Clinical Characteristics and Prognosis of Infants and Children <3 Years of Age With Thyroglossal Duct Cyst Complicated With a Parapharyngeal Mass: A Case Series Study

Thyroglossal duct cysts (TGDCs) are congenital and developmental abnormalities in infants and young children. This retrospective case series study examined the characteristics of 7 patients <3 years (mean age, 1.9 years) with TGDC complicated with a parapharyngeal mass treated at one hospital between January 2019 and 2022. Four patients had a painless mass around the neck, 2 had a painless mass associated with snoring, and 1 presented repeated swelling and pain. B-ultrasound suggested 6 cases of TGDC and 1 possible lymphangioma. All patients were treated with Sistrunk surgery to remove the TGDC. Six patients had no cyst recurrence during follow-up (6 months to 2 years). In conclusion, TGDC complicated with a parapharyngeal mass has complex and variable clinical manifestations. Completely removing the cyst while sparing thyroid cartilage and surrounding vascular and neuroanatomical structures is important to avoid complications. The patients are likely to be free from recurrence after surgery.

Papillary Thyroid Cancer in Thyroglossal Duct Cysts: A Pictorial Review and Case Series

ABSTRACT

Thyroglossal duct cyst is the most common congenital neck mass, but the incidence of malignancy within a thyroglossal duct cyst is rare, estimated at 1%. Most cancers arising within thyroglossal duct cysts are incidentally detected after surgical excision. We present the preoperative radiologic findings of 8 patients with papillary thyroid cancer arising within a thyroglossal duct cyst, as evaluated on ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography scan.

Thyroglossal Duct Cyst Papillary Carcinoma With Airway Compromise

Thyroglossal duct cysts are typically benign and usually asymptomatic. Malignant transformation is uncommon. Intralaryngeal extension is rare and results in dysphonia or dyspnea. There is no literature nowadays reporting the thyroglossal duct cyst carcinoma combining the clinical features of intralaryngeal extension. The authors present a case of progressive hoarseness and midline neck mass for 2 years. The laryngoscope and computed tomography revealed a 6-cm thyroglossal duct cyst containing ectopic thyroid tissue with intralaryngeal extension and causing airway obstruction. Complete excision with Sistrunk operation revealed papillary thyroid carcinoma. The patient resumed normal phonation after the surgery. There was no evidence of tumor recurrence and no hoarseness or dyspnea at 6 months follow up. This is the first reported case of a huge thyroglossal duct cyst carcinoma with intralaryngeal extension causing airway compromise. Complete excision of tumor is essential and vital to the symptom relief. A thyroglossal duct cyst carcinoma with endolaryngeal involvement should be considered in the differential diagnosis when the case has a massive midline neck mass with ectopic thyroid tissue and develops dyspnea or hoarseness concurrently.

Evaluation of preoperative cutaneous fistula as a risk factor for recurrence of thyroglossal duct cyst in children

The aim of this study is to investigate the risk factors for recurrence after thyroglossal duct cyst (TGDC) surgery, differentiating between infections with and without a cutaneous fistula. This is a retrospective analysis of all paediatric TGDC in a tertiary care centre with at least 2 years of postoperative follow-up. One hundred and thirty-one patients met the inclusion criteria of the study. A multivariate analysis was performed to analyse the main risk factors for recurrence (presence of a fistula, infection, age). 116/131 patients were managed primarily in our institution; 15 patients had previously been operated on in another centre. The recurrence rate was 4.3% (5/116) when the patient was operated on in our institution at the first operation, and overall, recurrence of TGDC occurred in 20/131 (15.3%) patients. Age was not a risk factor for recurrence (p = 0.596). Two or more episodes of preoperative TGDC infection were a statistically significant risk factor in univariate analysis (p = 0.021) but not in multivariate analysis adjusted for age and the presence of a cutaneous fistula (p = 0.385). In multivariate analysis, cutaneous fistula formation was an independent risk factor for recurrence when adjusted for age and preoperative TGDC infection (Hazard ratio = 5.35; p = 0.011).

CONCLUSIONS

A preoperative cutaneous fistula was a critical and independent risk factor for recurrence of operated TGDC, whereas age and TGDC infection were not identified as risk factors for recurrence after surgery. This information should be given to patients and parents before surgery.

WHAT IS KNOWN

• The risk factors for recurrence after thyroglossal duct cyst surgery described in the literature are preoperative infection and young age, but this is not supported by strong evidence. • The role of cutaneous fistula formation is unclear.

WHAT IS NEW

• The main risk factor for recurrence of TGDC is the presence of a preoperative cutaneous fistula, with an estimated hazard ratio of 4.95 (p = 0.016) in multivariate analysis. • The presence of two preoperative infections was also associated with a greater risk of recurrence in univariate analysis; age and gender were not associated with an increased risk of recurrence.

