Thyroglossal duct cyst carcinoma: case series

Background: Thyroglossal duct (TGD) carcinoma occurs in about 1 to 2% of TGD cysts. Preoperative diagnosis is difficult, and consensus on optimal treatment is lacking. Methods: All patients who underwent surgical treatment of a TGD cyst at our institution, a tertiary centre, were reviewed and TGD carcinoma was identified. Clinicopathologic and follow-up information was examined. Results: Among the 139 patients treated for TGD cysts, 9 patients (6.5%) had a TGD carcinoma. All were papillary carcinoma. There was a female predominance, and the median age at diagnosis was 44 years. The median follow-up was 6.7 years. All patients underwent a Sistrunk procedure. A total thyroidectomy was performed in eight of nine patients. The median size of the TGD carcinomas was 10 mm. Two patients underwent therapeutic neck dissection at the time of the total thyroidectomy. Two patients experienced a recurrence regionally on follow-up. Eight of nine patients received radioactive iodine therapy and suppressive doses of thyroxine. Conclusions: Strong conclusions are difficult to draw owing to the rarity of the disease. However, management should be similar to that of differentiated thyroid cancer and based on risk group stratification. An ultrasound-guided fine-needle biopsy is a valuable test in every patient with a suspicion of TGD cyst. A diagnosis of TGD carcinoma should prompt evaluation of the thyroid gland and cervical lymph nodes bilaterally. A Sistrunk procedure is the minimum therapeutic procedure, coupled with a total thyroidectomy for higher-risk cancers.