Metástasis ganglionar cervical bilateral de un cáncer originado en un quiste tirogloso / Bilateral lymph node metastases from a thyroglossal duct cyst carcinoma

RESUMEN Presentamos una paciente de 47 años, sexo femenino, tiroidectomía total por bocio multinodular hace 20 años. Consulta por adenomegalias yúgulo-carotídeas bilaterales cuya citopunción evidenció metástasis ganglionar bilateral de cáncer papilar de tiroides. Ecografía y tomografía evidenciaron quiste tirogloso. Cirugía: operación de Sistrunk más vaciamiento cervical central y bilateral selectivo. Anatomía patológica: cáncer papilar de tiroides en quiste tirogloso, adenomegalias metastásicas. El 5-7% de los quistes tiroglosos tienen tejido tiroideo, el 1% de ellos desarrollarán carcinoma, y de estos, un 7-15% presentarán metástasis ganglionar cervical. Informamos una patología infrecuente con una inusual presentación clínica: adenomegalias cervicales bilaterales, cuya citopunción orientó la búsqueda del tumor primario.

ABSTRACT We report the case of a 47-year-old female patient with a history of total thyroidectomy 20 years before due to multinodular goiter, with palpable jugular-carotid lymph nodes in both side of the neck. The fine needle aspiration biopsy revealed bilateral lymph node metastases of a papillary thyroid carcinoma. A thyroglossal duct cyst was found on ultrasound and computed tomography scan. Surgery: Sistrunk procedure plus selective central and bilateral selective neck dissection. Pathology report: papillary thyroid carcinoma in a thyroglossal duct cyst with lymph node metastases. Thyroid gland tissue may be present in 5-7% of thyroglossal duct cysts; 1% may develop cancer and cervical lymph node metastases will occur in 7-15% We report a rare condition with unusual clinical presentation: bilateral enlargement of neck lymph nodes with a positive fine needle aspiration biopsy that guided the search for the primary tumor.

Papillary carcinoma in a thyroglossal cyst: a rare case report and review of literature

Thyroglossal cysts are the most common thyroid anomaly with a majority of it being diagnosed at fourth decade of life. Authors report a case of 32-year-old lady with a globular swelling of 3×2 cm moving with deglutition with no cervical lymph nodes and a normal thyroid function test. Intra operatively a distinct lesion of 3×2 cm was found superior to the thyroid gland with firm nodules in the right lobe of the thyroid. Patient underwent total thyroidectomy with central compartment neck dissection and Sistrunk’s operation followed by a negative radio iodine scan and thyroid hormone suppression. This was considered based on intraoperative nodularity of the thyroid gland.

Estudio de caso de quiste tirogloso lingual: una urgencia en la vía aérea del lactante menor / Lingual thyroglossal cyst case study: an airway emergency in the young infant

El quiste tirogloso es una de las principales causas de tumores congénitos en el cuello, cuyo sitio menos frecuente de presentación es la lengua; no obstante, es importante conocer esta ubicación, principalmente en los lactantes menores, ya que debido a sus características anatómicas presentan disnea ­como síntoma principal­ con diferentes grados de severidad, que puede llegar a comprometer su vía aérea y su vida. Se presentan dos casos de lactantes que ingresan por estridor y signos de falla ventilatoria: en principio, se les realizó una nasofibrolaringosocopia flexible, que evidenció una lesión de aspecto quístico en la base de la lengua; luego, se complementó con un estudio imagenológico, cuya primera opción diagnóstica fue un quiste tirogloso lingual; por último, se les realizó una microlaringoscopia de suspensión más una marsupialización endoscópica con corte frío y radiofrecuencia, lo que dio como resultado una adecuada evolución posoperatoria. Basados en los casos previos, proponemos un algoritmo de tratamiento que hace énfasis en el uso de imágenes diagnósticos y la técnica quirúrgica.

The thyroglossal cyst is one of the main causes of congenital neck tumors, being the tongue infrequent site of presentation. However, it´s relevant to know this location, mainly in young infants, since, due to its anatomical characteristics respiratory distress is a main finding, it could be presented in different degrees of severity, until it completely compromises the airway and the life of the patient. Two cases of infants are admitted due to stridor and signs of ventilatory failure are presented. In both cases, flexible nasofibrolaryngoscopy was performed, showing a cystic appearance lesion on the tongue, and a diagnostic study was subsequently completed with images giving the lingual thyroglossal cyst as the first diagnostic option. Both patients underwent surgical management with suspension microlaryngoscopy plus endoscopic marsupialization with cold cut and radiofrequency with adequate postoperative evolution. Based on the previous cases, we propose a management algorithm emphasizing the use of diagnostic images and surgical technique.