Coincidence of Thyroid Tumor and Thyroglossal Duct Remnants. Review of the Literature and Presentation of Three Cases

Aims and Background

The coincidence of benign or malignant thyroid tumors with thyroglossal duct remnant (TDR) cysts is rare. Although the precise etiology is still unclear, thyroid origin and spread from a primary site have been suggested and this obviously has important implications for the therapeutic approach. Three cases of thyroglossal duct carcinoma are presented and its management is discussed on the basis of the current rationale for treatment of thyroid cancer. The indication for surgery depends on positive findings in the thyroid gland (nodules, FNAB). The aim of this study was to review our experience in the management of papillary thyroid diseases associated with TDR.

Materials and Methods

The records of three patients with thyroid tumors associated with TDR treated at the Department of ENT and Head and Neck Surgery of the First Medical Faculty UK of Prague between January 1991 and January 2001 were analyzed. We searched for risk factors of thyroid carcinoma: history of ionizing radiation, history of thyroid diseases, age, tumor size, tumor spread and histopathological factors.

Results

We used a triple approach consisting of clinical and ultrasound examination and fine-needle aspiration biopsy for preoperative assessment. Our diagnostic and therapeutic procedures included TDR excision (Sistrunk or Schlange procedure) and total thyroidectomy. Although the therapeutic approach could be a matter of discussion, most patients agreed with our suggestion of relatively radical but non-mutilating treatment. Postoperative radiation or radioiodine ablation is considered in cases of TDR carcinoma or thyroid carcinoma associated with TDR. Oncological follow-up included clinical and ultrasound examination three times during the first year, twice in the second year, and once yearly thereafter. Tumor marker evaluation and/or scintigraphy were performed 6, 12 and/or 24 months following surgery.

[Papillary Carcinoma Arising in Thyroglossal Duct Cyst in the Right Lateral Neck]

A 47-year-old woman was admitted to our institution with the chief complaint of a right cervical mass. Imaging examination findings showed a cystic mass of 25mm with a nodular lesion in the right cervical region. Therefore, we performed extirpation of the right cervical cystic mass to allow diagnosis of the lesion. The histopathological findings showed a partial thyroid tissue on the cyst wall covered with glandular epithelium or metaplastic squamous epithelium, and tumor cells proliferating in the papillary form. Considering the histopathological evidence of the characteristic epithelium of the thyroglossal duct cyst, the potential carcinogenesis from the remnant thyroid tissues, and the absence of primary tumor in the thyroid gland, the patient was diagnosed with thyroid papillary carcinoma arising from the thyroglossal duct cyst in the right lateral cervical region. We found recurrence of the right cervical lymph node at 1 year and 5 months after the initial operation. Thus, we performed dissection of the right cervical lymph nodes. Two years and 10 months after the operation, neither recurrence nor metastasis have been observed. It was suggested that, thyroid papillary carcinoma arising from the thyroglossal duct cyst should be taken into consideration when a lateral cervical mass lesion is found.

Thyroglossal Duct Cyst Carcinoma in Child and Adult. Two Case Reports

Thyroglossal duct cyst carcinoma is rarely mentioned in literature representing only 0,7-1,6% of cases with these embryonic remnants. Two patients with thyroid duct cyst carcinoma, a 14-year-old girl and a 44-year-old man operated on in our department, both diagnosed postoperatively are described. In the first one a classical Sistrunk operation was performed removing a 3 cm asymptomatic mass, a milimetric papillary carcinoma being incidentally discovered at paraffin section pathology. The second case presented a 4 cm cyst with benign clinical and ultrasonic features excepting a 8 mm nodule in the right thyroid lobe. Cytology was inconclusive such as a Sistrunk procedure together with a right thyroid lobectomy were done. Pathology revealed a limited carcinomatous focus in the cyst wall but also a papillary thyroid microcarcinoma. Both cases was thereby diagnosed only after microscopic examination. Conservative approach adopted due to "œinnocent" clinical appearance, subcentimetric size and absence of any risk factor in the two cases achieved stable, verified over time healing confirming the favorable prognosis of this rare pathology.

