Incidental finding of thyroglossal duct cyst in a neonate during endotracheal intubation: a case report

BACKGROUND

Thyroglossal Duct Cyst (TDC) is a common lesion of the midline neck, originating from an incomplete involution of the thyroglossal duct. It is typically observed in pre-scholar patients and surgery is the treatment of choice to prevent infections. Here reported a case of incidental diagnosis in a newborn patient.

CASE PRESENTATION

a 3-week-old male baby was admitted to our hospital for weight loss and projectile vomits after breastfeeding. After a diagnosis of hypertrophic pyloric stenosis, the baby underwent pyloromyotomy. During the endotracheal tube placement, the anesthetist noticed the presence of a midline neck mass. The suspect of TDC was confirmed by an intraoperative ultrasound, so, despite the age of the patient, we proceeded with the excision of the lesion according to Sistrunk's procedure to avoid future complications and anesthesia.

CONCLUSIONS

even if TDC is a common lesion of pediatric patients, anecdotical neonatal cases were described in the literature, all of them symptomatic. An accurate physical examination and ultrasound are essential diagnostic tools to distinguish TDC from other middle neck lesions, particularly ectopic thyroidal tissue. Sistrunk's procedure is the most effective surgical approach. When diagnosis is made in a newborn, we suggest postponing surgery, unless the baby requires general anesthesia for other surgical procedures, such as in our case.

Prevalence of thyroid gland tissue in midline neck dermoid cysts in children and a proposed new 'thyroglossal entrainment' hypothesis for their formation

BACKGROUND

Thyroglossal duct cysts and dermoid cysts both commonly present as midline neck lumps in children. They are treated as separate entities with different embryological origins. There are isolated reports of thyroid gland tissue in a dermoid cyst, concurrent thyroglossal and dermoid cysts, and cysts with mixed histology. It is not known if these are rare or common.

METHODS

All children undergoing excision of a congenital midline neck cyst between January 2017 and December 2022 were identified. Histopathology slides were reviewed in detail.

RESULTS

In 53 children, there were 26 thyroglossal duct cysts, 24 dermoids, 1 lymph node and 2 with no diagnostic material identified. Five dermoids (28 per cent) had associated thyroid gland tissue, and 1 (4 per cent) had hybrid histology with keratinising and respiratory epithelium. Infection occurred in 17 per cent of dermoids prior to excision and 8 per cent of dermoids recurred after excision.

CONCLUSION

Hybrid histology, infection and recurrence are all common in midline neck dermoids. A new theory for their embryological origin is proposed, with the suggestion that some may need more extensive surgery.

Ectopic Salivary Glands - a Differential Diagnosis to a Thyroglossal Duct Cyst

Background: Midline developmental neck lesions primarily consist of thyroglossal duct remnants. Their recurrence is uncommon following thorough resection, which includes hyoid removal (the Sistrunk procedure). Case report: A 3-year-old girl presented with mucoid secretion drainage and swelling in the anterior mid-neck region, clinically resembling a thyroglossal duct remnant. Following an initial Sistrunk procedure, the lesion recurred, prompting a subsequent resection. Histological analysis revealed a mucocele alongside acinar and mucous ectopic salivary glands. Conclusions: The ectopic salivary gland can manifest along the midline of the neck and may clinically resemble the signs and symptoms of a thyroglossal duct cyst. Importantly, it can exhibit recurrence post-surgery, even following hyoid resection.

[Thyroglossal duct cysts in adult : clinical and therapeutic features]

Thyroglossal duct cysts (TDCs) are rare congenital cervical malformations in adults, which expose to two major risks: infection and malignant degeneration which remains the most dreaded complication in adults.

AIMS OF THE STUDY

This study aims to establish the clinical, management of TDC during adulthood, as well as the evolutionary aspects of these malformations in this age group.

PATIENTS ET METHODS

This is a retrospective study on 61 adults over 18 years old, undergoing TDC surgery in our department.

