyond the cyst wall), the Sistrunk procedure alone with observation of the thyroid may be sufficient. In this patient population, RAI is unlikely to be of any substantial benefit.

Thyroglossal Duct Cyst Carcinoma in a Young Female: Case Report and Review of Literature

“…Women are more likely than men to have a TGDC carcinoma at a 2.1 : 1 male-to-female ratio. The average age of presentation is in the fourth decade of life [3, 4]. The presence of calcifications within the TGDC and/or regional lymph nodes seen on ultrasound are specific markers for papillary thyroid carcinoma, and the presence of a solid component is suggestive of malignancy [6].…”

“…It is appropriate to consider RAI treatment in those patients with large tumors and lymph node involvement or those with malignancy present in both the thyroid and TGDC [10]. The risk of metastatic spread for TGDC carcinoma is low, and therefore elective neck dissection is not generally recommended but should be performed for clinically positive nodal disease [3].…”

“…The prevalence of TGDCs is thought to be roughly 7% of the population, with 1% of those developing into TGDC carcinoma. The most common type of malignancy within a thyroglossal duct cyst is papillary thyroid cancer, seen in >90% of cases [3].…”

“…Fine-needle aspiration (FNA) has low diagnostic accuracy, and therefore, its role is debated. Rapid increase in size of the mass or a mass that is firm and palpable can be indicative of malignancy [3–5]. Imaging can sometimes indicate the possibility of malignancy when certain features are present, such as a solid component within the TGDC [4].…”

“…Imaging can sometimes indicate the possibility of malignancy when certain features are present, such as a solid component within the TGDC [4]. Given the rarity of TGDC carcinoma, treatment algorithms are not clearly defined [3].…”