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Papillary Carcinoma of Thyroglossal
Duct Cyst
Dr. Pawanjit Rohila
Prof. R.K.Karwasra
Deptt. Of Surgery and Surgical Oncology
Pt. BD Sharma PGIMS Rohtak
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Carcinomas of thyroglossal duct cysts are extremelyrare (1.5%)
Papillary.80%
Mixed papillary/follicular9.5%
Squamous cell.7.6%
Others.2.9%
Most of the times the diagnosis is postoperative
There is no clear consensus regarding furthermanagement after adequate excision of the cyst
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40 years old female presented with asymptomatic ,submental,midline swelling for last 5 years, increasing in sizefor last 6 months and increased suddenly after FNAC
6x6x4 cm non-tender, firm mass at the level of hyoid bone Not moving with deglutition and protrusion of tongue
Bilaterally palpable cervical lymph nodes
X-ray STN revealed soft tissue mass anterior to hyoid without
calcifications Patient was euthyroid and thyroid gland was normally located
on ultrasonography
FNAC of the mass reported to be Adenomatous goiter
Case One
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Pre-op Diagnosis : Thyroglossal Duct cyst with hematoma following FNAC
PLAN : Sistrunks procedure with frozen section examination
Operative Findings6x6x5cm mass having blood clots within, adherent
to hyoid and bilateral multiple nodes
Thyroid was normal upon palpation
Sistrunks procedure performed
Tissue sent for Frozen Section Examination
Papillary carcinoma in TGDC with invasion of cyst
wall, LN
+for metastasis
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Total thyroidecectomy with bilateral MRND (type III) performed
Final Histopathology Report Revealed
Papillary Carcinoma in a thyroglossal duct cyst with extracystic extension
Normal thyroid tissue in cyst wall, both lobes of Thyroid
showing normal structure without any focus ofmalignancy
Level II, III, and VI nodes positive for metastasis
I131 SCAN..1.6% UPTAKE
PATIENT REFERRED FOR RADIOABLATION
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2nd Case 24 years old female presented with progressively increasing
asymptomatic midline swelling in sub-mental region for last
1 years and pain in the swelling for last 25 days after FNAC. 44 cms. Firm, non-tender mass above the level of hyoid
bone .
Moving with deglutition and protrusion of tongue without
palpable cervical LAP. Patient was euthyroid and thyroid gland was normally located
on USG.
FNAC of the mass reported to be metastasis from papillarycarcinoma of thyroid.
CECT neck revealed a hypo dense lesion of 4.54 cm withcalcification showing heterogeneous enhancement seen inthe floor of mouth. Few subcentimetric lymph nodes wereseen in bilateral cervical region.
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Pre-op diagnosis : TGDC with Papillary carcinoma
Plan : Sistrunks opn. With Total Thyroidectomy and LN Sampling
Operative findings 4.54 cm Fibrocystic mass above the hyoid bone
adherent to the underlying muscles
Thyroid gland was normal on palpation
A single enlarged level II lymph node on the right side. Few enlarged lymph nodes were excised
Frozen section examination ofLNs revealed reactivehyperplasia
Formal neck dissection not done.
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Total thyroidectomy with Sistrunks operation performed
Final Histopathology Report revealed
Thyroid as unremarkable
Lymph nodes as reactive.
Papillary carcinoma in ectopic thyroid tissue
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No Clear Consensus In LiteratureRegarding Management
Sistrunks Procedure With Thyroid
Suppression
V/STotal Thyroidectomy With MND
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Justifications For Total Thyroidectomy
Any papillary carcinoma in neck originates in thyroidgland
Papillary carcinomas are multifocal in origin
Enables post operative thyroid scan and thyroidablation
Thyroglobulin estimation is more relevant if there is
no thyroidPatient needs thyroid suppression therefore why to
leave the possible culprit behind ?
Procedure is safe and has low morbidity
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Our view
Total thyroidectomy is safe with lowmorbidity
Patient follow-up and management is bettercontrolled after thyroidectomy
Radio ablation is possible only afterthyroidectomy
Patient takes Eltroxin lifelong in either case so
why to leave the possible culprit behind?
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Thanks