Shahid Jamal, Nadira Mamoon, Muhammad Luqman.
Thyroglossal duct Carcinoma.
J Coll Physicians Surg Pak Jan ;12(12):755-9.

The thyroglossal duct lesions are usually benign, the malignant lesions are very rare. We came across one such case where the patient presented as a small nodule in front of neck. The clinical and per-operative diagnosis was of a benign thyroglossal duct cyst. On histopathological examination it was found to be a papillary carcinoma.

Case Report: A 43 years old male, who was a known diabetic and hypertensive, reported to the surgical specialist. He presented with a swelling in the front of neck. The swelling was 2 x1.5 cms in size, mobile, well-circumscribed and cystic in nature. The swelling moved with swallowing and on protrusion of tongue. A clinical diagnosis of thyroglossal duct cyst was made and excision of the cyst was planned. Per-operatively a cyst was detected which was excised completely. On gross examination the specimen was well-circumscribed nodular measuring 2 x 1.5x1 cms. Its cut-surface showed a cystic space measuring 1.2 cms in diameter. The cyst wall showed a few irregular gray white areas with focal protrusion inside the cyst cavity. Several representative sections were taken. The material was processed in automatic tissue processor (Sakura, Japan), embedded in paraffin and 3-5m sections were cut. The sections were stained with haemotoxylin and eosin (H&E). On microscopy, there was a cyst wall composed of fibrocollagenous tissue with a few lymphoid aggregates. There were congested blood vessels. The lining of the wall in some areas showed proliferation of atypical cells. The nuclei were optically clear and some cells had grooved nuclei. There were many well-formed papillary structures. These types of papillary process were present in the wall as well as extending into the cyst cavity. Occasional mitoses and Psammoma bodies were present. The diagnosis of papillary carcinoma of the thyroglossal duct cyst was made. Considering the rare diagnosis, second opinion of two other histopathologists was sought who concurred with our diagnosis. The patient was then thoroughly evaluated for any residual tumour by isotopic thyroid scan and CT scan but no other tumour deposit was found in the main thyroid gland. Total thyroidectomy was done and ablation of the thyroid remnants with radioactive iodine was performed. Patient was put on suppressive doses of thyroxin and 6 months follow up with I131, whole body scan and thyroglobulin level. The patient was symptom-free and follow up investigations were within normal limits till 1x1/2 years.

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