RESULTS

The average age was 33.7 years with a sex ratio M/F of 1.10.The circumstances of discovery were dominated by a median cervical swelling in 53 patients (86,9%). The swelling was median in 28 cases and located in ad-hyoid in 32 cases. Cervical ultrasound confirmed the diagnosis of TDC in all patients. CT scans were performed on 15 patients. Surgical excision according to the Sistrunk method was performed on all patients. Three of our patients have experienced a degenerated TDC requiring total thyroidectomy with central neck dissection, followed by radioactive iodine therapy.

CONCLUSION

CT scan keeps indications in adults. The treatment is surgical in order to prevent the risks degeneration, which is specific complication in adulthood.

Congenital Neck Masses

There are many possible causes of congenital neck masses, with the most common ones being thyroglossal duct cysts, branchial cleft anomalies, and vascular malformations. Most congenital neck masses are asymptomatic in the neonatal period, but depending on the location and the size, they can cause airway obstruction and serious complications at birth. Proper diagnosis is important for optimal treatment planning, and if the airway is compromised, multidisciplinary teamwork is critical for proper airway management. This review summarizes the clinical features, etiology, diagnosis, management, and prognosis of different types of congenital neck masses.

Congenital Midline Cervical Cleft and Thyroglossal Duct Fibrous Cord-Like, is There a Mixed Presentation?

INTRODUCTION

Congenital midline cervical cleft is a rare condition and is frequently misdiagnosed as thyroglossal duct cyst. Otherwise, the combination of congenital midline cervical cleft and thyroglossal duct fibrosis in the same patient is as rare as important to be registered with the intention to inform and offer specific managements details for the literature.

CASE PRESENTATION

Eight-year-old boy with simultaneous congenital midline cervical cleft and a thyroglossal duct fibrosis. The anatomic, clinical, radiologic, and pathologic characteristics of the congenital midline cervical cleft are described as well as surgical technique for removal and repair with Z-plasty.

CONCLUSION

Congenital midline cervical cleft is a rare condition and when diagnosed must be surgically treated as early as possible. Its differential diagnosis is a clinical challenge.

Thyroglossal duct cyst carcinoma case series-Management strategy and outcomes

OBJECTIVE

To review the clinical presentation, diagnosis, pathology and management strategies in a modern cohort of patients with thyroglossal duct cyst carcinoma.

STUDY DESIGN

Retrospective case series following PROCESS Guidelines.

SETTING

Comprehensive cancer centre.

METHODS

Data recorded included: gender, age at diagnosis, clinical presentation, thyroid function, diagnostic investigations, cytological results, final histology, staging and follow up status. The risk of malignancy in cytological analysis was stratified according to the Royal College of Pathologists classification in United Kingdom.

RESULTS

Twelve patients were included. The majority of patients (66.7%) presented with an isolated thyroglossal duct cyst. Only 4 patients had preoperative cytological suspicion of carcinoma (sensitivity: 33.3%). At the time of presentation all patients were euthyroid. Following diagnosis of malignancy, a total thyroidectomy was performed in all patients, with the exception of 2, who had a thyroglossal duct cyst carcinoma of less than 10mm. Among the 10 patients who underwent total thyroidectomy, 7 (70%) patients had proven carcinoma in the thyroid gland, 3 with deposits of less than 10mm. The average size of the thyroid cancer deposits was 7.2mm (1-20mm). With a mean follow-up of is 44 months (5-120), all patients were alive and free of recurrence at the end of the study period.

CONCLUSION

Thyroglossal duct cyst carcinoma is a rare condition and its management should be discussed in a multidisciplinary meeting. As with differentiated thyroid cancer originating in the thyroid gland, it bears extraordinary survival rates. Accordingly, the management of these cancers has shifted towards a more conservative approach although its peculiarities must be taken into account: ease of extracystic invasion and possible different lymph node invasion.

