Papillary carcinoma in a thyroglossal duct remnant. Three case reports and discussion on management

To report three cases of papillary thyroglossal duct carcinoma (TDCa), and to discuss the diagnostic and therapeutic methods.

We studied the clinical, pathological findings of the tumor, treatment and outcome data on 3 patients treated at our Institution for a papillary TDCa carcinoma and we compared the results with the published cases. Preoperative Fine Needle Aspiration (FNA) and intraoperative frozen section exam was performed in patients 1 and 2. Following the Sistrunk operation (SO), limited thyroidectomy were performed on patients 1 and 2, due to benign lesion. Neck dissections were performed on patients 2 and 3 (second operation after initial SO in other Institute), due to regional lymphadenopathy. The diagnosis of papillary TDCa was confirmed in all cases. Lymph nodes metastases were identified in patients 2 and 3. All patients were treated with levothyroxine therapy. After a median follow-up of 59 months, all patients are alive without recurrence.

Papillary TDCa is a rare malignancy with excellent prognosis. FNA and intraoperative frozen section exam are the most useful methods for confirmatory diagnosis. Resection of the thyroglossal duct carcinoma by the Sistrunk operation is an adequate surgical approach. Further thyroidectomy should be limited to one either lobe or pyramidal lobe in high risk patients. Total thyroidectomy is recommended only when there is clinical evidence of multifocal malignancy in thyroid gland. Postoperative hormone suppression is advocated.