Pathology of thyroglossal duct: an institutional experience

Thyroglossal duct (TGD) is a developmental anomaly in which a remnant of the thyroid anlage is left in the neck during its descent from the foramen cecum of tongue to final pretracheal position. A persistent duct can lead to thyroglossal duct cyst (TGDC). Histologically, TGDC contains an epithelial lining of squamous or pseudostratified ciliated columnar epithelium and ectopic thyroid gland tissue in the duct wall. TGD-associated malignancy is rare, and the majority is papillary thyroid carcinoma (PTC). A total of 242 patients with a diagnosis of TGD-associated lesions were identified in our institute. Two hundred and seventeen cases were diagnosed as TGDC. Sixty-eight of 217 (31.3 %) cases of TGDC had ectopic thyroid tissue in the cystic wall. Thirty-nine cases had preoperative fine needle aspiration (FNA). Of these cases, 37 of 39 (94.9 %) demonstrated macrophages and 19 (48.7 %) also showed cells of squamous and/or columnar epithelial lining. Only two cases showed rare thyroid follicular cells. Thyroid carcinoma was identified in 18 of 242 (7.4 %) cases. All cases were diagnosed as PTC including 12 cases of classic PTC (66.7 %), 3 cases of follicular variant (16.7 %), 2 cases of tall cell variant (11.1 %), and 1 case of classic PTC with focal tall cell features (5.6 %). Nine cases had TGD component (either epithelial lining cysts or ectopic thyroid tissue). Ten patients also underwent total thyroidectomy (67 %). Of these patients, four had no tumor and one had an incidental medullary carcinoma. Five of 10 (50 %) cases had incidental PTC with a size range of 0.1-0.3 cm. Five patients had follow-up by imaging studies; no suspicious or nodular lesions were found in the thyroid. In conclusion, we report an institutional case cohort of 242 patients with TGD-associated lesions, including 217 TGDC and 18 cases of PTC. Only seven cases fulfilled the diagnostic criteria of TGD-associated PTC, i.e., the presence of components of TGD and a normal thyroid. In the remaining 11 cases, we could not differentiate with certainty between pyramidal primary thyroid PTC/Delphian node metastasis or TGD-associated PTC.

[Thyroglossal duct carcinoma combined with systemic lupus erythematosus: one case report]

Thyroglossal duct carcinoma is a malignant tumor which occurs in the thyroglossal duct cyst. The incidence of thyroglossal duct carcinoma has been reported as approximately 1%. Up to now, just about 250 cases of thyroglossal duct carcinoma have been reported in the literature,most of which are single case reports and small case series. In most cases, the diagnosis of the thyroglossal duct carcinoma is not made until the histologic examination after surgery operation. The preoperative examination such as CT or fine needle aspiration cytology can help the preoperative diagnosis. But the surgical treatment for the thyroglossal duct carcinoma is still controversial. Now we report a case of a thyroglossal duct carcinoma combined with systemic lupus erythematosus. The patient herself found an anterior neck mass in the median submental region one year ago. The preoperative CT examination suggested thyroglossal duct cyst with pouch canceration(papillary carcinoma). Then she underwent a Sistrunk procedure and level I neck dissection, and the histopathological diagnosis was thyroglossal duct carcinoma. The patient was treated with levothyroxine therapy at suppressive dose after the surgery. Now the patient is at regular follow-up with no relapse occur.

[Thyroglossal cyst and papillary carcinoma. Management proposals]

The thyroid descends through the foramen cecum leaving the thyroglossal duct, which disappears between the fifth and the tenth week of pregnancy. The lack of involution of any part of this duct results in thyroglossal cyst formation. Its diagnostic approach is made by cervical ultrasound, computed tomography and magnetic resonance imaging. Approximately 1 % of the thyroglossal cyst formation contains malignant elements, and the most reported primary tumor has been papillary carcinoma. The recommended treatment for these carcinomas is controversial and it has evolved as time goes by. From Sistrunk procedure to neck dissection with total thyroidectomy and complementary therapies, such as iodine ablation and thyroid supplements, yet there is still no consensus as to the type of surgery and postoperative management it should be used to treat this carcinoma. Therapy should be applied according to each specific case, and it should be based on histological diagnosis, the invasive character of the tumor, and the lymph node affectation. In this paper we review the literature published so far with regards to the treatment of this carcinoma.

Thyroglossal duct cyst carcinomas: is there a need for thyroidectomy?

OBJECTIVE

Thyroglossal duct cyst (TGDC) carcinoma is a rare entity and its management is controversial. The aim of this retrospective study was to: (a) identify patients with TGDC carcinoma followed up in our clinic and (b) study specific characteristics of the disease and their association with thyroid carcinoma.

DESIGN

Medical files of patients with TGDC carcinoma were reviewed and tumour characteristics, lymph node metastases, treatment and follow-up were evaluated.

RESULTS

A total of 6 patients, 4 females and 2 males, mean age 39.3 years (median 33.5), were treated for papillary thyroid carcinoma arising in a TGDC. Carcinoma of the thyroid gland was found simultaneously in 4 of these patients, while in one patient thyroid carcinoma developed 10 years after the diagnosis of TGDC carcinoma. A variable clinical picture and presentation was recorded. The most aggressive manifestation of the disease in terms of local infiltration, local recurrence and lymph node metastases was observed in our youngest patients.