[Papillary carcinoma in a thyroglossal duct remnant: a case report]

This case report has described a case of papillary carcinoma of thyroglossal duct in a young male. This patient was admitted with a mass in the anterior neck for 2 years. Preoperative Bultrasonography, CT and MR showed a subcutaneous cystic mass with irregular calcification shadow in the central region of the neck without obvious enhancement. Initial diagnosis was thyroglossal duct cyst, and was excised by Sistrunk under general anesthesia. The postoperative pathological examination showed thyroglossal duct cyst combined with thyroid papillary carcinoma, which was confirmed by immunohistochemistry as thyroglossal duct papillary carcinoma.

Predictors of residual disease following pediatric thyroglossal duct cyst excision

OBJECTIVES

Residual thyroglossal duct cyst (TGDC) following surgical excision is not uncommon. This study aimed to search for risk factors for residual disease that either required revision surgery or were resolved with only conservative treatment and follow up.

METHODS

A retrospective study of consecutive children who underwent surgical excision for thyroglossal duct cysts between 2008 and 2021 at Schneider Children's Medical Center of Israel, a tertiary referral center in Israel.

RESULTS

Out of 102 children, 54 (53 %) had an uneventful recovery, 32 (31 %) had post-operative complications which were managed without revision surgery, and 16 (16 %) underwent revision surgery. A comparison of the three groups showed that children who had early post-operative complications (up to one month) were more likely to respond to conservative treatment (57 %). In contrast children with late complications had a higher probability (59 %) of undergoing revision surgery. The presence of a pre-operative cutaneous fistula was significantly associated with revision surgery (p = 0.012). In addition, children with no prior history of neck infection were more likely to have an uneventful recovery (p = 0.005).

CONCLUSIONS

TGDC disease has a wide range of clinical presentations both before and after surgery. A significant percentage of children with persistent post-operative symptoms may resolve without revision surgery. The presence of a pre-operative cutaneous fistula and late post-operative complications are the main risk factors for revision surgery.

Papillary Carcinoma of Thyroglossal Duct Cyst- A Diagnostic and Therapeutic Conundrum

Thyroglossal duct cysts (TGDC) are the most common congenital midline neck mass. It accounts for 70% of congenital neck masses in children and 7% in the general population. Untreated, Thyroglossal duct cyst may transform into a thyroid carcinoma in less than 1% of cases. A 47 year old female patient presented with complaints of swelling on the anterior aspect of neck for 1 year which was progressively increasing in size. Smears from needle aspiration revealed features suspicious of Papillary carcinoma of thyroid which was confirmed as on histopathology. Thyroid gland and the adjacent lymph nodes were free of the tumour on Computed Tomography (CT). Thyroglossal duct cysts undergoing neoplastic change is more common among women. Though sistrunk's procedure is widely accepted as a primary management, the role of total thyroidectomy with radioiodine therapy still remains a controversy due to contrasting opinions available in the literature.

Evidence and controversies in management of thyroglossal duct cyst carcinoma

PURPOSE OF REVIEW

The aim of this study was to analyse the rational of the possible therapeutic approaches to thyroglossal duct cyst carcinomas (TGDCCa), especially in consideration of their potential airway involvement, discussing the most debated issues concerning employment of thyroidectomy, neck dissection and adjuvant treatments.

RECENT FINDINGS

The literature is unanimous in defining the Sistrunk procedure as the baseline of surgical treatment of TGDCCa, and in equating the vast majority of thyroid-like TGDCCas to classic thyroid cancers from a biological point of view, while the rarer squamous cell carcinomas seem to behave more aggressively. Thyroidectomy, neck dissection and radioactive iodine treatment are considered for high-risk lesions, with the addition of customized partial resection of laryngeal cartilages when airway involvement is encountered. Furthermore, the analysis of thyroid mutational markers has promise for accurate prevision of more aggressive clinical behaviours.

