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Laryngorhinootologie 2019; 98(04): 257-264
DOI: 10.1055/a-0850-0154
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Vorgehen bei Schilddrüsenkarzinomen in einer medianen Halszyste

Management of thyroid carcinoma arising from thyroglossal duct cyst
Jan Heidemann
Charite Universitätsmedizin Berlin Campus Benjamin Franklin, Klinik für HNO-Heilkunde
,
Annett Pudszuhn
Charite Universitätsmedizin Berlin Campus Benjamin Franklin, Klinik für HNO-Heilkunde
,
Veit Maria Hofmann
Charite Universitätsmedizin Berlin Campus Benjamin Franklin, Klinik für HNO-Heilkunde
› Institutsangaben
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Publikationsverlauf

04. Oktober 2018

24. Januar 2019

Publikationsdatum:
25. Februar 2019 (online)

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Zusammenfassung

Schilddrüsenkarzinome aus Residuen des Ductus thyreoglossus sind eine Seltenheit und werden meist als Zufallsbefund postoperativ festgestellt. Es gibt keine klaren Richtlinien für das korrekte therapeutische Vorgehen nach erfolgter Resektion, insbesondere bezüglich der Notwendigkeit einer totalen Thyroidektomie und Radioiodtherapie. Vor dem Hintergrund der aktuellen Literatur wird eine Fallserie von fünf Patienten mit Schilddrüsenkarzinomen in einer medianen Halszyste präsentiert. Es erfolgte eine retrospektive Analyse aller Patienten mit einem Schilddrüsenkarzinom in einer medianen Halszyste im Zeitraum zwischen 2002 und 2017.

Von 578 Patienten, die aufgrund einer medianen Halszyste operiert wurden, konnte bei fünf dieser Patienten (3 Frauen, 2 Männer), im Alter von 16–73 Jahren (Altersmittelwert 51; Median 56 Jahre) ein Schilddrüsenkarzinom gesichert werden. Klinisch stellten sich alle Patienten mit einer schmerzlosen Schwellung im Bereich des Zungenbeins vor. Die Diagnose wurde in allen Fällen postoperativ gestellt, in einem Fall wurde in der präoperativen Bildgebung bereits ein Malignom vermutet. Histologisch zeigte sich in allen Fällen ein papilläres Schilddrüsenkarzinom. Vier Patienten erhielten im Intervall eine totale Thyroidektomie und Radioiodtherapie, zwei davon zusätzlich eine Neck dissection des medialen und lateralen Kompartiments, der fünfte Patient hat sich einer weiteren Diagnostik und Therapie entzogen. Es wurden in allen vier Fällen keine Karzinome der Schilddrüse oder Lymphknotenmetastasen nachgewiesen.

Aufgrund der Seltenheit von Schilddrüsenkarzinomen in medianen Halszysten existiert derzeit kein standardisiertes therapeutisches Vorgehen. Es sollte eine Risikostratifizierung vorgenommen werden, um Patienten, die von einer zusätzlichen Thyroidektomie profitieren könnten, zu identifizieren. Die Prognose ist sehr gut.

Abstract

Thyroid carcinoma presenting within thyroglossal duct remnants is rarely reported. Mostly diagnosis is received postoperatively after resection of the cyst. No definite agreement exists regarding the therapeutical management after excision of the cyst especially concerning the necessity of total thyroidectomy and radioiodine therapy. A series of five cases is presented and relevant literature is reviewed.

A retrospective review of all patients with thyroglossal duct cyst carcinoma treated between 2002 und 2017 was performed. Out of 578 patients with a thyroglossal duct cyst in five (3 women and 2 men) in the age of 16–73 years (mean: 51, median: 56 years) a thyroidal carcinoma could be identified. All of them presented with a painless hyoidal swelling. Diagnosis was made in all cases after surgery, but in one case, malignancy was presumed in the preoperative MRI. Papillary thyroid carcinoma was found in all samples. Four of the patients underwent total thyroidectomy and radioiodine therapy, in two of them a neck dissection of medial and lateral compartment was performed. The last patient withdrew from further diagnostics and therapy.

In all four samples, no carcinoma of the thyroidal gland or nodal metastasis was found. Due to the rare occurrence of thyroidal carcinoma in thyroglossal duct cysts, therapeutical management is controversial.

Stratification of patients to risk groups should be used to identify patients, who would benefit from an additional thyroidectomy. Prognosis is excellent.

Schlüsselwörter

mediane Halszyste - Schilddrüsenkarzinom - papillär - Schilddrüsenkarzinom - Extrathyroidal - maligne Entartung - Thyroidektomie

Key words

thyroglossal carcinoma - thyroglossal cyst - thyroglossal remnant - thyroid carcinoma - papillary
 

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