Cáncer Papilar en Quiste Tirogloso. Caso Clínico y Revisión de la literatura / Papillary Cancer in Tirogloso Cyst. Case report and review of literature

INTRODUCCIÓN: Los quistes tiroglosos son las lesiones más comunes de la línea media cervical y se ha descrito el carcinoma papilar de tiroides en el 1%. Debido a su baja incidencia no existe un consenso acerca del tratamiento óptimo. Caso clínico: Paciente mujer de 34 años de edad consulta por aumento de volumen cervical doloroso y se evidencia nódulo doloroso en región cervical media. Ecografía de tiroides visualiza una lesión quística compleja. Se completa el estudio con tomografía computada del cuello con contraste que evidencia quiste del conducto tirogloso con compromiso inflamatorio-infeccioso, por lo que se decide cirugía. Biopsia evidencia cáncer papilar de 0.25 cm en quiste del conducto tirogloso, con bordes quirúrgicos negativos. Por bajo riesgo se decide control imagenológico estricto. DISCUSIÓN: Los quistes del conducto tirogloso comprenden las lesiones cervicales congénitas más frecuentes. Se presentan como masas indolentes y asintomáticas. El diagnóstico es confirmado mediante ecografía y la tomografía es utilizada para ampliar el estudio. La aparición de cáncer tiroideo en estos quistes es poco común, y generalmente son indistinguibles de las lesiones benignas en el preoperatorio. En relación al manejo del cáncer papilar en quiste del conducto tirogloso no existe un consenso de su tratamiento óptimo. Para los casos de bajo riesgo se sugiere control anual con TSH y ecografía tiroidea. Para aquellos pacientes de alto riesgo se sugiere tiroidectomía total y ablación de los restos tiroides con yodo radioactivo, con control anual con niveles de tiroglobulina. El pronóstico es excelente, con tasas de remisión que superan el 95%. CONCLUSIONES: Los carcinomas en quistes de conducto tirogloso son poco comunes y en la mayoría de los casos son lesiones diagnosticadas de manera incidental después de la resección quirúrgica. Para definir necesidad de tiroidectomía, debe realizarse estudio individualizado por un equipo multidisciplinario con amplia experiencia.

INTRODUCTION: Thyroglossal cysts are the most common affection of the cervical midline. Papillary carcinoma has been described in 1% of this cysts. Due to its low incidence a consensus on the optimal treatment does not exist. Clinical case: A 34 year old female with no relevant past medical history, presented with a painful cervical mass of many weeks of appearance. The thyroid ecography showed a complex cystic lesion and the cervical computed tomography with contrast evidenced a cyst of the thyroglossal duct with inflammatory and infectious findings. Surgery with no incidents was performed. Biopsy reported a 0.25 cm papillary cancer in the thyroglossal duct cyst, with negativa surgical margins. Strict follow up with imaging studies was decided. DISCUSSION: the thyroglossal duct cyst are the most common congenital cervical affections. Classically, they present as indolente, asyntomatic masses on the cervical midline. The diagnosis is confirmed with ecography and computed tomography is used to extent evaluation. Thyroid cancer in thyroglossal duct cyst is uncommon and generally indistinguishable from benign lesions in the preoperative phase. A consensus regarding the optimal management of this patients does not exist. For low risk cases, an anual control with THS and thyroid ecography is suggested. For patients with high risk a Sistrunk with total thyroidectomy and radioactive ablation of thyroids remnants is recommend. Follow up with anual thyroglubin levels should be performed. The prognostic is excellent, with more than 95% remission rates. CONCLUSSIONS: Thyroglossal duct cyst carcinomas are rare. In most cases, diagnosis is made incidentally after surgical resection. To decide wheter thyroidectomy is necessary each case should be analyzed individually by a multidisciplinary team with vast experience.

