Papillary carcinoma in a thyroglossal duct remnant: A case report and discussion on management

ObjectiveThyroglossal duct carcinoma is a malignant tumor arising within a thyroglossal remnant. It is a rare entity, seen generally in adults, and characterized by relatively non-aggressive behavior. This case is presented because of its rarity and the presence of cervical lymph node metastasis.Case reportA 37-year-old female patient presented with a slowly and progressively growing mid-line neck mass. Neck ultrasound and computed tomography scanning revealed a mid-line sub-mental pre-hyoid highly enhancing neck mass, bilateral cervical lymphadenopathy, and tiny nodules in both lobes of the thyroid gland. Fine needle aspiration cytology of the neck mass revealed papillary thyroid carcinoma. The patient underwent total thyroidectomy, Sistrunk procedure, bilateral level I–IV neck dissection, and postoperative I131 ablation and hormonal suppression with thyroxine. The patient has been disease free for 1 year after the operation.ConclusionComputed tomography scanning and fine-needle aspiration cytology enhance the preoperative diagnosis. Sistrunk procedure is the standard treatment with a clinically and radiologically normal thyroid gland, while the more aggressive treatment is necessary in advanced cases. The concept of prognostic risk groups should be used to identify patients who would need a more aggressive approach. The prognosis is generally excellent with adequate treatment.