Ryan E Nelson1, Hassan Ahmad2, Douglas M Hildrew3, Claire M Lawlor3, Rizwan Aslam1, Andrew Sholl4, Emad Kandil5. 1. Department of Otolaryngology - Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA. 2. Department of Otolaryngology - Head and Neck Surgery, Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, IL. 3. Department of Otolaryngology - Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA ; Department of Otolaryngology - Head and Neck Surgery, Ochsner Clinic Foundation, New Orleans, LA. 4. Department of Pathology and Laboratory Medicine, Tulane University School of Medicine, New Orleans, LA. 5. Department of Surgery - Endocrine and Oncologic Surgery, Tulane University School of Medicine, New Orleans, LA.
Abstract
BACKGROUND: The thyroglossal duct fails to involute in up to 7% of adults, creating a thyroglossal duct remnant (TGDR) attached to the hyoid bone. Thyroid malignancies have been reported in approximately 1% of TGDRs. In previous reports of TGDR carcinoma, patients had radiographic evidence of a TGDR at initial clinical presentation. Alternatively, hypertrophy of a TGDR is well described in patients with hypothyroidism because of the growth of functional ectopic thyroid tissue. We present the case of a patient who had no radiographic evidence of a TGDR prior to thyroidectomy but presented 14 months after surgery with a recurrent cervical mass. CASE REPORT: A 58-year-old female underwent total thyroidectomy for micropapillary thyroid cancer. Fourteen months later, she presented with an enlarging cervical mass. She underwent a Sistrunk procedure, and surgical pathology revealed a TGDR with compensatory glandular hypertrophy. CONCLUSION: To our knowledge, this is the first report of a TGDR follicular adenoma initially appearing as a result of compensatory thyroid glandular hypertrophy following total thyroidectomy for a micropapillary thyroid carcinoma. Our case presented a novel clinical dilemma regarding the best management for a patient with a new TGDR along with a recent history of micropapillary thyroid cancer.
BACKGROUND: The thyroglossal duct fails to involute in up to 7% of adults, creating a thyroglossal duct remnant (TGDR) attached to the hyoid bone. Thyroid malignancies have been reported in approximately 1% of TGDRs. In previous reports of TGDR carcinoma, patients had radiographic evidence of a TGDR at initial clinical presentation. Alternatively, hypertrophy of a TGDR is well described in patients with hypothyroidism because of the growth of functional ectopic thyroid tissue. We present the case of a patient who had no radiographic evidence of a TGDR prior to thyroidectomy but presented 14 months after surgery with a recurrent cervical mass. CASE REPORT: A 58-year-old female underwent total thyroidectomy for micropapillary thyroid cancer. Fourteen months later, she presented with an enlarging cervical mass. She underwent a Sistrunk procedure, and surgical pathology revealed a TGDR with compensatory glandular hypertrophy. CONCLUSION: To our knowledge, this is the first report of a TGDR follicular adenoma initially appearing as a result of compensatory thyroid glandular hypertrophy following total thyroidectomy for a micropapillary thyroid carcinoma. Our case presented a novel clinical dilemma regarding the best management for a patient with a new TGDR along with a recent history of micropapillary thyroid cancer.
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