SUMMARY

Even if rare, clinicians should be aware of TGDCCa due to the possibility of incidental diagnosis and, in the case of more advanced clinical scenarios, for its potential airway involvement. Sistrunk procedure combined with thyroidectomy, neck dissection and adjuvant therapy provide excellent results in high-risk patients. Additional study of pathological thyroid markers in TGDCCa is desirable to allow more individualized treatments.

[Papillary carcinoma in a thyroglossal duct cyst; diagnostics and treatment]

This is a case review of a 53-year-old female who presented with an asymptomatic thyroglossal duct cyst. Fine needle aspiration cytology was negative for malignant cells. However, CT findings showed a multilocular cyst of 4,4x2,5x4,5 cm with a solid mass of 1,8 cm and calcifications, suggestive for a thyroid carcinoma inside the thyroglossal duct cyst. A Sistrunk procedure was performed and pathology showed a papillary carcinoma inside the thryoglossal duct cyst. The coexistence of carcinomas in thyroglossal duct cysts is extremely rare, with most being papillary carcinomas. The Sistrunk procedure is often regarded as adequate, but controversies exist concerning the need for thyroidectomy and/or neck dissection. Our patient did not receive a thyroidectomy based on her patient- and tumourcharacteristics.

Thyroglossal duct lipoma: A rare case report

RATIONALE

Thyroglossal duct cyst (TGDC), the most common midline neck mass, has several histological diagnoses other than cyst in the literature. We present the first case of thyroglossal duct lipoma.

PATIENT CONCERNS

A 63-year-old woman presented with a painless soft midline neck mass for more than 3 years, which enlarged in size and caused a lump sensation during swallowing.

DIAGNOSES

Sonography revealed a 3.5 × 3.0 × 3.0-cm homogenous isoechoic oval lesion without an acoustic shadow beyond the thyroid glands. An ultrasound-guided biopsy revealed abundant sheets of fat cells with infiltration of some lymphocytes and histiocytes. Computed tomography revealed a 3.5 × 3.0 × 3.0-cm well-circumscribed ovoid mass with Hounsfield unit (HU) between -50 and -100 and a thyroglossal duct remnant. All these findings supported the diagnosis of thyroglossal duct lipoma.

INTERVENTIONS

The patient underwent Sistrunk operation for excision of the neck tumor, and pathological examination revealed an adipose tumor surrounded by benign thyroid tissue, confirming the diagnosis of thyroglossal duct lipoma.

OUTCOMES

Neither postoperative complication nor recurrence was noted at the 18-month follow-up.

LESSONS

This is the first case of thyroglossal duct lipoma in the literature. Our study extends the disease spectrum of thyroglossal duct mass and suggests that clinicians should consider thyroglossal duct lipoma in the differential diagnosis of a midline neck mass.

Prevalence and Features of Thyroglossal Duct Cyst on Ultrasonography, According to Radioactive Iodine Therapy: A Single-Center Study

Objective: The relationship between radioactive iodine therapy (RIT) and prevalence of thyroglossal duct cysts (TGDC) on ultrasonography (US) has not been reported. We assessed the prevalence and US features of TGDC according to RIT. Methods: From July 2017 to June 2018, 3,146 subjects underwent thyroid or neck US at our center. The presence or absence of TGDCs was prospectively investigated based on real-time US examination. Among the 3,146 subjects, 261 subjects were excluded because of <18 years of age, unclear information of RIT, or the presence of a radiation therapy history to the neck. Eventually, 2,885 subjects were included in this study. Results: Of the 2,885 subjects finally included, 126 (4.4%) showed a TGDC on US. Those with RIT history showed a higher prevalence of TGDCs than those without (no statistical difference, p = 0.062). In 697 male subjects, there were statistical differences in type of surgery, RIT history, and session number of RIT between those with or without TGDCs (p < 0.0001). In 126 subjects with TGDCs, only sex showed a significant difference between those with or without RIT history (p = 0.015). However, there were no significant differences in the location, size, and shape of TGDCs (p > 0.05). The common US features of TGDC were suprahyoid location, ~1 centimeter, and flat-to-ovoid or round shape. Conclusions: RIT may increase the prevalence of TGDCs, particularly in men.

