Thyroid Cancer in Thyroglossal Duct Cysts Requires a Specific Approach due to Its Unpredictable Extension

Abstract

DTC in thyroglossal duct cysts occurs at a younger age and with more aggressive features at presentation. Concomitant cancer in the thyroid and lymph node metastases is present in most cases. Lymph node compartment involvement is different from that of cancers in the thyroid gland. Therefore, surgical treatment should include both thyroglossal duct cyst resection and total thyroidectomy, with individualized surgical nodal dissection. Subsequent management should follow current DTC guidelines.

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

“…Follicular carcinoma, squamous cell carcinoma, and various other histologic types of thyroid epithelial neoplasms have been described but are considered extremely rare [2, 3, 15, 17-20, 22, 23]. TGDC PTCs are morphologically identical to those arising in the thyroid gland and can be recognized by their papillary and or/follicular architecture, the presence of classical PTC nuclear features, and frequently infiltrative pattern of growth [22]. Soft tissue involvement of pericystic soft tissues by tumor is a common finding, observed in 59 % of cases in the present study.…”

“…There is, however, theoretic consideration that these tumors may represent metastases from a primary carcinoma of the thyroid gland [50]. While the presence of a concurrent papillary carcinoma of the thyroid gland has been reported in 17-83 % of patients with TGDCCa who have undergone thyroidectomy [6-14, 21, 22, 25, 26, 28-32, 34, 35], the thyroid gland tumors are microscopic in most instances, and the synchronous neoplasms considered as multifocal independent primary carcinomas [12,16,20,22].…”

“…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.…”

“…The reported incidence of carcinoma occurring in TGDCs ranges from \1 to 19.6 % [5][6][7][8][9][10][11][12][13][14][15][16], although probably more in the 2 % range when referral and academic bias are removed from consideration [4]. The vast majority of TGDC carcinomas (TGDCCa) are papillary thyroid carcinomas (PTCs), thought to originate from the ectopic thyroid gland tissue which is commonly (approximately 70 % of cases) found in association with TGDCs [2,4,7,9,[16][17][18][19][20][21][22]. The clinical presentation of TGDCCa do not differ significantly from that of nonneoplastic TGDC, although a fixed mass is worrisome, with most cases of malignancy diagnosed postoperatively following pathologic evaluation of the lesion [2,17,20,21].…”

“…Currently, the American Joint Committee on Cancer (AJCC) staging (2010) criteria for cancer of thyroid gland tumors is not consistently applied to these tumors and has not been recommended [6,8,20,22,25,26]. This study of a community practice based series of TGDCCa is presented with analysis of histopathologic features and recommendations of the use of staging to alter therapeutic management.…”