CONCLUSIONS

Long-term follow-up is necessary for patients with thyroid carcinoma arising in a TGDC. In view of the frequent co-existence of thyroid cancer in these patients, we would recommend detailed thyroid evaluation and, eventually, total thyroidectomy at initial diagnosis of TGDC carcinoma.

Thyroid cancer in thyroglossal duct cysts requires a specific approach due to its unpredictable extension

CONTEXT

Differentiated thyroid cancer (DTC) in thyroglossal duct cysts is uncommon. The requirement of total thyroidectomy and lymph node dissection is still controversial.

SETTING

The study was performed in a referral thyroid cancer center at an academic hospital.

PATIENTS

We conducted a single center retrospective study of a consecutive series of 26 patients with DTC in thyroglossal duct cyst, all having undergone cyst resection and total thyroidectomy.

MAIN OUTCOME MEASURES

Diagnostic modalities, surgical treatment, histopathological features, and clinical outcome were included in the study.

RESULTS

Thyroglossal duct cyst cancer histotype was papillary in 23 of 26 patients (88.5%) and follicular-Hurthle in 3 of 26 cases (11.5%). A concomitant papillary DTC in the thyroid gland was found in 16 of 26 cases (61.5%), and it was multifocal in 8 of 16 cases (50%). At presentation, the patients with cancer in both the thyroglossal duct cyst and the thyroid were older than the patients who only had cancer in the thyroglossal duct cyst (44.9 ± 7.6 vs 32.0 ± 12.7; P = .006). Lymph node dissection, performed in 17 of 26 patients (65.4%), indicated that the central compartment was involved in 6 patients (35.3%, all having cancer also in the thyroid), the laterocervical compartments in 10 patients (58.8%), and the submental in 4 (23.5%). Six patients (23.1%) had persistent disease at 6-year median follow-up.

CONCLUSIONS

DTC in thyroglossal duct cysts occurs at a younger age and with more aggressive features at presentation. Concomitant cancer in the thyroid and lymph node metastases is present in most cases. Lymph node compartment involvement is different from that of cancers in the thyroid gland. Therefore, surgical treatment should include both thyroglossal duct cyst resection and total thyroidectomy, with individualized surgical nodal dissection. Subsequent management should follow current DTC guidelines.

Surgical management of primary thyroid carcinoma arising in thyroglossal duct cyst: an experience of a single institution in Serbia

Thyroglossal duct cyst (TDC) carcinoma is a comparable rare entity and treatment strategies have not been standardized. Here, we report a favorable outcome of TDC carcinoma patients based on our therapeutic strategy. Twelve patients with TDC carcinoma treated in our department from 1986 to 2012 were enrolled. Ten patients underwent Sistrunk's procedure in other institutions and referred to our institution for re-operation after the diagnosis of TDC carcinoma and the remaining two underwent initial surgery in our institution. Eleven patients were diagnosed as papillary and one as follicular carcinoma originating from TDC. We performed total thyroidectomy for 11, and limited thyroidectomy for one patient. Three patients (25%) had carcinoma lesions in the thyroid. We routinely dissected level I bilaterally and 6 of 11 patients (55%) with papillary carcinoma-type TDC carcinoma had metastasis. Level II/III nodes were biopsied and if positive, we performed level II-IV dissection. Of the 5 patients positive for level II/III, 2 were also positive for level IV. For the 3 patients with synchronous carcinoma in the thyroid, we performed level VI dissection and two had metastasis in this level. To date, 1 patient showed a recurrence to the lung, but none of the patients in our series died of carcinoma. For surgery of TDC carcinoma, Sistrunk's procedure, total thyroidectomy with level I dissection is mandatory. Whether level II-IV dissection is performed depends on pathology of biopsied level II/III nodes. Level VI dissection is also recommended especially when carcinoma lesions are pre/intra operatively detected in the thyroid.

Thyroglossal duct cyst carcinoma: case series

BACKGROUND

Thyroglossal duct (TGD) carcinoma occurs in about 1 to 2% of TGD cysts. Preoperative diagnosis is difficult, and consensus on optimal treatment is lacking.

METHODS

All patients who underwent surgical treatment of a TGD cyst at our institution, a tertiary centre, were reviewed and TGD carcinoma was identified. Clinicopathologic and follow-up information was examined.

RESULTS

Among the 139 patients treated for TGD cysts, 9 patients (6.5%) had a TGD carcinoma. All were papillary carcinoma. There was a female predominance, and the median age at diagnosis was 44 years. The median follow-up was 6.7 years. All patients underwent a Sistrunk procedure. A total thyroidectomy was performed in eight of nine patients. The median size of the TGD carcinomas was 10 mm. Two patients underwent therapeutic neck dissection at the time of the total thyroidectomy. Two patients experienced a recurrence regionally on follow-up. Eight of nine patients received radioactive iodine therapy and suppressive doses of thyroxine.