Intrathyroid Thyroglossal Duct Cyst Simulating a Thyroid Nodule

A case of intrathyroid thyroglossal duct cyst is reported. A 50-year-old woman presented with a right lateral neck mass that was clinically indistinguishable from a thyroid nodule. Ultrasound-guided fine-needle aspiration biopsy (US-FNAB) revealed normal-looking squamous cells. Right thyroid lobectomy was performed and microscopic examination revealed a cyst lined by squamous epithelium that was consistent with a thyroglossal duct cyst. The lesion was completely surrounded by normal thyroid tissue. Our experience suggests that intrathyroid thyroglossal duct cyst should be remembered in the differential diagnosis of a thyroid nodule. Detection of benign squamous cells by US-FNAB may be useful for ruling out the possibility of a cystic thyroid tumor.

Congenital Midline Cervical Cleft

Congenital midline cervical cleft (CMCC) is a rare disorder of the ventral neck that is clinically evident at birth and must be differentiated from the more common thyroglossal duct cyst. The case of CMCC presented here was associated with chromosomes 13/14 de novo Robertsonian translocations as well as midline deformities including a sacral tuft and a minor tongue-tie. The case is presented as well as discussion of histopathology, embryology, and surgical treatment.

Application of Trotter Approach for Large Intralingual Thyroglossal Duct Cyst in an 88-Year-Old Patient

Thyroglossal duct cysts (TDCs) are the most common congenital cyst formations in the neck, typically occurring at midline infrahyoid positions in younger patients. Traditional management has used the Sistrunk procedure to minimize recurrence rates. Reports on elderly patients are sparse, and currently only 16 cases have been reported in patients older than 70 years and 4 patients older than 80 years. This report describes the oldest known patient with TDC who had a purely intralingual location requiring a Trotter approach and a Sistrunk procedure for symptomatic management.

Thyroglossal Duct Cyst: Abbreviated Review and Case Report

The thyroglossal duct cyst (TGDC) is the most common developmental cyst of the neck. The cyst typically occurs along the midline of the neck on the ventral surface. Malignant transformation is rare and can be diagnosed only after histologic examination of a biopsy specimen. This article presents a brief, focused narrative review, which includes a discussion of successful treatment of a TGDC, and a single case report that describes a Sistrunk-like procedure.

Papillary Thyroid Carcinoma Cervical Lymph Node Metastasis with Cystic Change Differentiated from Congenital Cystic Lesions with the Assistance of Immunohistochemistry: A Case Study

Diagnosis of cystic papillary thyroid carcinoma (PTC) lymph node metastasis at head neck region can be a challenge in the absence of known PTC history. The congenital cystic lesions of head neck, especially thyroglossal duct cyst (TGDC) and branchial cleft cyst (BCC), are major differential diagnoses in this clinicopathological scenario. The location of cyst and morphology of lining epithelium are critical clues for reaching correct diagnosis. However it is not uncommon that the flattened bland epithelial lining can be seen in both cystic metastases and congenital cystic lesions. Given that Pax8 and TTF-1 are common markers in thyroid follicular epithelium; we applied immunohistochemical stains of those two markers on aforementioned cystic lesions. Here we reported a case of cystic PTC metastasis to lymph node without prior malignancy history and cases of TGDC and BCC. Both Pax8 and TTF-1 stainings highlighted the cyst lining in PTC metastatic lymph node, while they were negative in the lining of TGDC and BCC. Collectively, Pax8 and TTF-1 immunohistochemical studies are very helpful tools for making correct diagnosis of head neck cystic lesions in the challenging clinical cases.

