THYROGLOSSAL DUCT CARCINOMA WITH CERVICAL LYMPH NODE METASTASIS

• Published in: JIBI INKOKA TEMBO Vol. 59; no. 2; pp. 93 - 98
• Main Authors: Fujita, Keigo, Hirano, Takashi, Moriyama, Munehito, Kodama, Satoru, Suzuki, Masashi
• Format: Journal Article
• Language: Japanese
• Published: Society of Oto-rhino-laryngology Tokyo 15.04.2016
• Subjects: metastatic cervical lymph nodes; papillary carcinoma; thyroglossal duct carcinoma
• ISSN: 0386-9687; 1883-6429
• DOI: 10.11453/orltokyo.59.2_93

Thyroglossal duct cyst is one of the most common congenital abnormalities of the cervical region. Complications are rare, although appearance of a carcinoma has been counted as one of the complications. We present the case of a 49-year-old man with a small papillary carcinoma arising in a thyroglossal duct cyst, with cervical lymph node metastasis. He was admitted to another hospital with the diagnosis of a painless anterior neck mass. Neck mass excision was performed, and histopathology of the resected specimen revealed cervical lymph node metastasis from a papillary carcinoma. The patient was referred to our hospital at this time. Contrast-enhanced computed tomography at our hospital showed a heterogeneous mass measuring 8 mm in diameter in the infrahyoid region of the anterior neck, and also suspicious metastatic lymph nodes at level II and level VI in the right neck. FDG-PET/CT revealed a slightly higher uptake in the soft-tissue component of the anterior neck mass, which was located in front of the hyoid bone as compared to the thyroid gland. A Sistrunk operation with central and right modified radical neck dissection was performed. Histopathology of the resected specimen revealed a papillary carcinoma arising from the thyroglossal duct and metastatic papillary carcinoma in the cervical lymph nodes. In our case, thyroglossal duct carcinoma was diagnosed by initial detection of a metastatic papillary carcinoma in the cervical lymph node, although it typically presents as a midline palpable neck mass. It remains controversial whether papillary carcinoma in the thyroglossal duct develops de novo or as a type of metastasis from an occult tumor nidus in the thyroid gland, thyroglossal duct carcinoma may be considered when metastatic papillary carcinoma was identified in the neck lesion.