Thyroglossal duct cysts: 20 years' experience (1992-2011).

The objective of the present study is to report on the clinical course and management of thyroglossal duct cysts. Retrospective review of all patients who underwent surgery for thyroglossal duct cysts between 2000 and 2013 at a tertiary referral center was carried out. The operations were performed using a modification of the Sistrunk operation: transcervical cystectomy, partial dissection of the hyoid bone, and dissection of all tracts identified during surgery. A total of 352 patients (176 men, 176 women) underwent surgery for a cyst (n = 282) or discharging sinus (n = 70). The mean age for the incidence of cysts was 26 years. Four of the patients (1.4 %) had a papillary thyroid carcinoma in the epithelium of the cyst. The follow-up period ranged from 7 months to 10 years. The overall recurrence rate was 4.5 %. Resection is often regarded as an elective surgical procedure in patients with thyroglossal duct cysts, but surgery should always be considered. Papillary thyroid carcinoma in the epithelium of the cyst is a rare but possible differential diagnosis. Dissection of all tracts found is recommended and partial dissection of the hyoid bone is mandatory. Dissection of the foramen cecum is not imperative. The recurrence rates with this approach are comparable to more extensive methods such as those described by Sistrunk.

Cholesterol granuloma in thyroglossal cysts: a clinicopathological study.

Thyroglossal duct cyst (TDC) is a congenital anomaly caused by retention of epithelial remnants from the descent of the thyroid gland during embryological development. Cholesterol granuloma represents a granulomatous reaction to precipitates of cholesterol crystals in tissue, usually related to middle-ear disease. The association of TDC with cholesterol granuloma has hardly been reported. This study describes five patients with TDC and cholesterol granuloma over a 16-year-period. The treatment consisted of excision of the TDC and the mid-portion of the hyoid bone and excision of a core of tissue between the hyoid bone and the foramen cecum (Sistrunk procedure). We speculate that the pathogenesis of cholesterol granuloma in TDC resembles that in the paranasal sinuses, as both sites provide a closed, poorly ventilated hollow structure with slow drainage. Our five patients accounted for 13% of all patients with TDC treated in our center during the same period, indicating that cholesterol granuloma in TDC may not be as rare as previously thought.

Enlargement and transformation of thyroglossal duct cysts in response to radiotherapy: imaging findings.

BACKGROUND AND PURPOSE: Thyroglossal duct cyst remnants (TGDC) are a common midline neck mass that is mostly encountered in childhood. Enlargement after an upper respiratory tract infection or, rarely, cancer within TGDC, is a well-documented phenomenon. In the pediatric population, it rarely presents a diagnostic quandary. However, in an adult population, especially one treated for head and neck cancer with radiation therapy (RT), any enlarging cystic mass would be concerning and would raise the specter of metastatic disease. We propose that inflammation associated with RT results in secretory stimulation and/or obstruction of a persistent thyroglossal duct, resulting in changes within a pre-existing TGDC. MATERIALS AND METHODS: We present a case series of 8 patients with subclinical TGDC treated with RT for various head and neck cancers, in which we radiographically observed enlargement or cystic transformation (more cystlike appearance) of the cyst. RESULTS: In all patients there was in retrospect a small thyroglossal remnant, though not necessarily a discernible cyst, that was observed after radiotherapy to enlarge and become more cyst-like. CONCLUSIONS: In patients with pre-existing TGDC undergoing RT to the neck, enlargement and cystic transformation may be encountered radiographically and should not be misinterpreted as a tumor. Our series bolsters a recently reported description of the same phenomenon.

Unusual soft tissue manifestations of Neisseria meningitidis infections.

Soft tissue involvement is an unusual presenting feature for children with meningococcal infection. We describe 2 children, 1 with conjunctivitis and another with a thyroglossal duct cyst abscess associated with Neisseria meningitidis, and review previous reports of these entities to emphasize the broad spectrum of meningococcal disease and pertinent aspects of treatment and of prophylaxis of contacts.

Rare presentation of thyroglossal duct cyst after radiation therapy to the neck.

Thyroglossal duct cyst (TDC) is a congenital lesion which usually manifests as an enlarging painless neck mass in a child or young adult. We highlight an unusual presentation of TDC in an adult which developed after radiation therapy to the neck. We discuss the probable sequence of events and emphasize the need for radiologists, radiation oncologists and the surgeons to be aware of this entity when evaluating patients after radiation therapy.

Primary papillary carcinoma in a thyroglossal duct cyst.

Thyroglossal duct cysts (TDC) are the most common congenital anomalies of the thyroid gland and less than 1% of them become malignant. The malignancy most often found is papillary carcinoma. The diagnosis is usually made postoperatively. Controversy exists whether TDC are primary or secondary and also as for their treatment regime. In this case report, we present a 30-year-old woman with papillary carcinoma of the TDC, identified only by pathology after surgical ablation by Sistrunk's procedure. Invasion of the carcinoma to the adjacent tissues or lymph node metastases were not found. Thyroid function tests were normal as well as the thyroid scan. After a two-year follow up, the patient remained asymptomatic with no evidence of recurrence, as tested clinically and by ultrasonography. Since our patient had no marginal invasion of the carcinoma in the surrounding tissues or lymph node metastases, we recommended the Sistrunk's surgical procedure, suppressive treatment by thyroid hormones and long term follow-up.

Thyroglossal duct cyst masquerading as a haematoma.