CONCLUSIONS

Strong conclusions are difficult to draw owing to the rarity of the disease. However, management should be similar to that of differentiated thyroid cancer and based on risk group stratification. An ultrasound-guided fine-needle biopsy is a valuable test in every patient with a suspicion of TGD cyst. A diagnosis of TGD carcinoma should prompt evaluation of the thyroid gland and cervical lymph nodes bilaterally. A Sistrunk procedure is the minimum therapeutic procedure, coupled with a total thyroidectomy for higher-risk cancers.

The role of pre-operative infection in the recurrence of thyroglossal duct cyst

OBJECTIVES

To evaluate the role of pre-operative infection in thyroglossal duct cyst recurrence and post-operative complications of Sistrunk procedure.

METHODOLOGY

Medical records of 55 patients undergoing thyroglossal duct cyst excision from 1998 to 2005 were reviewed. The following data was collected: age at operation, gender, surgical technique, presence and length of infection prior to operation, time interval between resolution of infection and operation, recurrence, management of recurrence, and complications.

RESULTS

Forty-two patients (76.3%) had no recurrence following Sistrunk procedure, while 13 patients (23.7%) underwent one or more additional procedures due to recurrence. Our results indicate that 61.5% (8 of 13) of those with a failed Sistrunk had pre-operative thyroglossal cyst infection that lasted more than 6 months. In 92.3% of patients with recurrence, the interval between resolution of infection and time of operation was less than one month.

CONCLUSION

Effective treatment of thyroglossal duct cyst infection, at least one month pre-operatively, is warranted to reduce post-operative recurrence rate.

[Papillary carcinoma in thyroglossal duct cyst]

Authors present a rare case of the papillary thyroid carcinoma in thyroglossal duct cyst in a 40 year-old woman. Preoperative assessment (palpation and ultrasonography) showed symptoms of typical thyroglossal duct cyst and the final diagnosis was established after histopathological examination of the surgical specimen. Epidemiology, diagnostic methods and treatment of this rare disease were also discussed in the study.

Papillary carcinoma arising in a thyroglossal duct cyst; two case reports and review of the literature

We present in this report two cases of papillary carcinoma arising in a thyroglossal duct cyst. The first case was a 32-year-old female patient who presented with a neck mass of 5 years' duration that had recently increased in size. The patient was otherwise asymptomatic. The second patient was a 41-year-old male patient who presented with a submental mass that had been growing over the previous several months. Associated symptoms included local symptoms such as dysphagia and hoarseness and general symptoms such as fatigue and weight loss. Pathological examination revealed the presence of papillary carcinoma in the mass with presence of focus of papillary carcinoma in the thyroid bed in both cases. Periosseous invasion of the hyoid bone and involvement of the submandibular lymph nodes were observed in the second patient. The patients underwent total thyroidectomy with lymph node dissection followed by radioactive iodine therapy and are currently on thyroxin replacement.

Papillary carcinoma arising in a thyroglossal duct cyst: case report and discussion of management modalities

A case of papillary carcinoma arising in the wall of a thyroglossal duct cyst is described. These cancers are very rare and rather adult-specific. Preoperative diagnosis may be enhanced using fine-needle aspiration cytology and computing tomography findings. The standard treatment of thyroglossal duct cyst carcinoma is the sistrunk procedure. The concept of prognostic risk groups should be used to identify patients who would additionally undergo total thyroidectomy.

[Thyroglossal duct cyst with laryngeal extension]

Thyroglossal cyst is frequently located in the thyrohyoid region. In rare cases, it breaches and remodeles anatomical structures of the larynx and manifests with dysphonia and laryngeal obstruction. A 60-year-old patient with a big thyroglossal duct cyst with laryngeal extension and cartilage erosion is described. Computed tomography clearly demonstrated the nature of the cyst and its extension into the larynx.

Fatal asphyxia by a thyroglossal duct cyst in an adult

Thyroglossal duct cysts arise from remnants of embryonic thyroglossal duct that connects the foramen cecum at the base of the tongue to the thyroid gland. The remnants enlarge secondary to secretions from the epithelial lining. Usually, thyroglossal cysts present as non-tender masses. However, they may also become infected, produce fistulas or give hoarseness and dysphagia. Rarely, especially if the mass is located at the base of the tongue, airway obstruction and dyspnea can ensue. This unusual presentation has been mainly seen in very young children and has caused death in about half of these cases. Nevertheless, in the adult population, very few cases of airway obstruction by thyroglossal duct cysts have been reported, only one being fatal. We present the case of a 55-year-old man who died from fatal asphyxia caused by a thyroglossal cyst.

