Papillary Carcinoma Arising In A Thyroglossal Duct Cyst: Diagnostic Pitfalls And Surgical Decision-Making

Abstract

The most prevalent congenital midline neck masses are thyroglossal duct cysts (TGDCs), which are commonly benign. Only 1% to 2% of cases progress to malignant transformation, of which papillary carcinoma is of the most prevalent histological subtype. The best course of action for surgery, especially the role of a total thyroidectomy, is still up for debate, and preoperative diagnosis is difficult. A 25-year-old woman arrived with a gradually growing midline neck Swelling that was painless. Imaging revealed a cystic lesion with microcalcifications and an increasing intracystic solid component. Papillary cancer was suspected by fine-needle aspiration cytology (Bethesda V). FDG PET-CT revealed intense uptake within the intracystic solid component without evidence of thyroid or nodal involvement. The patient had underwent Sistrunk procedure with total thyroidectomy . Histopathology showed no thyroid gland malignancy, thyroid follicles inside the cyst wall, and conventional papillary carcinoma coming from the cyst wall of the thyroglossal duct. There were Negative surgical margins. It is rare for papillary cancer to develop in a TGDC, and it is usually discovered after surgery. The diagnostic difficulties and the justification for customized surgical decision-making are demonstrated by this example. Some people with a history of cytological suspicion of cancer may benefit from a total thyroidectomy to help with surveillance, even if there is no visible thyroid involvement.