Thyroglossal duct cyst carcinoma: A case report about diagnostic and surgical challenges

A thyroglossal duct cyst (TGDC) is the most common congenital midline neck mass, resulting from the incomplete obliteration of the thyroglossal duct during embryogenesis. Although typically presenting in childhood, TGDCs can remain asymptomatic and manifest later in life. Proper diagnosis is crucial to avoid unnecessary interventions and complications.

We report the case of a 26-year-old South Asian male who presented with a painless, fluctuant midline neck swelling that had progressively enlarged over the past few months. Clinical examination revealed a well-defined, mobile mass at the level of the hyoid bone that exhibited upward movement with tongue protrusion, a hallmark feature of TGDC. Ultrasound confirmed a cystic lesion, and fine-needle aspiration ruled out any malignant features. The patient underwent successful surgical excision via the Sistrunk procedure, which involves the removal of the cyst along with the central portion of the hyoid bone to minimize recurrence. Postoperative recovery was uneventful. Histopathology report revealed a unifocal tumor and after MDT's discussion total thyroidectomy was planned. Patient was asked to follow-up for radiation therapy afterwards.

TGDCs can present at any age and should be considered in the evaluation of midline neck masses. A thorough clinical assessment, supported by imaging, is crucial for accurate diagnosis. The Sistrunk procedure remains the gold standard for treatment, significantly reducing the risk of recurrence. In cases with suspicious features or malignancy, total thyroidectomy may be necessary for complete disease management. Early identification and appropriate intervention improve patient outcomes.