Mucin-secreting papillary adenocarcinoma of the hyoid bone: a unique case

We present a unique case of a mucin-secreting papillary adenocarcinoma of intestinal type which has invaded and completely destroyed the hyoid bone and metastasized to the cervical lymph nodes bilaterally. The tumour is believed to have originated from a malignant thyroglossal duct remnant, and was managed with surgery and radiotherapy. We describe the case and discuss the literature regarding hyoid bone tumours.

Papillary carcinoma in a thyroglossal duct cyst

Papillary carcinoma arising in a thyroglossal duct cyst is a rare tumor. We report the case of 64-year-old man treated for thyroglossal duct cyst. Preoperatively, the thyroid gland was normal on physical examination and imaging studies. The Sistrunk procedure was done. The histopathological examination revealed thyroid papillary carcinoma. Postoperatively thyroid hormon was given to suppress serum TSH levels and the patient was followed at regular intervals. During a 5-year follow-up period, no recurrence of the disease occured.

Thyroglossal duct cyst: a cytopathologic study of 26 cases

Thyroglossal duct cyst (TDC), or embryologic remnants of thyroid gland, is a common congenital anomaly. TDC may cause a midline neck mass, which occasionally may become infected, and rarely gives rise to carcinoma. As a number of other nonneoplastic and neoplastic lesions can cause cystic masses in the neck, we explored the role of fine-needle aspiration (FNA) in making a preoperative diagnosis of TDC for a more accurate and timely clinical intervention. Twenty-six cases of TDC were identified from the cytopathology files of The Johns Hopkins Hospital in a 15-yr period (1990-2004). Material was obtained by FNA with or without radiologic (ultrasound) guidance. Smears were air-dried and stained with Diff-Quik, or wet-fixed and stained with Papanicolaou stain. Cytomorphologic characteristics were serially analyzed. Follow-up (tissue resection [n = 9] and clinical charts [n = 17]) was reviewed in all cases. Patients ranged in age from 8 to 83 yr (mean age, 55) with M:F ratio of 1.4:1. The size of the cyst ranged from 1.2 to 5 cm (mean 2.5 cm), as evaluated on radiological scans. The most common clinical presentation was a non-tender, mobile neck mass, which was painful on swallowing. Follow-up confirmed TDC in 18/26 cases (69%), whereas 8/26 cases resulted in various other benign lesions. During the same time period, 11/18 (61%) cases of surgically resected TDC were missed on prior FNA. Therefore, FNA showed a diagnostic sensitivity of 62% and a positive predictive value (PPV) of 69% for the diagnosis of TDC. The cytomorphologic features of TDC included the following: colloid (thick and fragmented, thin and watery, or mucinous), macrophages, lymphocytes, or predominantly neutrophils. The epithelium was ciliated columnar, metaplastic squamous or of mature squamous type. Thyroid epithelium was only rarely present (11%). FNA is only moderately sensitive for a preoperative evaluation of TDC. Cytomorphologic features are not unique; however, in the right clinicoradiologic setting should lead to an accurate diagnosis. Abundant colloid, most often with ciliated columnar epithelium, is the predominant cytopathologic finding. Thyroid epithelium is rarely identified. Differential diagnosis involves branchial cleft cyst, lymphoepithelial cyst, thyroid gland lesions, and lymphadenopathy (of various etiologies).

[Papillary carcinoma in an isthmic thyroglossal duct cyst: clinical considerations]

Cancer in a thyroglossal duct cyst is uncommon (incidence: approximately 1%). There are about 250 reported cases in the literature, most of which are papillary cancers or, less frequently, squamous or follicular carcinomas. The preoperative diagnosis of thyroglossal duct cyst carcinoma may be facilitated by an ultrasound neck examination or fine needle aspiration cytology (FNAc). As reported in the literature, however, the diagnosis is often obtained only at histopathological examination. We describe a case of a 43-year-old male patient with a papillary carcinoma in an isthmic thyroglossal duct cyst. Ultrasound of the neck demonstrated a nodular hypo-anechogenic cystic neoformation of the isthmus of the thyroid, while Fnac was not diagnostic. An isthmectomy of the thyroid was initially performed. Frozen examination of the cystic lesion revealed a papillary carcinoma in the thyroglossal duct cyst. A total thyroidectomy with central lymphectomy was therefore performed. Carcinoma in the thyroglossal duct has a low mortality (5-year mortality: < 2%), but a long-term follow-up is mandatory, due to the low, short-and medium-term recurrence rate.

