Presentation, Management, and Outcome of Thyroglossal Duct Cysts in Adult and Pediatric Populations: A 14-Year Single Center Experience.

OBJECTIVES: A thyroglossal duct cyst (TDC) is a frequent congenital midline anomaly of the neck that usually manifests during the first decade of life. We aimed to describe the presentation, management, and outcome of TDC in pediatric and adult cases. METHODS: A retrospective observational analysis was conducted for all patients diagnosed and treated for TDC between 2000 and 2014 in a single center in Qatar. Data included patients' demographics, presentations, preoperative investigations, anesthesia type, histopathological findings, surgical management, recurrences, and complications. RESULTS: We identified 102 patients, of which 57% were males. The mean age of patients was 20.2±15.6 years. A bimodal distribution of TDC has been observed, which peaked between the ages of 6-13 years and at ≥19 years. The preoperative evaluation mainly includes ultrasonography (66%), thyroid function test (44%), and fine-needle aspiration cytology (10%). The median size of the cyst was 25 (2-60) mm. Patients mainly presented with an asymptomatic midline neck mass at or below the hyoid bone (82%), followed by fistula (9%), infection (2%), and dysphagia (2%). Eighty-nine cases were identified preoperatively as TDC. The histopathological findings confirmed TDC with hyoid bone in 61 cases, and TDC alone in 38 cases. Eighty patients underwent the Sistrunk procedure while excision of TDC alone was observed in 18 cases. Five cases of recurrent disease were also treated. Adults had a greater median cyst size (30 (9-60) vs. 22 (2-55) mm; p = 0.005) and required prolonged operation time (69 (1-169) vs. 32.5 (1-140) mins; p = 0.004) compared to the pediatric group. CONCLUSION: The occurrence of TDC shows a bimodal age distribution. Preoperative evaluation and time for surgery vary whereas clinical presentations, surgical management, and postoperative outcomes are comparable among adult and pediatric groups. Ultrasonography is the preferred diagnostic modality, and the Sistrunk procedure remains the primary choice of treatment.

Clinical presentation and outcome of mesenteric vein thrombosis: a single-center experience.

Mesenteric venous thrombosis (MVT) is an uncommon event. We retrospectively analyzed data for patients who were admitted with MVT between June 2005 and May 2012 in Qatar. The study included 35 patients with a mean age of 45 ± 11 years. The risk of MVT was significantly high among males who smoked and females of Arab ethnicity. The main manifestations of MVT were abdominal distension and vomiting. The major etiological factors included deficiency in protein C and S, homocysteinemia, and prior abdominal surgery. Computed tomography (CT) findings were helpful in 80% of the patients. Bowel resection with primary anastomosis was performed in 25 (71%) patients. The overall mortality rate was 17%. High index of suspicion, detection of risk factors, CT imaging, and timely intervention are essential for better prognosis.

Clinical presentation, management and outcomes of gastrointestinal stromal tumors.

INTRODUCTION: The present study investigated the incidence, management and outcome of Gastrointestinal Stromal Tumors (GIST) in Qatar. METHODS: A retrospective review of all GIST patients admitted between 1995 and 2012 was conducted. Patients' demographics, clinical presentation, tumor characteristics, radiological, pathological and immunohistochemical findings, surgical procedures, recurrence and mortality were recorded. RESULTS: A total of 48 GIST patients were identified. Stomach (56%) and small intestine (27%) were the most common sites of tumor. The majority of cases (n = 27) had tumor size >5 cm, 31 cases had primary and 15 cases had locally advanced tumor. Patients were stratified as high, intermediate, and low risk (43.8%, 18.8% and 37.5%, respectively). Almost all the cases were surgically managed and 94% were completely resectable. Robotic partial resection was performed in 4 cases and 5 cases underwent laparoscopic resection. Chemotherapy was initiated in half of patients. During follow up (average 37.5 months), 33 patients showed complete recovery, 7 had recurrent or metastatic disease and 2 died due to liver metastasis. CONCLUSION: The incidence of GIST in Qatar is apparently low. Surgical resection is the preferred choice of treatment; however, robotic and laparoscopic resections are feasible and safe approaches in some cases.

Clinical presentation, management, and outcome of patients with incidental renal angiomyolipoma in qatar.

OBJECTIVES: Our study aimed to analyze the clinical presentation, management, and outcome of renal angiomyolipoma patients incidentally detected upon computed tomography (CT) examination. METHODS: Between 2004 and 2008, all patients who underwent abdominal CT examination for any reason at the radiology department at Hamad General Hospital, Qatar were retrospectively reviewed. The diagnosis of renal angiomyolipoma was based on abdominal CT evaluation. Angiomyolipoma patients were followed-up by CT evaluation as per standard care for three years to observe any change in size and outcome. RESULTS: A total of 13,115 patients were screened, of which 56 (40 females and 16 males) had renal angiomyolipoma. The mean age of patients was 52±13 years with 46% Qatar nationals. The majority (95%) of cases had unilateral tumors (52% right-sided and 43% left-sided). Twenty-six cases showed increase in tumor size and the median increase was 0.5cm (0.1-3.6). Surgical intervention was required in four (7%) cases with tumor size ≥4cm. The overall mortality on follow-up was 7%. The cause of death included metastasis, renal failure, hepatic failure and mesenteric thromboembolism. CONCLUSION: Renal angiomyolipoma is an uncommon benign tumor with an overall prevalence of 0.4% in Qatar. It has characteristic clinical features and its recognition is often challenging for proper clinical diagnosis and treatment in asymptomatic patients. Asymptomatic patients need regular radiological surveillance. In contrast, surgical interventions are mainly required in symptomatic patients with increased tumor size (≥4cm). Timely diagnosis and treatment is necessary to avoid complications such retroperitoneal hemorrhage and renal impairment.