Clin Exp Otorhinolaryngol.  2014 Mar;7(1):69-72.

Coexistence of a Carotid Body Tumor and Thyroglossal Duct Carcinoma With Cervical Lymph Node Metastasis

• Kim JW
• Lee SW
• Hong HS
• Koh ES
• Choi EC
• Koh YW

Abstract

Thyroglossal duct carcinoma is uncommon, occurring in approximately 1% of all thyroglossal duct remnants. This rare neoplasm is characterized by relatively nonaggressive behavior with infrequent lymph nodal spread. Another rare neoplasm of the head and neck region is a carotid body tumor. A 78-year-old woman with a 3-year history of midline and bilateral neck masses was referred to us. Fine needle aspiration biopsies and a computed tomography scan suggested the diagnosis of thyroglossal duct carcinoma with cervical lymph node metastasis. Interestingly, the left-side neck mass was found to be splaying the carotid bifurcation, on computed tomography imaging. Carotid arteriography demonstrated a highly vascular mass in the bifurcation of the carotid artery that was compressing the internal and external carotid arteries. To our knowledge, this is the first reported instance of a thyroglossal duct carcinoma with neck metastasis accompanied by a carotid body tumor. In addition, the carotid body tumor in this case mimicked neck metastasis from the thyroglossal duct carcinoma.

Keyword

Thyroglossal duct cyst; Carcinoma; Lymphatic metastasis; Carotid body tumor

MeSH Terms

Aged
Angiography
Biopsy
Biopsy, Fine-Needle
Carotid Arteries
Carotid Artery, External
Carotid Body Tumor*
Carotid Body*
Diagnosis
Female
Head
Humans
Lymph Nodes*
Lymphatic Metastasis
Neck
Neoplasm Metastasis*
Thyroglossal Cyst

Figure

• 

  Fig. 1 Axial view of a computed tomography scan with contrast showing a round heterogeneously enhanced mass with irregular margins at the level of the hyoid bone with multiple enhanced, enlarged cervical lymph nodes on the right, at level II (A). Note that a highly enhanced mass was located at the carotid bifurcation (B). There was no abnormal lesion in the thyroid gland (C). Carotid arteriography demonstrated a highly vascular mass at the bifurcation of the carotid artery that was compressing the internal and external carotid arteries (D).

• 

  Fig. 2 Photograph of the intraoperative findings showing the surgical field of the right side of the neck after the completion of modified neck dissection (A). Surgical specimens showing the en bloc specimen of the neck dissection and thyroglossal duct carcinoma and total thyroidectomy specimen (B). Note that the CBT was located between the internal and external arteries, splaying the carotid bifurcation (C). P, primary tumor; LN, metastatic lymph nodes; T, thyroid gland; SMG, submandibular gland; CBT, carotid body tumor; ICA, internal carotid artery; Hypogl. N, hypoglossal nerve.

• 

  Fig. 3 Histopathologic findings. A thyroglossal duct cyst lined by a single row of columnar epithelium (H&E, ×40) (A). The tumor was composed of small and large papillary structures with fibrovascular cores (H&E, ×100) (B). The tumor cells lining the papillary structures showed nuclear grooves and nuclear clearing, which are characteristic nuclear features of papillary thyroid carcinoma. The nuclei showed a thick, irregular nuclear membrane, a high nuclear/cytoplasmic ratio, and somewhat eccentric nucleoli (H&E, ×400) (C). A lymph node showing subcapsular sinusoidal metastatic carcinoma. The histological appearance of the metastatic carcinoma is the same as that of the primary tumor (H&E, ×100) (D).

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