A thyroglossal duct cyst causing apnea and cyanosis in a neonate

This is a case of a 3-week-old male who presented to the emergency department with intermittent apnea and cyanosis. While in the emergency department, he had respiratory compromise with stress and required intubation. Further evaluation confirmed the diagnosis of a thyroglossal duct cyst. Congenital lesions causing extrinsic airway compression should be considered in all neonates with apnea, cyanosis, and respiratory compromise. Knowledge of pediatric airway anatomy and physiology is important in all cases where obstructive apnea is suspected.

Thyroglossal duct cyst with papillary carcinoma: what must be done?

OBJECTIVE

To present a report series of five cases, compare their clinical evolution, and establish the appropriate treatment.

METHODS

A retrospective study was performed with the clinical records from three health institutions in Mexico City, Mexico, in order to search for patients with histologic diagnosis of thyroglossal duct carcinoma and were classified by different risk stratifications to compare their outcome.

RESULTS

We found five patients, three females and two males, mean age 49 years. Four were treated by Sistrunk's procedure, total thyroidectomy, radioiodine ablation, and thyroxine suppression; one patient underwent Sistrunk's procedure only. Four patients were classified in the low- and median-risk group and had good outcome; one patient was in the high-risk group and had poor outcome.

CONCLUSIONS

The thyroglossal duct cyst must be studied in the adult population through fine-needle aspiration biopsy (FNAB) and a frozen section in cases in which FNAB is inconclusive or unavailable. When a diagnosis of a thyroglossal cyst carcinoma is made, an evaluation of the thyroid gland during surgery must be done as well as a careful examination to identify suspicious lymph nodes and neck dissection should be reserved for confirmed adenopathies. When an thyroglossal duct cyst has been excised using Sistrunk's procedure and the definitive histologic analysis reports malignancy, the thyroid gland must be studied. The extension of the surgery must be handled according to the criteria established for differentiated thyroid cancer.

Thyroglossal duct infections and surgical outcomes

PURPOSE

Thyroglossal duct cysts (TGDC) are the most common head and neck congenital anomalies in children and often present as infected neck masses. The authors reviewed their experience with TGDC to determine if preoperative infection was related to postoperative complications, including recurrence and postoperative infection.

METHODS

The medical records of 99 patients undergoing excision of TGDC from January 1991 to July 2002 were reviewed. Factors thought to be associated with recurrence (age, history of infection, drainage, abscess, and operative procedure) were analyzed.

RESULTS

Ninety-nine patients made up the study group. The mean age at operation was 5.0 years (range, 6 months to 16 years) with a male to female ratio of 1.6:1. TGDC recurred in 12.1% (12 of 99) of these patients. There was no gender difference for those with and without recurrence. The presence of an abscess or cellulitis preoperatively (22 of 99 patients) did not correlate with recurrence (NS). In addition, postoperative infection occurred in 13 of 99 patients and also was independent of preoperative infection. However, postoperative infection clearly was associated with an increased risk of TGDC recurrence. Seven of 87 patients without recurrence had a postoperative infection, whereas 6 of 12 of those who had a recurrence had a postoperative infection (P <.001). The mean follow-up was 3.7 years and was comparable for the 2 groups (recurrence v. resolution). Twelve patients successfully underwent a second procedure for recurrence.

CONCLUSIONS

In this large series of TGDC, preoperative infection occurred in approximately 1 of 5 patients and was not predictive of recurrence. Although postoperative infection did not correlate with the presence of preoperative infection, it was clearly associated with a statistically significant incidence of recurrent disease.

Laryngeal mask airway guided fibreoptic tracheal intubation in a child with a lingual thyroglossal duct cyst

The establishment of a tracheal airway with direct laryngoscopy can either be difficult or impossible in children with airway pathology. Multiple direct laryngoscopic attempts cause oedema and/or bleeding with subsequent difficult ventilation. The techniques utilizing the laryngeal mask airway (LMATM) and the fibreoptic bronchoscope have been reported. The case of a child with lingual thyroglossal duct cyst in which the LMA was useful to secure the airway and as a conduit for fibreoptic tracheal intubation is reported.

Papillary carcinoma of the thyroglossal duct cyst in childhood

Thyroglossal duct carcinoma is a rare malignancy that is usually diagnosed postoperatively. Approximately 150 cases have been reported in the literature. Eighty-five percent of these were papillary carcinomas. Controversies exist concerning its nature and treatment. In this report, we present an 11-year-old boy with an anterior cervical cystic mass originating in the thyroglossal duct. After a primary Sistrunk procedure, the cyst and tract extending to the foramen caecum at the base of the tongue in continuity with the midportion of the hyoid bone were resected. Histopathologic study demonstrated a papillary carcinoma. After 4 months of follow-up, the patient is asymptomatic without any evidence of recurrence. The clinical and histopathological features and therapeutic options are discussed.