Carcinoma Papilífero primário de ducto do cisto tireoglosso ­ relato de caso / Primary Papillary Carcinoma of the Thyroglossal Duct Cyst: Case Report

O cisto do ducto tiroglosso é uma anomalia congênita comum, decorrente da falha do desenvolvimento embriológico. Sempre que diagnosticado, é indicada a excisão cirúrgica do cisto, devido ao risco de infecção e malignidade, sendo mais comum o carcinoma papilífero da tireoide. Este trabalho relata o caso de uma paciente jovem que apresentou massa em região cervical anterior, cujo anatomopatológico confirmou o diagnóstico de carcinoma de cisto do ducto tireoglosso com tecido tireoidiano ectópico, sem evidência de carcinoma em glândula tireóide. Trabalho realizado através da revisão do prontuário, e em seguida, análise e discussão com base na literatura atual.Este artigo visou reforçar a importância de realizar um estudo anatomopatológico dos cistos do ducto tireoglosso e da diferenciação de carcinomas metastáticos e carcinomas primários.

Thyroglossal duct cyst is a common congenital anomaly, due to failure of embryological development. Whenever diagnosed, surgical excision of the cyst is indicated due to the risk of infection and malignancy, with papillary thyroid carcinoma being the most common. This paper reports the case of a young patient who presented mass in the anterior cervical region, whose anatomopathological confirmed the diagnosis of thyroglossal duct cyst carcinoma with ectopic thyroid tissue, without evidence of carcinoma in the thyroid gland. Work carried out by reviewing the medical chart, and then analysis and discussion based on current literature. This article aimed to reinforce the importance of conducting an anatomopathological study of the thyroglossal duct cysts and the differentiation of metastatic carcinomas and primary carcinomas.

Papillary Thyroid Carcinoma within Thyroglossal Duct Cyst: Case Series and Literature Review

Abstract Introduction Thyroglossal duct cyst (TGDC) is themost common congenital anomaly of the neck, and approximately 7% of all the adult population presents it. Ectopic thyroid tissue is found in the thyroglossal duct cyst wall in up to 65% of cases. This thyroid tissue has the potential to develop some type ofmalignancy, themost common of which is the papillary carcinoma of the thyroid. There are just over 270 cases of thyroglossal duct cyst malignancy reported in the literature. Objectives We aimed to study our population of patients in order to identify cases with thyroglossal duct cyst malignancy. Methods A retrospective chart review was conducted in the section of otolaryngology/ head and neck surgery at a hospital in Karachi, Pakistan, from January of 2004 to December of 2014 on patients with the diagnosis of thyroglossal duct cyst. Results Fifty-eight patients were diagnosed with TGDC, two of whom also presented with thyroglossal duct cyst carcinoma. Both patients revealed papillary thyroid carcinoma on histopathology. Case 1 had an open biopsy before undergoing definitive surgery. Both patients underwent subsequent total thyroidectomy after Sistrunk procedure, and case 2 had selective neck dissection revealing lymph node metastasis. Conclusion Thyroglossal duct cyst carcinoma is a rare finding that comes as a surprise to both the patient and the surgeon. We report 2 out of 58 cases diagnosed with thyroglossal duct cyst carcinoma.

Carcinoma papilar de quiste tirogloso: reporte de caso y revisión de la literatura / Papillary carcinoma of thyroglossal cyst: a case report and literature review

Resumen Introducción El carcinoma con localización en quiste tirogloso tiene una baja frecuencia, se encuentra alrededor del 1% de los pacientes con este padecimiento; la histología más frecuente es el carcinoma papilar de tiroides. Se realiza la descripción de un caso de carcinoma papilar de quiste tirogloso. Caso clínico Masculino de 54 años con tumor cervical anterior de seis meses de evolución, de 3 × 5 cm por cinco centímetros de diámetro. Ultrasonido de tiroides con nódulo tiroideo derecho TIRADS 4c, adenopatías sospechosas en nivel VI. Se realizó tiroidectomía total + Sistrunk, con reporte patológico de carcinoma papilar. Infiltró la cápsula y fibras del músculo estriado pretiroideo, tumor de lóbulo derecho de 2 × 1.5 × 1.3 cm, lóbulo izquierdo de 3.5 × 3 × 4 cm; se aplicó dosis de I-131. Discusión No existe un consenso acerca del tratamiento ideal del carcinoma papilar en el quiste tirogloso, aunque parece ser el tratamiento más adecuado la cirugía de Sistrunk con tiroidectomía total. Al tratarse de una presentación de cáncer bien diferenciado de tiroides poco frecuente, será difícil hacer conclusiones con un alto nivel de evidencia, pero deberán ser orientadas por las guías actuales para cáncer bien diferenciado de tiroides y tomar decisiones en equipos multidisciplinarios.