HYDATID CYST DISEASE IN THE LEFT LATERAL NECK: AN UNCOMMON PRESENTATION

Cysts commonly occurring in the neck include thyroglossal cyst and dermoid cysts in the midline, cystic thyroid nodules, branchial cysts and cystic Hygroma in the lateral neck. Hydatid cyst disease is commonly seen in the right lobe of the liver, the lung and rarely in other parts of the body. In general, cysts in the neck are not common in the second decade of life. In this article, we present a case of hydatid cyst presenting as left lateral cystic mass in an Ethiopian boy. The diagnostic difficulty, the need for diagnostic suspicion and consideration of hydatid cyst in the differential diagnosis and the management options are discussed.

Thyroglossal Duct Cyst with Intralaryngeal Extension

Objectives:

Thyroglossal duct cysts with intralaryngeal extension are rare. We present only the 10th reported case in the literature.

Methods:

The clinical presentation, diagnosis, and treatment of the patient are reviewed and summarized. The uniqueness of the case, as well as the diagnostic and treatment pitfalls of this subgroup of patients, is presented.

Results:

Our patient, at 76 years of age, is the only woman and the oldest person reported to have had a thyroglossal duct cyst with intralaryngeal extension.

Conclusions:

Intralaryngeal extension should be considered when there is hoarseness, dysphagia, or dyspnea associated with a thyroglossal duct cyst. Office laryngoscopy and computed tomography make the diagnosis. Care must be taken with airway management and intraoperative dissection for good outcomes.

Intralaryngeal Thyroglossal Duct Cyst: Implications for the Migratory Pathway of the Thyroglossal Duct

An atypically located thyroglossal duct cyst in a 42-year-old man is described. A purely intralaryngeal thyroglossal duct cyst is extremely rare and can mimic other laryngeal lesions. This case demonstrates that thyroglossal duct cyst is a possible cause of intralaryngeal swellings and would have significant implications for the manner in which they are managed.

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.

[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 cysts in a pediatric population: apparent differences from adult thyroglossal cysts

BACKGROUND AND OBJECTIVES

The clinical presentation of thyroglossal cyst and its variation from adult thyroglossal cyst has not been well studied. This study is to determine if the clinical presentation of thyroglossal duct cysts (TGDC) varies between children and adults and whether this affects the optimal management of individual cases.

DESIGN AND SETTING

Retrospective study of all cases operated on for TGDC from February 2008 to November 2011 in a tertiary care teaching hospital.

SUBJECTS AND METHODS

The gender, age, clinical presentation, radiologic imaging, surgical management, post operative complications, and recurrence rates between the children ( 18 years) were compared.

RESULTS

Of the 46 patients, 30 were adults and 16 pediatric; 46.5% of the adults and 74% of the children were females (P=.11). The mean (SD) age in adults was 40.5 (16.0) years, while in children the mean (SD) age was 9.0 (1.4) years, suggesting a bimodal presentation. Hypothyroidism was present in 6.7% of the adults and 56.3% of pediatric cases (P=.0004). Twenty percent of the adults had either an infected TGDC or fistulae, but none of the children had either infection (P=.0001). In both adults and children the duration of disease was significantly shorter in females. In the pediatric group, males had a larger compared to females (P=.006). The most common location of TGDC was the infrahyoid region. The Sistrunk procedure resulted in cure with no recurrences and complications in all.

CONCLUSION

TGDC is commoner in adults with no sex predilection. Children have a shorter duration of disease. Male children present with larger cysts. Hypothyroidism is more common in pediatric TGDC. Infected TGDC and fistulae are uncommon in children. The Sistrunk procedure is adequate for both groups.

Clinicopathological evaluation of thyroglossal cyst

INTRODUCTION

Thyroglossal cyst is a common congenital anomaly of the thyroid gland. Though malignant transformation is rare one case was a papillary carcinoma in my series.

METHODS

Retrospectively thyroglossal cyst who underwent surgery during the period of January 2004 to March 2009 were evaluated.

