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Monophasic synovial sarcoma of the neck in an 8-year-old girl resembling a thyroglossal duct cyst.

Synovial sarcomas of the head and neck are rare. Typically, they are localized laterally in the parapharyngeal space. We report the case of an 8-year-old girl with a monophasic round cell synovial sarcoma of the anterior neck, clinically resembling a thyroglossal duct cyst. Histologic, immunohistochemic and cytogenetic findings are presented with a brief review of the literature. This case reaffirms the importance of considering malignant neoplasms in the differential diagnosis of pediatric neck masses.

Child↗

Cysts of the thyroglossal duct.

Experiences with 53 consecutive patients undergoing surgical excision of thyroglossal duct cysts are reported. Four patients (7.5%) developed recurrent cysts after surgery. Analysis of cases revealed the following factors to contribute to an increased risk of recurrence: young age, skin involvement by the cyst, lobulation of the cyst, rupture of the cyst, and failure to follow the second principle advocated by Sistrunk.

Adolescent↗

A thyroglossal duct cyst causing apnea and cyanosis in a neonate.

This is a case of a 3-week-old male who presented to the emergency department with intermittent apnea and cyanosis. While in the emergency department, he had respiratory compromise with stress and required intubation. Further evaluation confirmed the diagnosis of a thyroglossal duct cyst. Congenital lesions causing extrinsic airway compression should be considered in all neonates with apnea, cyanosis, and respiratory compromise. Knowledge of pediatric airway anatomy and physiology is important in all cases where obstructive apnea is suspected.

Airway Obstruction↗

Laryngeal mask airway guided fibreoptic tracheal intubation in a child with a lingual thyroglossal duct cyst.

The establishment of a tracheal airway with direct laryngoscopy can either be difficult or impossible in children with airway pathology. Multiple direct laryngoscopic attempts cause oedema and/or bleeding with subsequent difficult ventilation. The techniques utilizing the laryngeal mask airway (LMATM) and the fibreoptic bronchoscope have been reported. The case of a child with lingual thyroglossal duct cyst in which the LMA was useful to secure the airway and as a conduit for fibreoptic tracheal intubation is reported.

Airway Obstruction↗

Reoperation for cysts of the thyroglossal duct.

OBJECTIVE: To determine the causes of recurrence of thyroglossal duct cysts (TDCs). DESIGN: A case series. SETTING: A university-affiliated children's hospital. PATIENTS: Between 1974 and 1990, 121 children were treated for TDCs. They ranged in age from 1 month to 18 years. Of these 121 children, 23 had recurrent TDC. INTERVENTIONS: Simple aspiration of the cyst, incision and drainage, cystectomy without hyoidectomy and the Sistrunk operation. MAIN OUTCOME MEASURES: Initial procedures that led to recurrence and procedures that resulted in cure. RESULTS: Six children had recurrence of TDCs after simple cystectomy without hyoidectomy; all were cured by the Sistrunk operation. Fourteen children with infected cysts initially underwent a variety of procedures with recurrence and were eventually managed by the Sistrunk operation. TDCs recurred in eight of these. Three children without infected cysts had recurrence after the Sistrunk operation. Of 34 TDCs infected initially, 40% recurred, whereas of 87 TDCs that were not infected initially, only 8% recurred. CONCLUSION: Simple cystectomy without hyoidectomy and pre-existing infection are the main causes of recurrence of TDCs.

Adolescent↗

Thyroglossal duct carcinoma.

Thyroglossal cysts are common developmental abnormalities of the thyroid gland. The malignant form of these cysts, however, is extremely rare, with fewer than 100 cases reported since 1915. Here we add 10 cases of malignant thyroglossal cysts, nine women and one man, encountered at M.D. Anderson Cancer Center, based on a retrospective review of 51 recorded cases of thyroglossal cysts between 1950 and 1990. All 10 patients underwent a primary Sistrunk procedure. Histologic findings showed nine papillary and one follicular carcinoma. Based on review of the histopathologic material, four patients required no additional therapy. Five patients underwent total thyroidectomy; three of the five also underwent neck dissection. A single microscopic focus of carcinoma in the thyroid gland was found in only two instances. No evidence of nodal metastases was found. One patient with an abnormal thyroid scan is awaiting further treatment. Based on these findings, the Sistrunk procedure is an effective form of therapy for malignant thyrogloassal cysts.

Adenocarcinoma↗