Hartl Dana M, Al Ghuzlan Abir, Chami Linda, Leboulleux Sophie, Schlumberger Martin, Travagli Jean-Paul
Department of Otolaryngology Head and Neck Surgery, Institut Gustave Roussy, Villejuif, France.
Ann Surg Oncol. 2009 Sep;16(9):2595-601. doi: 10.1245/s10434-009-0571-9. Epub 2009 Jun 30.
The incidence of cancer in thyroglossal duct cysts (TDC) is low and management is controversial. The objective was to report the rate of multifocality, lymph node metastases, and long-term results for TDC carcinomas in adults.
Files from 1979 to 2008 were reviewed for tumor stage, multifocality in the lobes, lymph node metastases, treatment, and follow-up.
A total of 18 patients (13 females, 5 males, average age 41.5 years) were treated for papillary carcinoma arising in a TDC. Of these, 15 underwent total thyroidectomy, 1 isthmusectomy and 2 a Sistrunk procedure only. Also, 16 patients underwent neck dissection of the central and/or lateral compartments. Tumors were staged pT1 (n = 15), pT3 (n = 3), pN0 (n = 4), pN1a (n = 3), pN1b (n = 9), Nx (n = 2), M0 (n = 17), and M1 (n = 1, lung metastases). Tumor foci were found in the thyroid lobes in 9 of 16 patients(56%). Lymph node metastases were found in 12 of 16 (75%). Nodes were positive in 6 of 15 central compartment dissections (40%) and in 9 of 15 lateral neck dissections (60%). Metastases to the lateral compartment, with no central compartment metastasis, were found in 6 of 15 patients (40%). Radioiodine was administered to 12 patients. Median follow-up was 12 years (range 1-22 years). All had negative ultrasound. Stimulated Tg levels available for 11 patients were undetectable for 10 and 2 ng/mL for the remaining patient.
This series shows a high rate of thyroid lobe foci and lymph node metastases but an excellent long-term outcome, characteristics shared with classic papillary carcinoma. Lateral neck metastases seem to be more frequent. These findings are in favor of following the current guidelines for differentiated thyroid cancer in general for the treatment of these rare tumors.
甲状舌管囊肿（TDC）中癌症的发病率较低，其治疗存在争议。目的是报告成人TDC癌的多灶性发生率、淋巴结转移情况及长期结果。
回顾1979年至2008年的病例资料，分析肿瘤分期、叶内多灶性、淋巴结转移情况、治疗方法及随访结果。
共有18例患者（13例女性，5例男性，平均年龄41.5岁）因TDC发生的乳头状癌接受治疗。其中，15例行全甲状腺切除术，1例行峡部切除术，2例仅行Sistrunk手术。此外，16例患者接受了中央区和/或侧方区的颈部清扫术。肿瘤分期为pT1（n = 15）、pT3（n = 3）、pN0（n = 4）、pN1a（n = 3）、pN1b（n = 9）、Nx（n = 2）、M0（n = 17）和M1（n = 1，肺转移）。16例患者中有9例（56%）在甲状腺叶中发现肿瘤病灶。16例中有12例（75%）发现淋巴结转移。15例中央区清扫术中6例（40%）淋巴结阳性，15例侧方颈部清扫术中9例（60%）淋巴结阳性。15例患者中有6例（40%）出现侧方区转移，而中央区无转移。12例患者接受了放射性碘治疗。中位随访时间为12年（范围1 - 22年）。所有患者超声检查均为阴性。11例患者可检测到刺激后的Tg水平，其中10例不可检测，其余1例为2 ng/mL。
本系列研究显示甲状腺叶病灶和淋巴结转移率较高，但长期预后良好，这与经典乳头状癌的特征相同。侧方颈部转移似乎更为常见。这些发现支持在治疗这些罕见肿瘤时遵循目前分化型甲状腺癌的一般指南。
