presentation natcon oral

8/3/2019 Presentation Natcon Oral

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Papillary Carcinoma of Thyroglossal

Duct Cyst

Dr. Pawanjit Rohila

Prof. R.K.Karwasra

Deptt. Of Surgery and Surgical Oncology

Pt. BD Sharma PGIMS Rohtak


2/13

Carcinomas of thyroglossal duct cysts are extremelyrare (1.5%)

Papillary.80%

Mixed papillary/follicular9.5%

Squamous cell.7.6%

Others.2.9%

Most of the times the diagnosis is postoperative

There is no clear consensus regarding furthermanagement after adequate excision of the cyst


3/13

40 years old female presented with asymptomatic ,submental,midline swelling for last 5 years, increasing in sizefor last 6 months and increased suddenly after FNAC

6x6x4 cm non-tender, firm mass at the level of hyoid bone Not moving with deglutition and protrusion of tongue

Bilaterally palpable cervical lymph nodes

X-ray STN revealed soft tissue mass anterior to hyoid without

calcifications Patient was euthyroid and thyroid gland was normally located

on ultrasonography

FNAC of the mass reported to be Adenomatous goiter

Case One


4/13

Pre-op Diagnosis : Thyroglossal Duct cyst with hematoma following FNAC

PLAN : Sistrunks procedure with frozen section examination

Operative Findings6x6x5cm mass having blood clots within, adherent

to hyoid and bilateral multiple nodes

Thyroid was normal upon palpation

Sistrunks procedure performed

Tissue sent for Frozen Section Examination

Papillary carcinoma in TGDC with invasion of cyst

wall, LN

+for metastasis


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Total thyroidecectomy with bilateral MRND (type III) performed

Final Histopathology Report Revealed

Papillary Carcinoma in a thyroglossal duct cyst with extracystic extension

Normal thyroid tissue in cyst wall, both lobes of Thyroid

showing normal structure without any focus ofmalignancy

Level II, III, and VI nodes positive for metastasis

I131 SCAN..1.6% UPTAKE

PATIENT REFERRED FOR RADIOABLATION


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2nd Case 24 years old female presented with progressively increasing

asymptomatic midline swelling in sub-mental region for last

1 years and pain in the swelling for last 25 days after FNAC. 44 cms. Firm, non-tender mass above the level of hyoid

bone .

Moving with deglutition and protrusion of tongue without

palpable cervical LAP. Patient was euthyroid and thyroid gland was normally located

on USG.

FNAC of the mass reported to be metastasis from papillarycarcinoma of thyroid.

CECT neck revealed a hypo dense lesion of 4.54 cm withcalcification showing heterogeneous enhancement seen inthe floor of mouth. Few subcentimetric lymph nodes wereseen in bilateral cervical region.


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Pre-op diagnosis : TGDC with Papillary carcinoma

Plan : Sistrunks opn. With Total Thyroidectomy and LN Sampling

Operative findings 4.54 cm Fibrocystic mass above the hyoid bone

adherent to the underlying muscles

Thyroid gland was normal on palpation

A single enlarged level II lymph node on the right side. Few enlarged lymph nodes were excised

Frozen section examination ofLNs revealed reactivehyperplasia

Formal neck dissection not done.


8/13

Total thyroidectomy with Sistrunks operation performed

Final Histopathology Report revealed

Thyroid as unremarkable

Lymph nodes as reactive.

Papillary carcinoma in ectopic thyroid tissue


9/13

No Clear Consensus In LiteratureRegarding Management

Sistrunks Procedure With Thyroid

Suppression

V/STotal Thyroidectomy With MND


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Justifications For Total Thyroidectomy

Any papillary carcinoma in neck originates in thyroidgland

Papillary carcinomas are multifocal in origin

Enables post operative thyroid scan and thyroidablation

Thyroglobulin estimation is more relevant if there is

no thyroidPatient needs thyroid suppression therefore why to

leave the possible culprit behind ?

Procedure is safe and has low morbidity


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12/13

Our view

Total thyroidectomy is safe with lowmorbidity

Patient follow-up and management is bettercontrolled after thyroidectomy

Radio ablation is possible only afterthyroidectomy

Patient takes Eltroxin lifelong in either case so

why to leave the possible culprit behind?


13/13

Thanks

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