Caso Clínico: Quiste Tirogloso, Cirugía de Sistrunk / Clinical Case Report: Thyroglossal Duct Cyst, Sistrunk Surgery

INTRODUCCIÓN: El quiste tirogloso es una anomalía congénita de la glándula tiroides y de la línea media a nivel del cuello, afecta al 7% de la población mundial. Se presenta como un tumor indoloro, móvil con la deglución. El diagnóstico se realiza con ecografía y biopsia por aspiración con aguja fina, para determinar existencia de malignidad la cual corresponde al 1%. El tratamiento de elección es quirúrgico mediante la técnica de Sistrunk. CASO CLÍNICO: Paciente masculino de 63 años, sin antecedentes patológicos, presentó desde hace un año un tumor en parte central de cuello, de consistencia dura de aproximadamente 3 cm, con aumento progresivo de tamaño. Al examen físico: Tumor de 3 x 2.5 cm que se moviliza con la deglución. EVOLUCIÓN: Se realizó Cirugía de Sistrunk, se envió muestra para estudio transoperatorio de patología el cual reportó presencia de quiste tirogloso, negativo para malignidad. No se presentaron complicaciones quirúrgicas, se colocó dren de Penrose que se retiró a los 5 días. El paciente permaneció hospitalizado durante 24 horas. El reporte definitivo de patología fue quiste tirogloso. Se realizó vigilancia a los 3 y 6 meses, y al primer y segundo año sin recurrencia. CONCLUSIÓN:El quiste tirogloso es una patología congénita benigna con un porcentaje de malignidad bajo, el pronóstico es excelente incluso si reporta malignidad. El diagnóstico se realiza mediante ecografía y biopsia por punción con aguja fina. La cirugía de Sistrunk constituye el tratamiento de elección, con tasas bajas de recurrencia. El acudir a control médico cuando se sospecha de un tumor en cuello ayuda a un diagnóstico temprano. (au)

BACKGROUND: The thyroglossal cyst is a congenital anomaly of the thyroid gland and the midline at the level of the neck, affecting 7% of the world population. It presents as a painless, mobile tumor when swallowing. The diagnosis is made with ultrasound and biopsy by fine needle aspiration to determine existence of malignancy, which is present in 1%. The treatment of choice is surgery using the Sistrunk technique. CASE REPORT: A 63-year-old male patient, who presented a 3 cm central neck tumor of hard consistency, with a progressive increase in size. Physical examination: 3 x 2.5 cm neck tumor that is mobilized with swallowing. EVOLUTION: Sistrunk Surgery was performed, a sample was sent for transoperative analysis, and the report was compatible with thyroglossal cyst negative for malignancy; the patient remained hospitalized for 24 hours without complications. The definitive pathology report confirmed the presence of a thyroglossal cyst. Follow ups were made at 3, 6 months, 1 and 2 years without recurrence. CONCLUSION: The thyroglossal cyst is a benign congenital disease with low malignancy probability; the prognosis is excellent even in presence of malignancy. The diagnosis is made by ultrasound and fine needle aspiration biopsy. Sistrunk surgery is the treatment of choice, with low recurrence rates. Receiving a medical evaluation when a neck tumor is suspected is helpful for the early diagnosis.

Thyroglossal duct cyst imaging: thyroid scintigraphy versus ultrasound

The two imaging modalities most frequently used in thyroglossal duct cyst [TDC] are thyroid scintigraphy and ultrasound. The imaging is mainly used to exclude the cyst from being the only functioning ectopic thyroid tissue. The main objective of this study is to compare the results of scintigraphy and ultrasound. A total of 56 patients referred to the National Cancer Institute [NCI], University of Gezira in the period from Jan 2007 to Dec 2009 were included in this study, 30 females and 26 males patients; with median of 12.5 years. Data were analyzed by SPSS software. Both thyroid scintigraphy and ultrasound reached the same imaging findings i.e. 53 patients with TDC and 3 patients with ectopic thyroid tissues. The Fisher exact test revealed no significant difference between the two modalities final results [P- value = 1]. In addition, Pearson correlation showed complete correlation between the final ultrasound and scintigraphy results [R2 = 1, P-value < 0.0001]. Furthermore, ultrasound has provided detailed cyst characterization. Both modalities revealed almost identical results. Ultrasound has the additional advantages of being non-ionizing radiation and accurately localizes and characterizes the TDC

Photo quiz What is your diagnosis? Diagnosis: carcinoma of the thyroglossal duct cyst

A 48-year-old woman was referred with an anterior midline neck mass which had gradually appeared without tenderness. The patient had a previous history of frequent painful swelling of the anterior part of her neck