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To the Editor.— The presence of gastric epithelium has a profound effect on the symptomatology of congenital cysts of foregut derivation. 1 Peptic ulceration with penetration of the trachea has caused death in patients who had dorsal enteric mediastinal cysts that were so epithelialized. 2 We report a case of a thyroglossal cyst containing gastric epithelium as part of its lining. Report of a Case.— A 12-year-old boy was admitted for excision of a lump in the front of his neck that had been present for ten years. A 2-cm mass in the anterior midline of the neck was the only abnormality on examination. This was round and soft and moved upward when the patient swallowed or protruded his tongue. Thyroid function study results were normal. The mass did not concentrate radioiodine. At surgery a cyst was found that was connected to the hyoid bone by a cordlike structure. The

To the Editor.— The report by Chandrasoma and Janssen (1982;247:1406) of a thyroglossal cyst lined by gastric epithelium is intriguing from an embryologic and a clinical perspective. However, we wish to indicate that thyroglossal cysts are not "universally benign" as claimed. The literature contains reference to some 90 examples of carcinoma in the thyroglossal tract, mostly of the papillary type. 1-5 In as many as 25% of cases, carcinoma may be present elsewhere in the thyroid gland. 3 The prognosis for patients with this neoplasm appears to be excellent, 2 but recently a fatality due to anaplastic carcinoma that arose in a thyroglossal duct remnant was reported. 5 Since seven patients with this disorder were observed in our institution during the past ten years 2 (additional manuscript submitted for publication), it is possible to speculate that a malignant neoplasm in a thyroglossal duct actually may not be terribly rare.