Abstract Introduction Carcinomas with thyroglossal cyst localization have a low frequency, about 1% of patients present this disease; the most frequent histology is papillary thyroid carcinoma. We describe a case of papillary carcinoma of thyroglossal cyst. Clinical case A 54-year-old man with an anterior cervical tumor of six months of evolution, not mobile, not painful, with diameters of 3 × 5 cm. Thyroid ultrasound with right thyroid nodule TIRADS 4c and suspicious adenopathies in level VI. Total thyroidectomy + Sistrunk was performed, with pathological report of multifocal conventional variant papillary carcinoma. It infiltrated thyroid capsule and adjacent prethyroid muscles; right lobe tumor 2 × 1.5 × 1.3 cm, left lobe tumor 3.5 × 3 × 4 cm; then, I-131 dose was applied. Discussion There is no consensus regarding the ideal treatment of papillary carcinoma in the thyroglossal cyst, although Sistrunk surgery with total thyroidectomy seems to be the most appropriate one. As this is a rare presentation of well-differentiated thyroid cancer, it could be difficult to draw conclusions with a high level of evidence for its management, but they should be guided by current guidelines of well-differentiated thyroid cancer and decisions should be made in multidisciplinary teams.

Ultrasonographic features differentiating thyroglossal duct cysts from dermoid cysts

PURPOSE: The purpose of this study was to identify ultrasonographic features that can be used to differentiate between thyroglossal duct cysts (TGDCs) and dermoid cysts (DCs). METHODS: We searched surgical pathology reports completed between January 2004 and October 2015 and identified 66 patients with TGDCs or DCs who had undergone preoperative ultrasonography. The ultrasound images were reviewed by two radiologists who were blinded to the pathological diagnosis. They evaluated the following parameters: dimensions, shape, margin, location in relation to the midline, level in relation to the hyoid bone, attachment to the hyoid bone, the depth of the lesion in relation to the strap muscles, internal echogenicity, internal echogenic dots, multilocularity, the presence of a longitudinal extension into the tongue base, posterior acoustic enhancement, the presence of internal septae, and intralesional vascularity. RESULTS: There were 50 TGDCs and 16 DCs. TGDCs were significantly more likely than DCs to have an irregular shape, an ill-defined margin, attachment to the hyoid bone, an intramuscular location, heterogeneous internal echogenicity, multilocularity, and longitudinal extension into the tongue base. CONCLUSION: Ultrasound findings may inform the differential diagnosis between TGDCs and DCs.

Cisto ducto tireoglosso: relato de caso e revisão de literatura / Thyroglossal duct cyst: case report and literature review

O cisto do ducto tireoglosso acomete principalmente crianças em idade pré-escolar, sendo uma das lesões mais comuns da linha média do pescoço. O presente artigo apresentará um caso de paciente com cisto do duto tireoglosso com diagnóstico realizado somente na adolescência, objetivando mostrar a importância do diagnóstico precoce desta patologia pelo risco de malignização da mesma.

The thyroglossal duct affects mainly children in preschool age, one of the most common injuries of the midline of the neck. This article will present a case of a patient with thyroglossal duct cyst with diagnosis performed only in adolescence, aiming to show the importance of early diagnosis of this pathology at risk of malignant transformation of it.

Diagnostic value of multi-slice spiral computerized tomographic fistulography in congenital fistula of neck / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the usefulness and effectiveness of multi-slice spiral computerized tomographic fistulography (MSCTF) in the diagnosis and treatment of congenital fistula of neck.@*Methods@#Thirty-four patients with thyroglossal fistulasor branchial cleft fistulas who were initial treated from July 2008 to August 2015 in Fujian Provincial Hospital were retrospectively analyses. Thirteen males and 21 females patients aging from 3 to 46 years old with a median age of 37 were included. There were thyroglossal fistula in 6 cases, the first branchialcleft fistula in 9 cases, the second branchialcleft fistula in 3 cases, the third branchialcleft fistula in 9 cases, and the fourth branchialcleft fistula in 7 cases. All the patients underwent preopeative MSCTF and the diagnoses were finally confirmed with surgery and histopathology. Multiplanar reconstruction(MPR), maximumintensity projection(MIP)and volume rendering(VR) were completed with AW Volume Share 4.2 image processing software after initial CT scanning.The internal openings, distribution, and neighboring relationship of the fistulas showed by MSCTF were analyzed and the surgical strategies were subsequently made.@*Results@#Except 2 cases, 32 patients had obtained successfully MSCTF image. The presence and location of the fistulas could be showed clearly on MSCTF. Based on the results of MSCTF examination, the surgical planes to treat the fistulas were made. The fistulas in all cases were successfully found and excised. Three cases underwent selective neck dissection. Postoperative infection occurred in 1 case. Unilateral vocal fold paralysis due to surgery recovered 3 months after surgery with follow-up. One case lost follow-up, the remaining 33 cases were followed up for 13-97 months with no the fistula recurrence.@*Conclusions@#MSCTF could provide valuable information and benefit surgical planning by demonstrating the coursesof congenital fistulas of neck in detail.

