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[Unusual location of a cyst & fistula of thyroglossal duct].
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Preoperative sonography in presumed thyroglossal duct cysts.
OBJECTIVE: To determine the utility of ultrasonography as a sole diagnostic study in the preoperative preparation of patients with presumed thyroglossal duct cysts. DESIGN: Retrospective chart review. SETTINGS: Children's Memorial Hospital, Chicago, Ill. PATIENTS: Forty-five pediatric patients with midline masses. MAIN OUTCOME MEASURE: Accuracy in the determination of a normally positioned thyroid gland excluding the presence of a solitary ectopic thyroid gland. RESULTS: A retrospective chart review was performed at our institution for the period February 1990 to January 1996. A total of 45 patients with midline masses were identified, 39 of whom had undergone preoperative ultrasonography as their sole diagnostic imaging study. In all 39 patients, both a cyst and a normal thyroid gland were identified. All 39 patients underwent the standard Sistrunk procedure. Thirty-seven patients had pathologically confirmed thyroglossal duct cysts. The remaining 2 had dermoid cysts. There were no cases of postoperative hypothyroidism. CONCLUSIONS: The incidence of ectopic thyroid in the diagnosis of thyroglossal duct cysts has been reported to be as high as 1% to 2%. In our surgical and clinical experience, the actual incidence of solitary ectopic thyroid tissue is substantially lower. Nevertheless, to prevent the inadvertent removal of the only functioning thyroid tissue, with resultant postoperative hypothyroidism and possible medicolegal consequences, we advocate the routine preoperative identification of normal thyroid gland. We recommend ultrasound as an accurate, cost-effective, noninvasive imaging modality in the preoperative evaluation of all patients with neck masses suspicious for thyroglossal duct cyst. Also, it does not require sedation.
Thyroglossal duct cyst: the New York Eye and Ear Infirmary experience and a literature review.
Thyroglossal duct cysts often present in childhood but can also afflict the adult population. In 1920, Sistrunk described surgical management and advocated the removal of the central portion of the hyoid bone, following the cyst tract to the base of the tongue. This surgical technique has not changed since its description 60 years ago. In this paper, a retrospective review of 70 thyroglossal duct cyst excisions performed at the New York Eye and Ear Infirmary from 1988 through 1996 is presented. The patient population consisted of 43 females (61%) and 27 males (39%). The average age at presentation was 21.5 years, with a range of 18 months to 64 years. The most frequent presenting symptoms was a painless midline neck mass. Computed tomography (CT) was the most frequent imaging study performed. Sixty-four patients underwent a Sistrunk procedure while five patients had excision alone. One patient was diagnosed but lost to follow-up. All five patients who underwent simple cystectomy required a second procedure. One patient who underwent the Sistrunk operation required revision. Nine patients had postoperative complications, with recurrence being the most common. We present our experience over an eight-year period.
[Thyroglossal duct cysts, surgery and histology].
70 years ago Sistrunck described a specific procedure for the management of thyroglossal duct cysts. However, this surgical procedure is not performed often. In a review on 28 cases, the authors have determined whether the Sistrunck's operation was too extensive in the treatment of thyroglossal duct cysts. 28 surgicals procedures have been performed during five years, 6 Schlange's procedure and 22 Sistrunck's procedure. We have had 17% of complications with only one recurrence, after six months, with Schlange's operation. During the interventions, we have been able to see and feel a duct in only one case. This difficulty in determining the presence of a duct intra-operatively could suggest that there was no duct. So we have undertaken a histological study of all 28 specimens obtained from surgery. Results showed the presence of one or multiple tracts in 72% of cases. Finally, this study show that Sistrunck's procedure is still the best operation for treatment of all cases of thyroglossal duct cysts. All other operations, and particularly Schlange's procedure, are inadequate because they are in contradiction with histological and embryological studies.
[Thyroglossal duct cyst(fistula) operation and recurrence prophylasis].