RESULTS

Age incidence of the cysts in the present series varied between 4 and 41 years. 12 (63%) patients were male and 7 (37%) patients were female. The sites of the lesion were as:thyrohyoid in 13 (68%),suprasternal in 1 (5%) and suprahyoid in 5 (27%) cases. Twelve patients had painless swelling on the neck and 7 had discharging sinus.Pre-operative cytological evaluation showed non-malignancy in all cases.Postoperative histological result turned out to be papillary carcinoma in 1 female patient of 33 years old and the remaining 18 had non-malignancy. This patient with papillary carcinoma had her thyroid gland in its normal position.

CONCLUSIONS

Malignant transformation should be ruled out in all cases of thyroglossal cyst and fistula. Post-operatively specimen should be sent for histological examination.

Subglottic thyroglossal duct cyst: a rare intralaryngeal presentation

Thyroglossal duct cysts are common midline neck swellings that can present at any site along their migratory pathway. They are frequently situated just below the hyoid bone. Extension to the subglottic area is very rare; such an unusual presentation can complicate the diagnosis of a thyroglossal duct cyst. We report the case of a 30-year-old man who presented with a subglottic thyroglossal duct cyst and associated laryngeal symptoms. To the best of our knowledge, only 2 similar cases have been previously reported in the literature, both of which occurred in 2-year-old boys. We believe, therefore, that ours is the first reported case of a subglottic thyroglossal duct cyst in an adult. We discuss the clinical presentation, diagnosis, and treatment of our patient, and we summarize the literature on intralaryngeal thyroglossal duct cysts.

Cervical bronchogenic cyst mimicking thyroglossal cyst: case report and literature review

BACKGROUND

Bronchogenic cysts are rare congenital malformations of ventral foregut development, often with an intrathoracic location. Presentation at the cervical region is very rare.

CLINICAL CASE

We present the case of a 29-year-old female who demonstrated a 3-cm medial neck mass in relation to the hyoid cartilage. The mass was painless with a rubbery consistency, moving with tongue movements. Cervical ultrasonography and thyroid scan were suggestive of nonfunctioning thyroglossal cyst. Histopathological examination revealed the presence of a cervical bronchogenic cyst.

CONCLUSIONS

Cervical bronchogenic cyst is a rare congenital malformation that usually appears as a painless neck mass. Imaging findings are not specific for differentiating thyroid, thyroglossal, branchial or thymus cyst; therefore, clinical observation of an asymptomatic lateral neck mass in an adult should include the possibility of a bronchogenic cyst in the differential diagnosis.

Congenital cystic lesions of the head and neck

This article presents clinical characteristics and radiologic features of congenital cervical cystic masses, among them thyroglossal duct cysts, cystic hygromas, branchial cleft cysts, and the some of the rare congenital cysts, such as thymic and cervical bronchogenic cysts. The imaging options and the value of each for particular masses, as well as present clinical and radiologic images for each, are discussed.

Papillary carcinoma in a thyroglossal duct remnant. Three case reports and discussion on management

OBJECTIVE

To report three cases of papillary thyroglossal duct carcinoma (TDCa), and to discuss the diagnostic and therapeutic methods.

CASE REPORTS

We studied the clinical, pathological findings of the tumor, treatment and outcome data on 3 patients treated at our Institution for a papillary TDCa carcinoma and we compared the results with the published cases. Preoperative Fine Needle Aspiration (FNA) and intraoperative frozen section exam was performed in patients 1 and 2. Following the Sistrunk operation (SO), limited thyroidectomy were performed on patients 1 and 2, due to benign lesion. Neck dissections were performed on patients 2 and 3 (second operation after initial SO in other Institute), due to regional lymphadenopathy. The diagnosis of papillary TDCa was confirmed in all cases. Lymph nodes metastases were identified in patients 2 and 3. All patients were treated with levothyroxine therapy. After a median follow-up of 59 months, all patients are alive without recurrence.