Experiencia en el manejo de la patología del conducto tirogloso: serie de casos / Experience in thyroglossal duct pathology: clinical case series

La patología del conducto tirogloso constituye la segunda anomalía cervical benigna más frecuente en la infancia. El diagnóstico es principalmente clínico. Sistrunk fue quien describió la técnica quirúrgica considerada de elección para el tratamiento definitivo de esta patología. Estudio descriptivo retrospectivo. Entre junio de 2008 y agosto de 2015 se realizaron 54 procedimientos en 45 pacientes (39 casos primarios). La mediana de edad fue de 4,7 años; 14/39 pacientes (31,1%) presentaron infección preoperatoria. Todos los pacientes fueron evaluados inicialmente por ecografía. Todos fueron tratados mediante la técnica de Sistrunk. La recidiva global fue de 17,8%.

The thyroglossal duct cyst pathology represents the second cause of bening cervical anomalies in childhood. Diagnosis is mainly clinical. Sistrunk (1920) proposed a surgical technique that is still considered the gold standard for definitive treatment of this condition. A retrospective study was made including patients who underwent surgery for thyroglossal duct cyst pathology in our department between June 2008 and August 2015. In this period, we performed 54 procedures in 45 patients (39 primary cases). Median age was 4.7 years; 14/39 patients (31.1%) had pre-operative infection. All patients were studied with neck ultrasound. A Sistrunk's procedure was performed in all cases. The global recurrence rate was 17.8% (8/45).

Thyroglossal Duct Cyst.

Thyroglossal duct cyst most common congenital malformation of the neck is formed due to failure of involution of the thyroglossal duct. We present a case of six-year-old female child who presented with a history of swelling since one year in the front of the neck in the midline. The swelling was painful, associated with high fever with purulent discharge off and on. The swelling was present in front of neck and moved with deglutition. There was no history of dyspnoea or dysphagia. Diagnosis of Thyroglossal Cyst was made clinically which was confirmed on Ultrasonography. All investigations, including thyroid profile were normal. Sistrunk’s procedure (complete excision of cyst with tract and part of middle of body of hyoid bone) was performed under GA with no post-operative complication.

Quiste del conducto tirogloso: experiencia en el Instituto Nacional de Salud del Niño, Lima 2008-2015

El quiste o fístula del conducto tirogloso es una alteración del desarrollo producida por la falta de involución del conducto de descenso de la glándula tiroides. Debido a la presentación y frecuencia en edad pediátrica consideramos necesario el presente estudio. Se revisaron 167 casos intervenidos en un periodo de ocho años, siendo el 61,1% de sexo masculino y mayor presentación en menores de seis años de edad 57,5%. Se presentaron como quiste tirogloso el 68,9% y el 31,1% restante como fístula con secreción. Su localización más frecuente es a nivel de la línea media 85% e infrahioideo 57,5%. Se reintervinieron 26 casos del total. La patología del conducto tirogloso es frecuente en pacientes pediátricos, siendo necesario el tratamiento quirúrgico con la resección medial del hueso hioides. A pesar de realizar los pasos descritos la recidiva es posible.

Thyroglossal duct cysts or fistulae are produced by an inadequate involution of the thyroid gland descending duct. The aim of this paper is to review its usual presentation and frequency in pediatric patients. We reviewed 167 cases who underwent surgery in an eight year period, 61.1% were male, and 57.5% were below 6 years of age. Thyroglossal duct cysts were present in 68.9% of the cases and 31.1% had cervical fistulae with secretion. Their most usual location was 85% at the cervical midline and 57.5% under the hyoid bone. Twenty-six cases required a second surgical procedure. Thyroglossal duct cysts are not uncommon in pediatric patients, surgical therapy is necessary, performing a medial resection of the hyoid bone. Despite an adequate surgical procedure, recurrences are possible.

