P1.087: Papillary Thyroid Cancer Arising in a Thyroglossal Duct Cyst in Children

Introduction: Thyroglossal duct cysts are common congenital anomalies found in approximately 7% of the general population, and less than 1% develop papillary carcinoma. Most cases are diagnosed in adults, but we identified 61 case reports in children with little clarity regarding the need for total thyroidectomy. Here we present 6 pediatric patients with papillary thyroid cancer arising in thyroglossal duct cysts to document clinical and treatment variables and outcomes.

Case Description: All patients had perioperative thyroid ultrasounds showing normal thyroid glands. Cancer was unsuspected in 5 patients. One patient, who had locoregional metastasis diagnosed preoperatively, received a left neck dissection with one positive pretracheal lymph node. No patients required initial or subsequent thyroidectomy. Follow-up included physical exam, chest X-rays, and cervical ultrasound. No patients had a recurrence, and all are NED. Patient data is summarized in the following table.

Discussion: In the available pediatric literature, the management of papillary thyroid carcinoma arising in thyroglossal duct cysts lacks clarity regarding initial total thyroidectomy after Sistrunk procedure. Out of the 61 pediatric cases identified, 31 patients underwent initial total thyroidectomy, but only 4 had concurrent papillary carcinoma of the thyroid gland. Although cancer foci varied from subcentimeter nodules to metastatic locoregional lymph nodes, our cases displayed no thyroid involvement on ultrasonic imaging. None underwent total thyroidectomy, and no recurrence were observed.

Conclusion: Pediatric patients with thyroglossal duct cyst papillary thyroid carcinoma can be managed by the Sistrunk procedure with neck dissection used for clinically evident and pathologic lymph nodes. If perioperative cervical ultrasound shows a normal thyroid gland, total thyroidectomy does not seem to be necessary, even in the presence of locoregional lymph node metastasis.