OBJECTIVE: To explore what leads to recurrent thyroglossal duct cyst (TGDC) following operation and how to improve the operation efficiency. METHOD: 32 patients with TGDC (including 8 recurrent cases) were performed operation for the second time. The cases who had infective signs received anti-inflammatory treatment prior to operation. Judge the relationship between thyroglossal duct cyst and hyoid bone before managing hyoid bone. The methylene blue was injected into TGDC for following up. Resect the small branches according to Sistruk procedure under the operation microscope. The residue underwent marsupiatization, electrocoagulation or radio frequency according to finger palpation. RESULT: 32 cases were successful with the operation and did not show any signs of recurrence after one-year following up. CONCLUSION: The recurrence of TDGC may be perfectly prevented as long as comprehensive treatment is carefully performed during the operation.
Papillary carcinoma of thyroglossal duct cyst. A case report.
A case of papillary carcinoma of thyroglossal duct cyst in a 68 year old woman is here described. Histology showed a papillary carcinoma of thyroid type inside the cyst. The wall of this latter contained normal thyroid follicles. Psammoma bodies and ground glass nuclei were also observed. The origin, pathology and relationship of this neoplasia with a thyroid primary are discussed.
Lymphoma mimicking a thyroglossal duct cyst in an adolescent.
Mass lesions of the head and neck in infants and children can be either developmental, inflammatory or neoplastic. Lymphomas (Hodgkin's or Non-Hodgkin's) commonly present as neck lumps in children. Although malignancy is not the commonest aetiology of paediatric cervical lumps, a high index of suspicion is critical to facilitate early diagnosis and treatment of cervical lesions. We present the case of a 15-year-old boy who presented with a solitary midline cervical lesion, which simulated a thyroglossal cyst on clinical examination. However, histopathological examination revealed it to be a Hodgkin's lymphoma. Related literature is also reviewed.
[The surgical treatment of thyroglossal duct cysts and fistulae].
The authors report the results of treatment in 20 patients with thyroglossal duct cysts and/or fistula. Three patients underwent the standard Sistrunk's operation (excision of the cyst with resection of the duct above the hyoid bone with the portion of the muscle surrounding to the foramen caecum), 13 patients were submitted to a modified Sistrunk's operation (removal of the cyst and/or fistula and resection of the middle portion of the hyoid bone with dissection above it only with macroscopic evidence of duct epithelium) and 4 patients underwent less radical procedures. There were no recurrence in those patients operated upon with the standard or modified Sistrunk's operation. On the contrary two recurrence were observed in patients operated in elsewhere by simple excising the cyst without hyoid bone resection. In conclusion the authors strongly support the modified Sistrunk's operation as treatment of choice in patients with thyroglossal duct cysts and fistula; This operative procedure can avoid long-term recurrence even though many authors suggest that only the standard Sistrunk's operation can guarantee the lowest rate of failures.
Thyroglossal duct cyst with papillary carcinoma: what must be done?
OBJECTIVE: To present a report series of five cases, compare their clinical evolution, and establish the appropriate treatment. METHODS: A retrospective study was performed with the clinical records from three health institutions in Mexico City, Mexico, in order to search for patients with histologic diagnosis of thyroglossal duct carcinoma and were classified by different risk stratifications to compare their outcome. RESULTS: We found five patients, three females and two males, mean age 49 years. Four were treated by Sistrunk's procedure, total thyroidectomy, radioiodine ablation, and thyroxine suppression; one patient underwent Sistrunk's procedure only. Four patients were classified in the low- and median-risk group and had good outcome; one patient was in the high-risk group and had poor outcome. CONCLUSIONS: The thyroglossal duct cyst must be studied in the adult population through fine-needle aspiration biopsy (FNAB) and a frozen section in cases in which FNAB is inconclusive or unavailable. When a diagnosis of a thyroglossal cyst carcinoma is made, an evaluation of the thyroid gland during surgery must be done as well as a careful examination to identify suspicious lymph nodes and neck dissection should be reserved for confirmed adenopathies. When an thyroglossal duct cyst has been excised using Sistrunk's procedure and the definitive histologic analysis reports malignancy, the thyroid gland must be studied. The extension of the surgery must be handled according to the criteria established for differentiated thyroid cancer.
Thyroglossal duct cyst: an analysis of 92 cases.