Sonographic features and clinical significance of the complications of the thyroglossal cysts / 中国耳鼻咽喉头颈外科

OBJECTIVE To assess the ultrasonographic features and clinical significance of the complications of the thyroglossal cysts. METHODS We retrospectively reviewed the ultrasonographic findings in 41 cases with complications of the thyroglossal cyst, which was confirmed surgically and pathologically. 43 cases with simple thyroglossal cyst consisted of the control group. The location, size, internal echo, internal septa, wall thickness, posterior acoustic feature, boundary, vascularity, and fistulas of the lesion were analyzed and compared with the control group. RESULTS Most of the inflammatory thyroglossal cyst showed thickening walls, indistinct boundaries, posterior echo enhancement, and peripheral vascularity on ultrasound images. There were significant differences of the thickness of the cyst wall, indistinct boundary, and peripheral vascularity between the two groups. CONCLUSION The characteristic findings of thyroglossal cyst with inflammation are thickened wall, indistinct boundary, and peripheral vascularities. Ultrasonography can be useful tool in determination of the appropriate time of the operation to reduce the recurrence rate.

Localización atípica del quiste tirogloso / Atypical location of thyroglossal duct cyst / Localização atípica do quisto tireoglosso

El quiste tirogloso es una malformación congénita asociada a la falta de involución del conducto tirogloso, ubicado entre el foramen de la lengua y la glándula tiroides. Su incidencia predomina en la infancia, aunque también se puede presentar en la adultez. Es común que la presencia de infecciones de las vías aéreas superiores o el desarrollo de fístulas hagan parte del cuadro clínico del paciente y se evidencie una masa. Se reporta el caso de un paciente de sexo masculino de 39 años de edad, que cursó con una lesión nodular corres- pondiente a un quiste tirogloso con apariencia de tejido tiroideo residual, de localización atípica en la línea media suprahiodea, que fue removido quirúrgicamente. Dada su ubicación, se requirió la pertinente planeación imaginoló- gica y prequirúrgica para la valoración de la glándula tiroides con el fin de resecar toda la lesión, usando la técnica de Sistrunk con remoción total del hueso hioides para evitar la recurrencia. Se discuten las características clínico-patoló- gicas de la enfermedad y se establece la importancia de la ubicación para la toma adecuada de decisiones clínicas o quirúrgicas que permitan brindar un tratamiento con un resultado seguro y eficaz para el paciente.

The thyroglossal cyst is a congenital abnormality resulting from a defective closing of the duct located between the foramen of the tongue and the thyroid gland. Its incidence predominates in childhood, although it can also occur in adulthood. It is common that the presences of upper airway infections or fistulas become a part of the patient’s clinical signs and as the mass becomes apparent. This report corresponds to a case of a 39 year old male patient with a nodular lesion. A thyroglossal cyst with an atypical location in the midline superior part of the hyoid bone was diagnosed, which was surgically removed. Because of its location careful imaging and presurgical planning was required for thyroid gland assessment. The Sistrunk technique was performed removing the hyoid bone completely to prevent recurrence. Clinico-patholo- gical features of the disease are discussed, the importance of the location for surgical considerations to provide the best outcome for the patient.

O quisto tireoglosso é uma malformação congénita asso-ciada à falta de involução do conduto tireoglosso localizado entre o ovale da língua e a glândula tiroides. Sua incidência predomina na infância, embora também possa se apre-sentar nos adultos, sendo comum na clínica do paciente a presença de infeções aéreas superiores ou a frequente presença de fístulas sendo evidenciada uma massa.No presente artigo se faz o reporte correspondente a um paciente masculino com 39 anos de idade, que apresentou uma lesão nodular convergente a um quisto tireoglosso com aparência de tecido tiroide residual, de localização atípica na linha media supra-hioideus, remo-vido cirurgicamente. Devido a sua locação foi preciso planejamento imagenológico para valoração da glândula tiroides, visando ressecar a totalidade da lesão mediante a técnica de Sistrunk, com remoção total do osso hioideus para evitar recorrência. O artigo discute as caracterís-ticas clinico patológicas desta doença e se estabelece que a adequada tomada de decisões clinicas e cirúrgicas depende em grande medida da locação da lesão.

Is There Any Benefit of Drain Placement on Postoperative Complications in Patients Undergoing the Sistrunk Procedure?

