Carcinoma of the thyroglossal duct cyst in a 38-year-old male patient is presented herein reviewingliteratures. The cysticmass, 2 × 2.5 × 3 cm. in size, was located in the midline of the neck below the hyoid bone and was easily excised without any troubles, since there were no invasion into surrounding tissues and lymph node metastases. Microscopically, foci of papillary carcinoma were scattered on the inner surface of the posterior wall of the cystic mass. The patient has been well ten months after surgery.論文http://purl.org/coar/resource_type/c_650

Hidaka, Osamu

Koga, Shinichiro

Muto, Yoshihiro

Satomi, Akira

Sho, Yoshiyuki

English

University of the Ryukyus Repository

琉球大学学術リポジトリ[症例報告]Carcinoma of the Thyroglossal DuctCyst : A Case Report and a Brief Review ofLiteratures言語: English出版者: 琉球大学医学部公開日: 2010-06-30キーワード (Ja): キーワード (En): thyroglossal duct cyst, papillarycarcinoma, surgical treatment作成者: Koga, Shinichiro, Muto, Yoshihiro, Satomi,Akira, Hidaka, Osamu, Sho, Yoshiyukiメールアドレス: 所属: メタデータhttp://hdl.handle.net/20.500.12000/0002015638URLRyukyu Med. J, 7(1): 45-50, 1984.Carcinoma of the Thyroglossal Duct Cyst: ACaseReport and a Brief Reviewof LiteraturesShinichiro Koga, Yoshihiro Muto, Akira SatomiOsamu Hidaka and Yoshiyuki ShoThe First Department of Surgery, School of Medicine,University of the RyukyusKey words : thyroglossal duct cyst, papillary carcinoma, surgical treatmentAbstractCarcinoma of the thyroglossal duct cyst in a　38-year・old male patient is presented hereinreviewingliteratures. The cysticmass, 2　×　2.5　×　3 cm. in size, was located in the midlineof the neck below the hyoid bone and was easily excised without any troubles, since there wereno invasion into surrounding tissues and lymph node metastases. Microscopically, foci of papillarycarcinoma were scattered on the inner surface of the posterior wall of the cystic mass. Thepatient has been well ten months after surgery.IntroductionBenign thyroglossal duct remnants ( cysts, fistulae and masses ) are occasionallyencountered in the clinical practice at the large hospital, but carcinoma arising from thethyroglossal duct remnant is a rare entity. Following the first reported case in 1915,about 100 cases of carcinoma originating in the thyroglossal duct remnant have beendocumented in Europe and America1-21, and several instances in Japan have been reportedin literatures.In this paper, a case with carcinoma of the thyroglossal duct cyst surgically treatedby us at the Ryukyu University Hospital is presented reviewing literatures on incidence,histologic characteristics and rationale for the treatment of this malignant lesion.Case ReportA 38-year-old man was admitted at the Ryukyu University Hospital on September6, 1983 with a four-yearhistory of a slowevolution of a cysticmass in the midlineof the neck. There were no symptoms associated with the mass.A cysticmass, about 2.5cm, in size, was palpable in the midline of the neckjustbelow the hyoid bone. The thyroid gland was found to be essentially normal,, inHiShimchiro koga, et al.palpation with no abnormality of thyroid scintigram. There was no cervicallymphadenopathy. Ultrasonography revealed a cystic lesion with hyperechogenic areas inthe mass, suggestive of calcification of the cyst wall.It was diagnostic of a benign thyroglossal duct cyst preoperatively, and simpleexcision of the cystic mass was carried out on September　20. The cystic mass waslocated in the midline of the neckjustbelow the hyoid bone and attached to the hyoidbone by a fibrousstalk. The mass was easilyremoved and found to be not associatedwith the thyroid gland. The regional lymph nodes were not enlarged.The excisedcysticmass was　2　×　2.5　×　3　cm. in size. The outersurface of themass was smooth and it contained yellow-brown and turbid fluid. However, a thickand shaggy lesion on the