Psammomatous calcification in association with a benign thyroglossal duct cyst

Embryologic remnants of thyroid tissue often line the thyroglossal duct tract and may commonly become cystic. Calcification in such a cyst is thought to be a specific marker for malignancy, which may develop in 1% of thyroglossal duct cysts. We describe a 3-year-old boy with a midline neck mass that showed radiologic calcification. Pathologic evaluation revealed psammomatous calcification in association with a benign thyroglossal duct cyst. These findings, not previously reported (to our knowledge), expand the radiologic differential diagnosis of calcified neck masses and broaden the spectrum of pathologic findings seen in association with benign thyroglossal duct cysts.

First branchial cleft anomaly presenting as a recurrent post-auricular abscess

Embryological anomalies of the first branchial cleft are uncommonly encountered. They usually present as cysts, swellings, or fistulas in the pre-auricular or post-auricular area or high in the neck, which may become infected. Failure to recognise these unusual cases may result in misdiagnosis, inadequate treatment, and subsequent recurrence. Further definitive surgery may thus be complicated. A case is reported of a patient who attended accident and emergency on three occasions with an infected post-auricular cyst, which was treated by incision and drainage. It was subsequently found to be a first branchial cleft anomaly.

[Papillary carcinoma in thyroglossal duct cyst]

OBJECTIVE

To report the management and outcome of three cases of papillary carcinoma (PC) in thyroglossal duct cysts (TGCs).

MATERIAL AND METHODS

We present case reports of one male and two female patients between the ages of 30 and 38 years who had DTR cyst. In addition, we discuss the theories about the pathogenesis of DTR carcinoma (de novo versus metastatic lesions).

RESULTS

In all three patients, we found a DTR that contained a vegetating mass. Subsequent pathologic examination revealed the presence of a PC. All patients underwent total thyroidectomy, and two of them concurrently had PC in the thyroid gland. Besides the PC in the TGC, the first patient had a "cold" scintigraphic thyroid nodule that was also a PC, whereas the second patient had a thyroid microcarcinoma that had not been detected before surgical intervention. The third patient did not have carcinoma of the thyroid. The patients received postoperative I131 and suppressive therapy with levothyroxine. During a follow-up period of 1 to 2.5 years (mean--1.75), we found no recurrence of the disease, and serum thyroglobulin remained undetectable in all cases.

CONCLUSION

Although use of total thyroidectomy followed by radioiodine therapy and suppressive treatment with levothyroxine is a matter of debate in patients with PC in TGCs, we conclude that this approach yields a favorable outcome in most cases, especially when the thyroid is also involved by the PC, and allows a better postoperative follow-up.

Ectopic thyroid and Hashimoto's thyroiditis arising from a thyroglossal duct cyst: a case report

A seventy-five-year-old male patient presented with a palpable smooth mass that moved upwards on swallowing, extending from the hyoid bone to the cricoid cartilage. Ultrasonography, scintigraphy, and thyroid hormone measurements showed the mass free from the thyroid gland. Following a diagnosis of infected thyroglossal duct cyst by fine needle aspiration biopsy, the mass was removed by surgery. Histopathologic diagnosis was Hashimoto's thyroiditis that developed from the ectopic thyroid tissue on the wall of thyroglossal duct cyst.

Primary papillary carcinoma arising in a thyroglossal duct cyst

We report a case of papillary carcinoma arising in a thyroglossal duct cyst, presenting with an anterior neck mass of a 31-year-old woman. The tumor was judged to be a primary lesion on the basis of intraoperative examination of the thyroid and pathologic findings of the mass. One year later, a small nodular mass in the left thyroid gland and lymph node enlargement of the right cervical lymph node were noted by follow-up imaging studies. Total thyroidectomy, right modified radical neck dissection and central neck dissection were performed. The thyroid gland revealed nodular hyperplasia without evidence of malignancy. On the other hand, the dissected neck lymph nodes revealed metastatic papillary carcinoma. Taken together, these findings suggested the tumor was a primary papillary carcinoma arising in the thyroglossal duct cyst.

[Papillary carcinoma of the thyroglossal duct cyst: a case report]

The thyroglossal duct cyst is the most common anomaly in thyroid development. To date, approximately 250 cases have been reported, the majority being papillary thyroid carcinomas. In most cases the diagnosis is established only after excision of a clinically benign thyroglossal duct cyst. Controversies exist in relation to a rational and effective therapeutic approach. A further case of thyroglossal duct papillary carcinoma affecting a 52 years-old man is presented to highlight the clinicopathological features of this condition. FNAC resulted false negative. Surgery consisted in a Sistrunk procedure, followed by total thyroidectomy and central lymphectomy after definitive histological diagnosis. In view of the prolonged course of papillary carcinoma, long-term follow-up is mandatory.