Primary thyroglossal duct cyst papillary carcinoma. Case report and literature review

Abstract

Aim: Primary papillary carcinoma in a thyroglossal duct cyst (PTGDPC) is a rare pathological condition diagnosed in only 1–2% of the cases of midline neck cysts. Diagnosis is most commonly made postoperatively after the cyst is dissected by Sistrunk’s operation. There is a lot of controversy over the definitive management of PTGDPC and the proper therapeutic approach to it especially when we consider using total thyroidectomy and subsequent adjuvant radioiodine therapy in the treatment. We report a case of papillary carcinoma in a thyroglossal duct cyst and review the relevant literature to clarify what algorithm should a clinician apply in such cases.
Materials and methods: We present a case of a 38-year-old woman with papillary carcinoma arising from a cyst in ductus thyroglossus which was histologically identified after Sistrunk’s operation. We discuss also the pathogenesis of papillary carcinoma in a thyroglossal duct cyst and the need to perform thyroidectomy.
Results: The patient (T. C.) was a 38-year-old woman hospitalized in the Clinic of Otorhinolaryngology at St. George University Hospital in Plovdiv with a diagnosis of midline neck cyst confirmed by neck computed tomography and ultrasound. Sistrunk’s procedure was used for the patient who was shown by postoperative histology and repeat verification to have papillary carcinoma. The patient’s thyroid was examined scintigraphically yielding inconclusive evidence for neoplasm and then removed by thyroidectomy. No synchronous papillary carcinoma in the thyroid gland was identified. The histology showed nodular colloid goitre. The patient received postoperatively radioactive iodine (I-131) therapy and hormone-replacement therapy with L-thyroxin.
Conclusions: We have found total thyroidectomy to be rather controversial
approach to managing papillary carcinoma in a thyroglossal duct cyst. Accurate identification of a possible primary focal area in the thyroid gland followed by total thyroidectomy in conjunction with I-131 ablation and hormone replacement therapy seem far more appropriate in such cases.