Thyroglossal Duct Cyst Carcinoma With Synchronous Thyroid Papillary Carcinoma: A Case Report and Literature Review

Abstract

Thyroglossal duct cysts (TGDC) are one of the most common congenital anomalies in the neck. Malignant transformation of these cysts is rare and synchronous involvement of the thyroid gland is even rarer. We report a case of synchronous occurrence of carcinoma in the thyroglossal duct cyst and thyroid gland and review the relevant literature. A 24-year-old woman who presented with a midline cervical mass, clinical examination, and complementary study was suggestive of a thyroglossal cyst with papillary carcinoma on fine-needle aspiration biopsy (FNAB) synchronous with thyroid papillary carcinoma with no cervical ganglion metastases documentation. Sistrunk's procedure plus total thyroidectomy was performed. With the clinical resemblance of benign and malignant cysts and the limitations of imaging techniques to distinguish between them, FNAB might be of use. Surgical treatment is warranted for the treatment of thyroglossal duct cyst carcinoma, but controversy still exists as to the extent of the surgical intervention. Sistrunk's procedure seems to be considered the gold standard when there is no evidence of thyroid involvement. However, in the presence of concomitant thyroid carcinoma, total thyroidectomy and cervical lymphadenectomy for evident node metastases are required. In the case of synchronous thyroglossal and thyroid carcinoma, most authors recommend pursuing both radioiodine therapy and hormone ablation. Thyroglossal duct cyst carcinoma is an uncommon feature that can arise from clusters of thyroid cells found within the cyst as in the present case. When confronted with this diagnosis it is fundamental to take into consideration the possibility of synchronous lesions as well as the extent of local and distance disease, since it has a direct influence on the choice of treatment provided to the patient. As there was a synchronous presence of papillary carcinoma in both the thyroglossal cyst and the thyroid gland, both the Sistrunk procedure and total thyroidectomy were performed, and radioiodine therapy was pursued as well as hormone ablation.

Research progress of ectopic thyroid cancer in thyroglossal duct cyst: A case report and literature review

“…[11] Currently, radioactive iodine therapy is only recommended for thyroglossal duct cancer in combination with ipsilateral thyroid cancer and lymph node metastases. [23] The most common genetic mutation in thyroid cancer is the BRAF mutation, which accounts for about 45% of papillary thyroid cancers, [32] and the most common BRAF family variant in thyroid cancer is BRAF V600E in the BRAF1 gene. Some studies have also shown that patients with BRAF mutations should be routinely treated with I 131 after surgery to reduce the risk of recurrence.…”

“…The former is primarily employed for the treatment of malignant transformation of the ectopic thyroid gland within the thyroglossal cyst and is the main surgical procedure performed in clinical practice with a low postoperative recurrence rate of only 3%. [23] The key steps of this procedure include excising the cyst and cancerous tissue, removing the hyoid bone, and eliminating the core tissue around the lingual bundle of the thyroid near the blind foramen from the lingual muscle. [24] The latter approach is typically used in cases where there is metastasis of ipsilateral thyroid cancer to the ectopic thyroid gland within the ipsilateral thyroglossal hyoid bone or in the presence of multiple thyroid cancers.…”

Individual treatment strategy of thyroglossal duct cyst carcinoma: a case report

“…The classic Sistrunk surgery began to be performed in 1920, and comprises resection of the thyroglossal duct cyst, fistula tract, middle segment of the hyoid bone and surrounding tissue of the tongue muscle (18). At present, Sistrunk surgery has become the standard surgical treatment for thyroglossal duct cyst and can reduce the recurrence rate to 3% (19). As malignancies in thyroglossal duct cysts are rarely identified preoperatively, most thyroglossal duct carcinomas are initially treated surgically as benign tumor.…”

Papillary thyroid carcinoma in thyroglossal duct cyst: a review article

“…Карциномът на тиреоглосния канал е много рядко събитие, с едва неколкостотин докладвани случая в литературата след първото му описание от Брентано през 1911 г. (18). Честотата на първичния карцином в тиреоглосалния канал в литературата варира от 0,7% до 1,6% (19).…”