CARCINOMA OF THYROGLOSSAL DUCT REMNANTS - REPORT OF 3 CASES AND A REVIEW OF THE LITERATURE

Neoplastic transformation in thyroglossal duct (TCD) remnants is estim ated to occur in about 1% of TGD cysts, with a total of 243 cases repo rted in the literature. Three new cases and a review of the literature are presented. All cases of TGD cysts at Indiana University Medical C enter between 1981 and 1994 were examined. Of 70 cases of TGD cysts, 3 were found to have TGD carcinomas (papillary carcinoma [2] and follic ular carcinoma [1]). The latter is the sixth reported case. About 80% of the reported cases were papillary thyroid carcinomas. In most cases of TGD carcinoma, the diagnosis was not clinically apparent. Few repo rts emphasize the role of needle aspiration and imaging procedures in the preoperative diagnosis of these tumors, The Sistrunk procedure is the standard treatment of TGD carcinoma; the need for thyroidectomy, h owever, remains controversial. Recommendations for management include: 1) fine needle aspiration, as appropriate for presurgical evaluation; 2) the Sistrunk procedure alone when the diagnosis is papillary carci noma and there is no clinical, or radiologic evidence of thyroid gland involvement; 3) total thyroidectomy and radioactive iodine therapy fo r TGD follicular carcinoma; and 4) long-term thyroid hormone suppressi ve therapy in all cases.