inner surface of the posterior wall, which was four times asthick as the anterior wall, was found.Histologically, the epithelial lining on the inner surface of the cyst wall was entirelydesquamated. The cyst wall was almost composed of fibrous to hyalinized connectivetissue, however scattered foci of papillary carcinoma identical to carcinoma of thethyroid gland were evident on the shaggy posterior wall. Calcification was also scatteredon the inner surface of the wall ( Fig. 1 ). The tumor cells were cuboid with slight cellularand nuclear pleomorphism. The each tumor cell was arranged in a layer and hyalinizedconnective tissues were projected into the lumen of the cyst ( Fig. 2 ). Areas of irregularcalcification were found in the connective tissue stalk.Fig. 1. Schematic illustration of cross section of the specimenPapillary carcinoma ( striped ) shows infiltration into the cyst wall ( white arrows ) and is notedwithin the confines of the cyst wall. Calcification ( black ) and normal thyroid tissue ( blackarrow ) are present.Thyroglossal duct carcinoma47Fig. 2. Microscopic findings of papillary carcinomaPapillary projections of carcinoma is noted. The stalk is thickened, hyalinized and partiallycalcified ( top ). Invasion of carcinoma in follicular pattern into the cyst wall is demonstrated(bottom) (HE, ×100).Invasive follicular carcinoma was also evident in the cyst wall. The tumor cellsshowed more cellularity and pleomorphism. A few normal thyroid tissues with colloid werepresent`′ in the cyst wall( Fig. 3 ).The postoperative course was uneventful and the patient has been well ten monthsafter operation.48Shinichiro koga, et al.Fig. 3. Microscopic findings of carcinoma and normal thyroid glandInvasive carcinoma is of follicular type with cellularity and pleomorphism ( top ).ルThe. normalthyroid follicles are filled with colloid ( bottom ) (HE, × 200 ),DiscussionSurveying literatures3トin Japan, up to March 1984, 6 cases of carcinoma arisingfrom the thyroglossal duct remnant, including our case, were acceptable for clinical andpathological analysis.Patientswere seen from ll to 66 yearswith an average of 35 years and frequentlyin the third decade. Al仙ough several cases in children under 10 years of age have beenThyroglossal duct carcinoma49documented in Europe and America2', none of cases under 10 years have been reportedin Japan3'-7'. In Japanesecases, the disease was uncommon in men, only one of sixbeing male patient, while no distinct predominance of female was demonstrated inEurope and America. All of the patients were asymptomatic.The mass was located in the midline of the neckjust below the hyoidbone inthe majority of cases, but in one instance the mass was present above the hyoid bone.The size of the tumorsrangedfrom 2 to 6 cm. with an average of 3.6 cm. The durationof the history of slowevolution of the mass was one month to 4 yearsbefore operationin Japanese cases, while it was longerthan one year, in some cases up to 15　years,in Europe and Americal'21.The lesion was usually cystic and was filled with yellowto brownish fluid, exceptfor a case in which it was solid. The gross feature of the lesion was closelysimilarto the appearance of benign thyroglossal duct cyst. Therefore, it is usually difficult tomake a definite diagnosis of carcinoma of the thyroglossal duct cyst. In the majorityof cases, however, small nodules or papillary projections from the. cyst wall were notedby careful examination of the specimen.Microscopically, the type of carcinoma was papillary carcinoma in all cases inJapan, while adenocarcinoma, squamous cell carcinoma and anaplastic carcinoma wererarely found in Europe and America"2'8'9'In regard with the diagnostic criteriae for carcinoma of the thyroglossal ductremnant, the following conditions have been proposed81; 1) no other carcinomas, 