Endocrine Abstracts (2008) 15 P80

An unusually large thyroglossal cyst harbouring a papillary thyroid cancer

Laila Parvanta1, Dan Berney2, Polly Richards3, Scott Akker4 & Robert Carpenter1

Departments of 1Breast and Endocrine Surgery, 2Histopathology; 3Radiology and 4Endocrinology, St Bartholomew’s Hospital, London, UK.

A 24-year-old girl was referred with a massive thyroglossal duct cyst (TGDC) and an intra-cystic papillary thyroid cancer (PTC). The impressive clinical photographs, striking radiological images and histology slides are presented.

She presented eight and half months post partum with a 10 cm midline neck lump of 4 years duration. She was asymptomatic and was on levothyroxine for Hashimoto’s thyroiditis.

Clinically, there was a cystic mass extending from just above the level of the hyoid bone to the sternal notch. Ultrasound of the neck showed a long cystic structure lying to the right of the midline, deep to the strap muscles, likely to be a TGDC. Within the cyst there was a 1.5 cm solid papillomatous lesion, with features suspicious of PTC. There were no intrathyroidal lesions. The cervical lymph nodes were unremarkable. MRI of the neck revealed a complex multilobulated, partly septated cyst. Within the superior pole, an avidly enhancing lesion likely to represent a PTC was seen, corresponding to the ultrasound.

A fine needle aspiration would have required percutaneous drainage of the TGDC to improve cytological yield. Potentially this may have compromised complete surgical excision. Therefore, a Sistrunk procedure was performed, with the TGDC removed intact together with the body of the hyoid bone. Histology revealed a 9 cm long TGDC with an intra-cystic 1.2 cm PTC. No normal thyroid tissue was identified and excision was complete.

Due to the size of the PTC and the presence of Hashimotos’s thyroiditis, a total thyroidectomy was performed prior to receiving radioiodine ablation therapy.

The presence of PTC within TGDCs is recognised and occurs in approximately 1%. The management remains somewhat controversial with regards to thyroidectomy and radioiodine ablation. This TGDC was unusual due to its size and complexity, as well as the presence of Hashimoto’s thyroiditis.

Article tools

My recent searches

No recent searches.