Introduction Same-day, outpatient Sistrunk procedure is commonly performed to manage thyroglossal duct cyst anomalies and may lead to postoperative complications. Surgical drains are placed to prevent complications, but recent observations show no advantage and rather increased health care costs and patient discomfort. Objective The study evaluated if drain placement in the Sistrunk procedure offers any benefit on postoperative complications. Methods A retrospective analysis of patient records having undergone same-day, outpatient Sistrunk procedure from 2004 to 2014 was done. Of 58 (38 male and 20 female) patients included, 38 did not have drains placed and the remaining 20 had drains placed. Mean and median age of patients was 18.1 and 13.5 years, respectively. Postoperative complications of patients with drains versus those without drains were statistically analyzed. Results Overall, about 10% of patients had hematoma/seroma (H-S), with 6.9% of patients needing aspiration for H-S; 3.4% had wound infections; and 1.7% had pus formation. No statistically significant differences in Sistrunk-related complications between patient groups (with drain or without drain) were seen using Fisher exact (two-sided) test: H-S (p = 0.08); need for aspiration (p = 0.29); wound infection (p > 0.05); and pus formation (p = 0.35). Chi-square test also did not show any significant difference in the groups in terms of number of follow-ups. Conclusion Surgical placement of a drain in the Sistrunk procedure does not seem to offer any advantage in terms of reducing common postoperative complications. Sameday Sistrunk procedure without any drain placement may be a safer alternative without necessitating hospitalization. More studies with larger sample size are needed for further substantiation.(AU)

Carcinoma papilar de quiste de conducto tirogloso sincrónico con carcinoma papilar de tiroides / Synchronous papillary carcinoma of thyroglossal duct cyst and papillary thyroid carcinoma

Presentamos el caso de un paciente diagnosticado de quiste de conducto tirogloso y un nódulo tiroideo ístmico en el que se evidenciaron focos de carcinoma papilar intraquístico concomitantes con carcinoma papilar en el nódulo tiroideo. La indicación terapéutica en estos casos es controvertida, y dependerá en la mayoría de los casos del estudio microscópico de la muestra. En nuestro caso se realizó en un primer tiempo la intervención de Sistrunk asociada a una istmectomía y tras conocer el resultado de ambas muestras se decidió realizar tiroidectomía total.

We report the case of a patient with a thyroglossal duct cyst and a nodule at the thyroid isthmus which showed intracystic papillary carcinoma foci concomitant with papillary carcinoma in the thyroid nodule. The therapeutic indication in these cases is controversial. In our case it was done in a first intervention a Sistrunk technique associated to an isthmectomy and after knowing the results of both samples was decided to perform a total thyroidectomy.

Resección del quiste tirogloso con preservación del hueso hioides / Resection of thyroglossal cyst with preservation of the hyoid bone

Introducción. El quiste del conducto tirogloso representa la lesión congénita más frecuente del cuello, con una incidencia de 7 % de la población general. La presentación típica consiste en una masa en la línea media, entre el foramen ciego y la glándula tiroides, que asciende con la deglución o protrusión de la lengua. Tradicionalmente, se ha recomendado la remoción del quiste mediante el procedimiento de Sistrunk. Se describe una modificación de la técnica quirúrgica, preservando el cuerpo del hioides. El objetivo del presente estudio fue evaluar la frecuencia de complicaciones perioperatorias y de recidiva después del procedimiento quirúrgico modificado. Materiales y métodos. Se hizo un análisis retrospectivo de una cohorte de pacientes sometidos entre marzo de 2003 y marzo de 2011 a la resección quirúrgica del quiste del conducto tirogloso con el procedimiento modificado. Las intervenciones fueron practicadas por un cirujano de cabeza y cuello de la Fundación Cardioinfantil (Bogotá). Resultados. En el estudio se incluyeron 43 pacientes que cumplían los criterios de inclusión. La mediana de seguimiento fue de 11 meses y la tasa de complicaciones fue 6,9 % (n=3). Se presentaron dos granulomas a cuerpo extraño y un mucocele, este último considerado como una recidiva (2,3 %). Discusión. En el presente estudio no se encontró un incremento en la frecuencia de complicaciones perioperatorias cuando se reseca el quiste del conducto tirogloso con la técnica modificada. La recurrencia de la enfermedad está en el rango de lo reportado en la literatura científica, por lo que consideramos que el procedimiento quirúrgico propuesto puede ser una opción segura y viable.

