Thyroid-derived papillary carcinoma along the embryologic thyroid descent pathway in three patients: a case report.
- 1Department of Otolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, China.
Abstract
Thyroid tissue descends from the foramen cecum to the pretracheal neck. Remnants along this pathway may form ectopic thyroid tissue or thyroglossal duct cysts (TGDCs), and rarely develop papillary thyroid carcinoma (PTC). These tumors may mimic benign cystic or cystic-solid lesions, making risk stratification, diagnosis of origin, and surgical planning difficult. Three women had thyroid-derived PTC at descent-pathway sites. Case 1 was a 33-year-old woman treated by Sistrunk procedure for presumed TGDC after fine-needle aspiration yielded cystic contents. Final pathology showed TGDC-PTC invading fibrous and skeletal muscle tissue, with BRAF V600E positivity; postoperative tongue-base and pharyngeal edema required emergency tracheotomy. Case 2 was a 29-year-old woman with a tongue-base lesion present before total thyroidectomy and central neck dissection for orthotopic pT1aN0M0 PTC. Transoral excision showed a 17-mm thyroid-derived PTC clinically favored as lingual thyroid PTC, with negative margins and no BRAF V600E or TERT promoter mutation; no local recurrence was seen at 15 months. Case 3 was a 57-year-old woman with an anterior midline hyoid-region lesion in which imaging suggested ectopic thyroid carcinoma or metastatic PTC. Frozen section confirmed thyroid-derived PTC with negative margins, supporting Sistrunk-type local excision and staged surveillance of the orthotopic thyroid; early postoperative ultrasound showed no suspicious cervical lymph node. Tongue-base, hyoid-region, and anterior midline lesions should be assessed together with the orthotopic thyroid and cervical lymph nodes. Histology and immunohistochemistry confirm thyroid follicular-cell origin but may not fully distinguish ectopic thyroid carcinoma, TGDC carcinoma, and metastatic PTC. Management should be guided by tumor size, invasion, margin and nodal status, orthotopic thyroid findings, molecular features, airway risk, and follow-up reliability.
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BibTeX
@article{yan2026thyroidderived,
title = {{Thyroid-derived papillary carcinoma along the embryologic thyroid descent pathway in three patients: a case report.}},
author = {Pinjie Yan and Tengfei Ma and Xin Yang and Fei Chen and Jun Liu and Shixi Liu and Jian Zou and Haiyang Wang},
journal = {Gland surgery},
year = {2026},
month = oct,
doi = {10.21037/gs-2026-0405},
url = {https://europepmc.org/article/MED/42996571},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Thyroid-derived papillary carcinoma along the embryologic thyroid descent pathway in three patients: a case report.
AU - Pinjie Yan
AU - Tengfei Ma
AU - Xin Yang
AU - Fei Chen
AU - Jun Liu
AU - Shixi Liu
AU - Jian Zou
AU - Haiyang Wang
PY - 2026
DA - 2026/10/01
JO - Gland surgery
DO - 10.21037/gs-2026-0405
UR - https://europepmc.org/article/MED/42996571
AB - Thyroid tissue descends from the foramen cecum to the pretracheal neck. Remnants along this pathway may form ectopic thyroid tissue or thyroglossal duct cysts (TGDCs), and rarely develop papillary thyroid carcinoma (PTC). These tumors may mimic benign cystic or cystic-solid lesions, making risk stratification, diagnosis of origin, and surgical planning difficult. Three women had thyroid-derived PTC at descent-pathway sites. Case 1 was a 33-year-old woman treated by Sistrunk procedure for presumed TGDC after fine-needle aspiration yielded cystic contents. Final pathology showed TGDC-PTC invading fibrous and skeletal muscle tissue, with BRAF V600E positivity; postoperative tongue-base and pharyngeal edema required emergency tracheotomy. Case 2 was a 29-year-old woman with a tongue-base lesion present before total thyroidectomy and central neck dissection for orthotopic pT1aN0M0 PTC. Transoral excision showed a 17-mm thyroid-derived PTC clinically favored as lingual thyroid PTC, with negative margins and no BRAF V600E or TERT promoter mutation; no local recurrence was seen at 15 months. Case 3 was a 57-year-old woman with an anterior midline hyoid-region lesion in which imaging suggested ectopic thyroid carcinoma or metastatic PTC. Frozen section confirmed thyroid-derived PTC with negative margins, supporting Sistrunk-type local excision and staged surveillance of the orthotopic thyroid; early postoperative ultrasound showed no suspicious cervical lymph node. Tongue-base, hyoid-region, and anterior midline lesions should be assessed together with the orthotopic thyroid and cervical lymph nodes. Histology and immunohistochemistry confirm thyroid follicular-cell origin but may not fully distinguish ectopic thyroid carcinoma, TGDC carcinoma, and metastatic PTC. Management should be guided by tumor size, invasion, margin and nodal status, orthotopic thyroid findings, molecular features, airway risk, and follow-up reliability.
SN - 2227-684X
SN - 2227-8575
ER -