CONCLUSIONS

Papillary TDCa is a rare malignancy with excellent prognosis. FNA and intraoperative frozen section exam are the most useful methods for confirmatory diagnosis. Resection of the thyroglossal duct carcinoma by the Sistrunk operation is an adequate surgical approach. Further thyroidectomy should be limited to one either lobe or pyramidal lobe in high risk patients. Total thyroidectomy is recommended only when there is clinical evidence of multifocal malignancy in thyroid gland. Postoperative hormone suppression is advocated.

Squamous cell carcinoma in a thyroglossal duct cyst and 99mTc-MIBI findings

The incidence of carcinomas in thyroglossal duct cysts is extremely low. The vast majority are papillary carcinomas, with only 14 cases of squamous cell carcinomas reported in the literature. A 78 years old male patient presented with an asymptomatic large mass in his anterior neck, considerably immobile, with inflamed overlying skin. Imaging studies confirmed the cystic nature-doughnut shape of the lesion, giving evidence of malignant infiltration of the surrounding tissues, without lymph node enlargement. Fine needle aspiration was positive for a possible squamous cell malignancy. A wide Sistrunk procedure was performed and the mass was excised along with the strap muscles and the infiltrated overlying skin. Histopathology confirmed the diagnosis of a moderately differentiated squamous cell carcinoma. In conclusion, scintigraphy with (99m)Tc-MIBI showed the characteristic doughnut sign. The rarity of this diagnosis along with differential diagnosis dilemmas are the key points of this presentation.

Thyroglossal duct cysts: evaluation and treatment of 49 cases

OBJECTIVE

The aim of the study was to evaluate the clinical features and treatment outcomes of patients with a thyroglossal duct cyst (TGDC) or fistula.

METHODS

The records of 49 patients (9 female, 40 male; mean age: 23.16 +/- 1.13 years; range 6 to 56 years) operated on between January 1995 and July 2009 were reviewed retrospectively. Patient's age, sex, duration of symptoms, clinical features, pre-operative diagnostic tests, treatment, histopathologic diagnosis, and post-operative complications were noted. All patients underwent the Sistrunk procedure.

RESULTS

Fifteen patients (30.6%) were < or = 20 years old, while 3 (6.1%) patients were 40 years old at the time of operation. There was cyst formation in 26 patients (53.1%) and fistula formation in 23 patients (46.9%). The lesions of 41 patients (83.7%) were located in the midline, while the lesions of 8 patients (16.3%) were located in the paramedian neck (5 left side, 3 right side). The most common presenting symptoms were painless mass in the midline of the neck and recurrent suppuration of fistula formation. Neck ultrasonography (USG) was the most common pre-operative diagnostic procedure and was performed on all patients with cyst formations. There were no major complications postoperatively. There was recurrence in only one patient after the Sistrunk procedure. One patient was incidentally diagnosed with thyroid papillary carcinoma after histopathological examination.

CONCLUSIONS

A TGDC is the most common congenital mass in the neck and is usually located midline. USG is suggested for a clinically suspected TGDC. The Sistrunk procedure is a safe and successful technique with low complication and recurrence rates. Even though carcinomas arising in TGDCs are uncommon, histopathological examination must be routinely performed to confirm the diagnosis and rule out malignancy.

[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.

Papilläres Schilddrüsenkarzinom in einer medianen Halszyste

Thyroglossal duct cysts are the most common anomaly in thyroid development. The occurrence of carcinoma in a cyst is reported to be about 1% of cases. Histopathological examinations reveal a papillary thyroid carcinoma in about 94% of these. We report the case of 38-year-old female having a massive, cervical cystic mass over a period of 18 months. An ectopic papillary thyroid carcinoma was diagnosed. A total thyoidectomy and bilateral neck dissection were performed. This revealed a small thyroid carcinoma and three positive lymphatic nodes. Whether the cystic carcinoma is the primary or a metastasis of the thyroid carcinomais discussed.