Thyroglossal Cyst (TGC) and Papillary Thyroid Cancer

Abstract

A 43-year-old lady presented to the OPD with anterior neck swelling with ulceration (Fig. 1). Patient had this anterior neck swelling for 20 years for which she was advised surgery but she did not opt for the same. She planned to seek medical help after the development of ulceration in the swelling. After clinical diagnosis of infected/malignant thyroglossal cyst, imaging and cytology was advised. CECT (Fig. 2a) showed lesion with infiltration into the left belly of digastric and mylohyoid muscle and left submandibular gland infiltration with infiltration of strap muscles with nodule in the right lobe of thyroid measuring 7.5 × 5.2 mm. Cytology from the lesion was Bethesda V: Suspicious for papillary thyroid carcinoma. On CECT discussion preoperatively contrast-enhancing lesion (Fig. 2b) was visible separate from thyroid? enlarged parathyroid (red arrow), hence total calcium and intact PTH were done which were found to be high (s. calcium 10.7 and intact PTH: 357), hence a diagnosis of primary hyperparathyroidism was made. Thereafter patient was planned for total thyroidectomy with sistrunks procedure and parathyroidectomy. Right superior parathyroid was found to be enlarged weighing 1000 mg. There was 50% fall in IOPTH (Miami’s criteria). The cyst was adhered to hyoid cartilage and left submandibular gland, which was removed along with the specimen. Total Thyroidectomy was performed along with sistrunks procedure (Fig. 3). Postoperatively patient developed biochemical and clinical hypocalcemia which was managed by oral calcium and active vitamin D3. Histopathology showed papillary thyroid cancer in thyroglossal cyst with involvement of submandibular gland without any tumor in thyroid gland with BRAF positivity. The patient received 125 mCi radioactive iodine treatment after surgery.

Roma Pradhan is the lead author of this chapter.