原發性甲狀舌管囊腫乳突癌：一病例報告

Primary Papillary Carcinoma of Thyroglossal Duct Cyst:A Case Report

甲狀舌管囊腫是一種先天發育上的異常。常以頸部前方靠近中線的腫塊來表現。原發於此囊腫的癌症非常少見。本科經歷一名24歲女性，主訴於頸部中線靠近甲狀軟骨上方附近，發現一無痛性腫塊約半年。理學檢查可見一3X3公分圓形、稍硬之腫塊，此腫塊與周圍組織無粘黏性，會隨舌頭運動與吞嚥動作而上下移動。電腦斷層掃瞄顯示此腫塊為一多囊狀組織且內含鈣化點，並有正常之甲狀腺組織於甲狀軟骨前方。病患接受Sistrunk’s operation。術後無任何吞嚥或發聲困難。病理報告為乳突癌，囊腫壁完整且無神經、淋巴或血管之侵犯。病患於回診追蹤時接受甲狀腺超音波與甲狀腺掃瞄，並無發現甲狀腺異常。故診斷為原發性甲狀舌管囊腫乳突癌。至目前為止追蹤已超過6個月，無任何復發腫塊或異常。此種囊腫在術前很少會診斷出癌症。一般來說淋巴轉移機會很小。治療方式以手術為主，Sistrunk’s operation 對大多數病患即足夠，如果懷疑有影響甲狀腺或鄰近淋巴組織，則需甲狀腺全切除與局部淋巴廓清術。因此種病例十分罕見，目前為止國內僅有一例報告，本科日前經歷一例，故提出報告並回顧相關文獻。

Thyroglossal duct cyst is a congenital anomaly often manifesting itself as a swelling in the anterior midline part of the neck. Development of primary carcinoma in a cyst of this type is rare. A 24 year-old female had a painless mass over the thyroid cartilage for six months. Physical examination showed a round, elastic-firm, movable, 3X3 cm mass. Neck CT scan showed a multilobulated cyst with calcification spots. The patient underwent classical Sistrunk's operation under the impression of thyroglossal duct cyst. Histo-pathology revealed a papillary carcinoma arising from the thyroglossal duct cyst. Post-operative thyroid echo and thyroid scan revealed no definite lesion in the thyroid gland. No recurrence or metastasis had been noticed 6 months after operation. Treatment by the Sistrunk's operation is recommended for most patients without evident neck node metastasis. Thyroidectomy and regional neck dissection is recommended if there is suspicion of thyroid tumor with neck metastasis.