From 1983 to 1989, ninety-two in hospital cases of surgically treated thyroglossal duct cysts were reviewed. 4 patients (4%) were found to have metaplastic changes of the lining epithelium. Recurrence and the potential for malignancy are two main problems in the treatment of thyroglossal duct cyst. We advocate the Sistrunk procedure to be the choice of surgical treatment for thyroglossal duct cyst.
Psammomatous calcification in association with a benign thyroglossal duct cyst.
Embryologic remnants of thyroid tissue often line the thyroglossal duct tract and may commonly become cystic. Calcification in such a cyst is thought to be a specific marker for malignancy, which may develop in 1% of thyroglossal duct cysts. We describe a 3-year-old boy with a midline neck mass that showed radiologic calcification. Pathologic evaluation revealed psammomatous calcification in association with a benign thyroglossal duct cyst. These findings, not previously reported (to our knowledge), expand the radiologic differential diagnosis of calcified neck masses and broaden the spectrum of pathologic findings seen in association with benign thyroglossal duct cysts.
Thyroglossal duct cyst. Report of a case.
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Thyroid hemiagenesis accompanying a thyroglossal duct cyst: a case report.
A case of thyroid hemiagenesis discovered incidentally in a patient presenting with a thyroglossal duct cyst is reported. Thyroid embryology is briefly reviewed. Various characteristics of thyroid hemiagenesis and thyroglossal duct cysts are explored.
Adenocarcinoma arising in a thyroglossal duct cyst: report of a case and literature review.
A case of thyroglossal duct cyst carcinoma is presented, and the previously reported cases are reviewed. The clinical features of these midline neck masses do not suggest the presence of a carcinoma which may be localized to a single area of the cyst wall. Therefore, submission of the complete surgical specimen for histologic examination is recommended even if frozen sections during surgery fail to reveal a carcinoma.
Thyroglossal duct cyst presenting as an anterior tongue fistula.
An unusual case of thyroglossal duct cyst occurring in the tongue base and fistulizing to the anterior tongue is presented. No previous descriptions have been found in the literature associating this embryological remnant with fistulization to the anterior tongue. The treatment was successfully accomplished through a combined transhyoid and intraoral approach.
Papillary carcinoma in a thyroglossal duct cyst: CT findings.
A case of papillary carcinoma arising in a thyroglossal duct cyst is presented. The cystic mass may have a variable anatomic location: intralingual, suprahyoid, thyrohyoid, and suprasternal, along the course of the embryologic descent of the thyroid gland. Computed tomography allows characterization and precise identification of the extent of the lesion prior to surgical resection.
Hereditary thyroglossal duct cysts.
OBJECTIVE: To examine the epidemiological and clinical characteristics of hereditary thyroglossal duct cysts (TGDCs). DATA SOURCES: A complete English-language literature review, assisted by MEDLINE and BIOSIS, of hereditary cases of TGDC was performed between 1975 and 1996. Three new cases from our institution were included in the study. STUDY POPULATION: Patients with a diagnosis of hereditary TGDC. DATA EXTRACTION: All case reports were reviewed by multiple observers to confirm the diagnosis of hereditary TGDC. DATA SYNTHESIS: A review of the literature revealed that a hereditary pattern has been described in 18 patients from 6 families; 11 of the 18 cases were reported in the United States. We report 3 new cases of TGDC herein, bringing the total of US cases to 14. In all 14 US cases, the patients were female presented at a mean age of 6.1 years, and had a predominantly autosomal dominant inheritance pattern. These findings are in sharp contrast to those in international cases (n = 7), in which only 29% of the patients were female and the mean age at presentation was much older (16.2 years). An autosomal dominant pattern of inheritance was found in 2 of 3 foreign families. Interestingly, the patients with an autosomal dominant pattern of inheritance were older than those with an autosomal recessive pattern (13.9 years vs 6.2 years, respectively). CONCLUSIONS: Cases of hereditary TGDC are female predominant and usually have an autosomal dominant pattern of inheritance. The sexual bias may be explained by genetic imprinting. Although no racial differences were noted in our study, distinct variations in presentation based on nationality were present. The recurrence rate after a Sistrunk procedure is similar to that in nonhereditary cases.