Introduction: Thyroglossal duct cyst is the most common congenital anomaly of the neck, with an overall incidence of 7%. The typical presentation is a mass in the midline between the foramen cecum and the thyroid gland, which moves with swallowing or protrusion of the tongue. Traditionally it has been recommended the removal of the cyst by the Sistrunk procedure. The authors describe a modified surgical technique that preserves the hyoid bone. The aim of our study was to evaluate the rate of perioperative complications and recurrences after this modified surgical procedure. Materials and methods: We conducted a retrospective analysis of a cohort patients undergoing resection of thyroglossal duct cyst with the modified surgical procedure between March 2003 and March 2011. Surgery was performed by a head and neck surgeon of Foundation Cardioinfantil, Bogotá. Results: 43 patients who met the inclusion criteria were included in the study. Median follow-up was 11 months and the rate of complications was 6.9% (n = 3). There were 2 foreign body granulomas and one mucocele, which was considered a recurrence (2.3%). Discussion: We did not find an increase in the rate of perioperative complications with the modified surgical technique. Recurrence of the disease is similar to the data reported in the literature and we believe that the proposed surgical procedure can be a safe and viable option.

Quiste tirogloso con granuloma de colesterol en una escolar simulando carcinoma de tiroides

Objetivo: Presentar el caso de una escolar con quiste tirogloso y granuloma de colesterol, hallazgo inusual que simuló clínica e imagenológicamente un carcinoma de tiroides. Esta asociación es infrecuente y hay pocos casos reportados. Caso clínico: Escolar femenina de 11 años, quién consultó por presentar disfagia y tumoración en región anterolateral izquierda del cuello, de 3x3 cm, de consistencia dura, dolorosa a la palpación, sin signos de flogosis. Ultrasonido de cuello evidenció conducto tirogloso permeable en la línea media con presencia de nódulo hipoecoico, de bordes bien definidos, sin calcificaciones que medía 1,8 x 0,9 cm. Se extirpó la tumoración que medía 3x2, 5x0, 8cm. y se observó cavidad quística de 0,8 cm. de diámetro mayor que contenía material de aspecto gelatinoso. Por debajo de éste, se observó nódulo bien circunscrito de 1,5 cm. de diámetro mayor, constituido por tejido firme de color blanco-amarillento. El estudio histopatológico reveló un quiste revestido por epitelio cilíndrico y respuesta inflamatoria linfohistiocitaria, con células gigantes tipo “cuerpo extraño” alrededor de hendiduras; que correspondían a d dd epósito de colesterol. Conclusión: Se presenta este caso por su rareza y porque puede confundirse clínica e imagenológicamente con una neoplasia maligna. Asimismo, pudiera corresponder al primer caso reportado en nuestro país.

Objective: We report the case of a 11 year- old girl with thyroglossal cyst and cholesterol granuloma, an unusual finding that clinically simulates thyroid carcinoma. This association is unusual and there are few reported cases worldwide. Case report: An 11-year-old girl consulted for dysphagia and a 3 x 3 cm hard mass. The mass was painful on palpation and was located in the anterolateral neck left. It was phlogosis-free. A neck ultrasound showed a 1.8 x 0.9 cm permeable midline thyroglossal conduct with a hypoechoic nodule with well-defined edges but without calcifications. A 3 x 2,5 x 0, 8cm tumor was removed. A 0.8 cm cystic cavity that contained gelatinous material was observed. Below that cavity, a well-circumscribed nodule was observed. It measured 1.5 cm and was made up of firm yellowish tissue. The histopathology examination revealed a cyst lined with columnar epithelium and inflammatory linfohistiocitic response with foreign body type giant cells around cracks that corresponded to a cholesterol deposit. Conclusion: We present this case because it is very unusual and because it can be clinically and radiologically mistaken for a malignant tumor. It could be the first case ever reported in Venezuela.

Computed Tomographic Evaluation of Thyroglossal Duct Cysts in Children Under 11 Years of Age / 전남의대학술지

The purpose of this study was to review the computed tomography (CT) features of thyroglossal duct cysts (TDCs) in children less than 11 years of age. A retrospective chart review was performed at Chonnam National University Hospital for the period of March 2005 to June 2011. CT scans of 16 patients having TDCs were evaluated for the following features: site of the mass, relationship to the midline, walls, margins, internal septa, rim enhancement, internal density, and the presence or absence of the thyroid gland. Of the 16 lesions, 8 (50%) were located in the midline and 12 (75%) were infrahyoid in location. Twelve (75%) of the 16 patients had well-circumscribed walls and peripheral rim enhancement. Internal septa were seen in four of the cysts, and all but one of the cysts demonstrated homogeneous or low-density attenuation. The most common CT findings of TDCs in children less than 11 years of age were a homogeneous or low-density lesion. TDCs in children under the age of 11 years were mostly located in the infrahyoid neck.