A Rare Case Report of Thyroglossal Duct Cyst Carcinoma Coexisting with Thyroid Carcinoma in an Adolescent.

IF 0.4 Q4 OTORHINOLARYNGOLOGY
Kleanthi Mylopotamitaki, Dionisios Klonaris, Georgios Kazamias, Christos Simandirakis, Irene Vourliotaki, Efthimios Karakostas
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Abstract

Background: Thyroglossal duct cysts (TDC) represent approximately 70% of all congenital neck masses, and up to 1% of them contain thyroid tissue malignancies. Clinical presentation of TDC carcinomas is usually indistinguishable from benign tumors preoperatively, and differential diagnosis can be challenging. We present a rare case of TDC carcinoma concurrent with thyroid cancer in an adolescent. Case Presentation. A 16-year-old Caucasian female, otherwise healthy, was referred with a painless, gradually expanding lump on the neck. Physical examination revealed a well-circumscribed, moderately hard, tender mass of the anterior neck midline anteroinferior to the hyoid bone. Imaging findings suggested TDC as the most likely diagnosis. The patient had a Sistrunk procedure under general anesthesia. Histopathological findings diagnosed a BRAFV600E-positive papillary thyroid carcinoma (PTC) in a TDC. A thyroid gland and neck ultrasound revealed a highly suspicious finding for malignancy right level VI lymph node, which was not confirmed by fine needle aspiration cytology (FNAC). Under general anesthesia, total thyroidectomy and central compartment lymph node neck dissection were performed. Histopathological findings revealed a thyroid parenchymal locus of PTC, as well as three lymph nodes infiltrated by PTC. The patient received adjuvant radioactive iodine ablation (RAI) therapy and is closely followed.

Conclusion: TDC carcinomas in conjunction with thyroid carcinomas in young patients are rare. Preoperative diagnosis can be challenging, as the vast majority of neck masses in young patients are benign in nature, and most malignant tumors lack specific clinical features. The diagnostic accuracy of FNAC is considered unsatisfactory due to its frequently cystic nature. Definitive diagnosis is based on histopathological findings. Clinicians should maintain a high level of suspicion for coexisting thyroid malignancies. Although surgical extirpation of the malignancy is considered standard of care, the treatment of TDC cancer should always be individualized by a multidisciplinary team.

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青少年甲状腺舌管囊肿癌合并甲状腺癌1例。
背景:甲状腺舌管囊肿(TDC)约占所有先天性颈部肿块的70%,其中高达1%包含甲状腺组织恶性肿瘤。术前TDC癌的临床表现通常与良性肿瘤难以区分,鉴别诊断具有挑战性。我们报告一例罕见的青少年TDC癌合并甲状腺癌的病例。案例演示。一位16岁的白人女性,其他方面健康,因颈部无痛,逐渐扩大的肿块而被转诊。体格检查发现在舌骨前中线处有一个边界清晰、中等硬度、柔软的肿块。影像学结果提示TDC是最可能的诊断。病人在全身麻醉下做了希斯特伦克手术。组织病理学结果诊断为TDC的brafv600e阳性甲状腺乳头状癌(PTC)。甲状腺和颈部超声显示高度可疑的右六层淋巴结,细针穿刺细胞学(FNAC)未证实。全麻下行甲状腺全切除术及中央室淋巴结颈部清扫术。组织病理结果显示甲状腺实质有PTC,并有3个淋巴结被PTC浸润。患者接受辅助放射性碘消融(RAI)治疗并密切随访。结论:TDC癌合并甲状腺癌在年轻患者中罕见。术前诊断可能具有挑战性,因为绝大多数年轻患者的颈部肿块本质上是良性的,而大多数恶性肿瘤缺乏特定的临床特征。由于FNAC常呈囊性,其诊断准确性不理想。最终诊断基于组织病理学结果。临床医生应该对共存的甲状腺恶性肿瘤保持高度的怀疑。虽然手术切除恶性肿瘤被认为是标准的护理,但TDC癌症的治疗应始终由多学科团队进行个体化治疗。
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来源期刊
Case Reports in Otolaryngology
Case Reports in Otolaryngology OTORHINOLARYNGOLOGY-
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20
审稿时长
13 weeks
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