Thyroglossal duct cysts most frequently present in childhood as painless midline swellings around the level of the hyoid. Classically the cyst moves upwards on protruding the tongue. Here we report a novel case of a thyroglossal cyst in an adult in whom the history, examination and fine needle aspiration cytology were typical of a traumatic haematoma. This case is also unique because the thyroglossal duct cyst extended beyond the thyroid gland to the suprasternal notch and actually required two parallel transverse cervical incisions for its complete en bloc removal.

Management of well-differentiated thyroid carcinoma presenting within a thyroglossal duct cyst.

BACKGROUND AND OBJECTIVE: Well-differentiated thyroid carcinoma (WDTC) is diagnosed in approximately 1.5% of thyroglossal duct cysts (TGDC). No clear consensus exists regarding further management after adequate excision of the cyst, especially the role of total thyroidectomy and postoperative radioactive iodine therapy. The current review was undertaken in an attempt to clarify these issues. METHODS: Demographic, clinical, tumor, treatment, pathology, and outcome data on 57 eligible patients reported in recent literature were pooled together with 5 patients treated at our institution for this analysis. RESULTS: A Sistrunk operation was performed for resection of the thyroglossal duct cyst in the majority (90%) of patients. Histologic examination of the tumor in the cyst revealed that papillary carcinoma was the most frequent (92%) histologic type. A total thyroidectomy was performed consequent to the diagnosis of thyroglossal duct cyst carcinoma in approximately half of the 62 patients. A malignant tumor was reported in 27% of the thyroidectomy specimens. Postoperative radioactive iodine therapy was administered in 16 (26%) patients. With a median follow-up of 71 months (range 1-456 months), the 5- and 10-year Kaplan-Meier overall survival was 100 and 95.6%, respectively. There were no disease-related deaths reported in any of the patients. Univariate analysis revealed that the only significant predictor of overall survival was the extent of primary surgery for the thyroglossal cyst. The addition of total thyroidectomy to Sistrunk operation did not have a significant impact on outcome (P = 0.1). Patients treated with postoperative radioactive iodine (RAI) fared significantly worse than those that did not need RAI, which may be explained by the fact that this modality would generally be used in patients with higher risk tumors. CONCLUSIONS: The Sistrunk operation is adequate for most patients with incidentally diagnosed TGDC carcinoma in the presence of a clinically and radiologically normal thyroid gland. Results of adequate excision using the Sistrunk operation are excellent and the concept of risk-groups should be used to identify patients, who would benefit from more aggressive treatment.

Lesiones quísticas del cuello: correlación clínica y de imagen / Cystic lesions of the neck image and clinical correlation

Se hace una revisión retro y prospectiva en 14 pacientes (8 mujeres, 6 hombres) con lesiones quísticas congénitas a nivel del cuello. Los autores analizan las lesiones más frecuentes encontradas a nivel del cuello supra e infrahioideo y que incluyen quiste del conducto tirogloso, quiste del segundo arco branquial, linfangioma o higroma quístico, sus manifestaciones clínicas correlacionadas con las características observadas a través de los métodos de imagen

Post-traumatic sialoceles and mucoceles of the salivary glands.

Three cases of post-traumatic sialocele involving the parotid region and one case of post-traumatic mucocele involving the submandibular region are presented. Computed tomography (CT) with contrast showed enhancing borders after a few weeks. Cases earlier than 2 weeks from occurrence showed no enhancement because of the absence of a well-developed capsule. Patients who had the disease longer showed better enhancement of the periphery with contrast because of capsule development. By CT scanning alone it is difficult to differentiated these lesions from other cystic lesions of the face and neck, although certain characteristics like location and rim enhancement may favor one lesion over the other.

Anatomical reconstruction of the thyroglossal duct.

The high postoperative recurrence rate of the thyroglossal duct cyst is well known. Since Sistrunk's operation was used, the recurrence rate was remarkably reduced, but the anatomical description of the thyroglossal duct through the entire tract has not been clarified in detail. For a more accurate anatomical understanding of the thyroglossal duct, 10 specimens obtained from Sistrunk's operation were studied using histological reconstruction, and a common running pattern of the thyroglossal duct was found. The cyst is usually located caudal to the hyoid bone mostly at the midline. The duct extends upward from the cyst ventral to the hyoid bone, with many or a few branches and secretory glands. These ducts or branches merge into a single duct at the level of the cranial portion of the hyoid bone. However, as it leaves the hyoid bone and approaches the foramen cecum, a single duct spreads out into many ductuli like the tip of a broom, which communicate with many secretory glands. There were three cases in which the duct was found behind the hyoid bone, but in no case did the thyroglossal duct run through the back of the hyoid bone. The duct behind the hyoid bone was recognized as a branch from the main duct in the dorsal direction. It ascended to the dorsal surface of the hyoid bone and terminated blind. These findings emphasized the importance of Sistrunk's operation to prevent a recurrence.

Cistos e fístulas do ducto tireoglosso / Fistulas and cysts of thyroglossal duct

Através deste levantamento procurou-se estudar a embriopatogenia, o quadro clínico, o diagnóstico diferencial e o tratamento dos cistos e fístulas do ducto tireoglosso. Foram levantados 21 pacientes, dos quais 17 apresentavam cistos e quatro fístulas do ducto tireoglosso

The thyroglossal cyst.

The thyroglossal cyst is the most common nonodontogenic cyst in the neck. This cyst may also occur in the lingual or submental areas, though more rarely. Malignant changes have been described. Clinically, no differentiation between a benign cyst and a malignancy can be made. The literature is reviewed regarding the embryology, epidemiology, etiology, symptomatology, radiology, histology, and treatment of this cyst and its malignant counterpart.