2)presence of carcinoma in the location of the thyroglossal duct remnants, 3)demonstration of normal thyroid tissue in the cyst wall not in continuity with the thyroidgland, and 4) evidence pf carcinoma invasion into the surrounding tissue. In our instance,carcinoma was confined in the cyst wall in which the normal thyroid tissues andinvasive foci of carcinoma into the outer layer of the cyst wall were evident. Accordingly,our case fulfilled these critenae.The histological diagnosis of the thyroglossal duct remnant depends upon thedemonstration of both thyroglossal duct epithelium and thyroid tissue in the cyst wall.There are two epithelial components present in the thyroglossal remenants. Therefore,the origin of thyroglossal duct carcinoma may be two sources; the one arising fromthe duct epithelium ( cuboid to columnar, squamous ), the other from the thyroid tissuein the cyst wall. In the former the histologic type is adenocarcinoma or squamous cellcarcinoma, in the latter papillary or follicular carcinoma identical to carcinomas of thethyroid gland. The most common type of carcinoma was papillary or follicularcarcinoma originating in the thyroid tissue in the cyst wall. Although Nussbaum et al.9>porposed that papillary carcinoma of the thyroglossal duct remnant represented metastaticlesion of the thyroid gland, these cases reported as thyroglossal duct carcinoma fulfill theaforementioned diagnostic characteristics and support primary carcinoma originating inthe thyroglossal duct.Preoperatively, the lesion was diagnosed to be a benign thyroglossal duct remnantsin almost all of cases. Accordingly, the initial operation was excision of the cyst in50Shinichiro koga, et al.all patients except several patients who had thyroidectomy and nodal dissections.Concerning surgical treatment, it is widely accepted that when也ere is no evidence ofextension of carcinoma beyond the cyst wall, excision of the cyst is of choice andfurther surgical intervention is not indicated, since postoperative prognosis in such casesis favorable without recurrences.References1) Hans, S.S., Lee, P.T. and Prodtor, B. : Carcinoma arising in thyroglossal duct remnants.Am. Surg. 42 : 773-777, 1976.2) Roses, D.F., Snively, S.L., Phelps, R.G., Cohen, N. and Blum, M. : Carcinoma of thethyroglossal duct, Am. T. Surg. 145 : 266-269, 1983.3) Yoda, M. and Ishikawa, T. : A case of thyroglossal mass with malignant feature. HormoneChn. 12 : 188, 1964 (in Japanese ).4) Kaneko, H∴ A ca串of malignantgoiter of a girl. KitakantoIgaku 15: 478-481, 1965 (in Japanese ).5) Nagafnine, N., Miyagi, Y. and Sho, Y. : A case of carcinoma arising in the thyroglossalduct remnants : a case report and review of the literature. J. Clin. Cancer　22 : 793-798,1979 ( in Japanese ).6) Inuyama, S., Takasaki, T., Ozu, R., Kawashiro, N., and Inuyama, N∴ papillaryadenocarcinoma arising from the remnants of the thyroglossal duct, a case report. J.Otolaryngol. 49 : 635-637, 1977 ( in Japanese with English abstract ).7) Yoshida, A., Kubota, T., Kaku, M., Matsui, K., Shimono, T. and Sakugawa. H.Carcinoma in thyroglossal duct remnants. J. Otolaryngol. 54 : 935-936, 1982 ( in Japanesewith English abstract ).8) White, L.L. and Talbert, W.M. : Sguamous cell carcinoma arising in thyroglossal ductremnant epithelium. OtolarYngol. Head Neck Surg. 90 : 25-31, 1982.9) Nussbaum, M., Buchwald, R.P., Ribner, A., Mori, K. and Litwins, J. : Anaplastic carcinomaarising from median ectopic thyroid ( thyroglossal duct remnant ). Cancer 48 : 2724-2718, 1981.

[症例報告]Carcinoma of the Thyroglossal Duct Cyst : A Case Report and a Brief Review of Literatures

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[症例報告]Carcinoma of the Thyroglossal Duct Cyst : A Case Report and a Brief Review of Literatures

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