Squamous cell carcinoma in a thyroglossal duct cyst (TGDC): clinical presentation, diagnosis, and management

Squamous cell carcinoma arising in a TGDC is a rare event, and a high index of suspicion is therefore needed for reaching a correct preoperative diagnosis to plan adequate therapy. The work-up should include fine needle aspiration cytology and high-resolution CT scan. The recommended therapy is adequate wide resection with frozen section control of the surgical margins. For localized lesions within the TGDC (diagnosed as an incidental histological finding), the Sistrunk operation is adequate. If, however, the tumor invades surrounding structures, wider resections (which may include strap muscles, thyroid, larynx, or base of tongue) are recommended. Neck dissection is reserved for cases with nodal metastasis. There is no role for prophylactic neck dissections except perhaps for the paratracheal nodes. Postoperative radiation therapy is recommended for larger lesions, positive surgical margins, or extensive nodal disease. Strict follow-up is recommended for prolonged periods of time, because local recurrences are common and could occur many years after the initial treatment.