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Two cases of abnormality in the normal embrionary migration of the thyroid gland are reported with hyoid and sublingual location. Both cases where misdiagnosed and operated as thyroglossal cysts. The methods of treatment are reviewed and emphasis is placed on the convenience to make gammagraphic studies in patients with a mid-line cervical mass.
About 100 cases of carcinoma arising in thyroglossal remnants have been reported in the world literature. Five additional cases were discovered incidentally on histopathological examinations of specimens following Sistrunk's operation for removal of thyroglossal cysts and are now reported. The possibility of preoperative clinical diagnosis and the modalities of treatment are discussed.
The authors present a case of osteoma of the tongue. This tumor was discovered without any functional symptom. Surgical resection with histological examination gives the diagnostic. This choristoma is rare, benign and clinically poor. Osteoma of the tongue is a heterotopic bone tissue and his main differential diagnosis are lingual thyroid and thyroglossal cyst. There are several opinions concerning the histogenesis of this choristoma, but an embryological anomaly is probable. Surgical removal of the tumor is curative, without any reported local recurrence.
Failures of descent of the medial anlage of the thyroid and incomplete obliteration of its vertical tract lead to midline or near-midline ectopias such as lingual thyroid and thyroglossal cysts. Each poses special diagnostic and therapeutic considerations. "Ectopias" of the thyroid gland lateral to the carotid artery and jugular vein, however, cannot be readily explained by current embryological information. In these instances, and especially for intranodal thyroid tissue, a metastasis from an occult thyroid primary is the mandatory first consideration.
Recent reports have suggested an association between familial adenomatous polyposis and papillary carcinoma of the thyroid. This report describes four patients, each with intestinal polyps and thyroid or thyroglossal cyst carcinoma. One patient had a medullary rather than papillary carcinoma of the thyroid and in another the intestinal polyps were due to Peutz-Jeghers syndrome. This may indicate a wider association between thyroid carcinoma and intestinal polyps than has previously been recognised.
One percent of excised thyroglossal duct remnants exhibit histologic malignancy, a thyroid papillary carcinoma in 80% of the cases. The prognosis is excellent except for anaplastic types. We report the case of a 44-year-old woman with primitive thyroid papillary carcinoma diagnosed histologically as thyroglossal cyst. Its unusual aggressiveness produced local and regional spread, metastases and the patient's death in spite of treatment: Sistrunk operation, local excision of a recurrence and laryngothyroidectomy. Thyroid histology revealed the absence of carcinomatous foci. We discuss the most noteworthy aspects of the case in relation to other reports.
Cancers of the thyroglossal tract are very rare. Seventy-four patients with a cyst of the thyroglossal tract were operated in our hospital between 1978 and 1991. A papillary carcinoma was discovered on histological examination in one case. This cancer was treated by Sistrunk's operation. The patient had no sign of recurrence one five years after the operation. This paper presents the case report of this unusual cancer of which fewer than 100 similar cases have been reported in the literature.
Computed tomography (CT) of the neck has been primarily applied to the assessment of malignant disease with few reports describing its utility in benign conditions. The authors report 13 cases of cystic neck masses evaluated by CT. Pathological conditions included brachial cleft cyst, laryngocele, thyroglossal duct cyst, cavernous lymphangioma, necrotic lymphadenopathy, and asymmetric jugular veins. Computed tomography was helpful in correctly predicting the etiology by determining the exact location of these masses in relation to the normal anatomic structures in the neck.
We report our experience in the out-patient triage of 100 patients presenting with a lump in the neck. The out-patient visit consisted of a general history and examination, assessment of the upper air and food passages and, where indicated, ultrasound and core needle biopsy of the lump. Other investigations were performed as appropriate. One hundred neck lump patients were seen in a 9 month period. Ninety-six of these lumps were diagnosed on an out-patient basis, only four requiring admission for formal excision biopsy. Among the diagnoses were eleven lymphomas, nine parotid neoplasms, nine lymph node metastases, five thyroglossal cysts, and four branchial cysts. Almost half the patients seen had either a reactive lymphadenopathy, or no abnormality. The establishment of a tissue diagnosis on an out-patient basis allowed appropriate referrals to be made and management plans to be formulated. The theoretical risk of seeding of malignant cells in the needle tract is acknowledged and discussed.
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Carcinoma of the thyroglossal tract is a rare entity. Three patients with thyroglossal cyst carcinomas are presented and the features of the disease, as reported in the literature, are discussed. Epidemiologically, females are more often affected than males and the average age of the patients described lies in the fourth decade. The aetiology is obscure, although previous irradiation is a possible risk factor. Carcinoma of the thyroglossal tract should also be suspected in patients with irregular masses. Pre-operative evaluation may include a thyroid scan and fine needle aspiration cytological examination of the cyst fluid. These tests, if positive, may alter the basic approach of the Sistrunk procedure to encompass thyroidectomy or wider margins. Neck dissection is preferred for cervical nodal disease. Adjuvant radiotherapy or radio-iodine is added if indicated by the histology, and the patient receives suppressive thyroxine therapy thereafter.
Imaging of the oral cavity and pharynx often is required in three settings: assessment of an inflammatory mass in association with odontogenic, tonsillar, or pharyngeal infections; determination of the cause of a submucosal mass; and staging of squamous-cell carcinomas. Spread of infection from the oral cavity and pharynx can lead to abscesses in the masticatory space, the retropharyngeal compartment, and in a parapharyngeal location. Submucosal masses include congenital cysts (thyroglossal and dermoid), benign neoplasms (hemangioma, schwannomas, pleomorphic adenomas juvenile angiofibromas), inflammatory cysts (mucous retention cysts, ranulas), and pseudotumors (osteophytes, carotid arteries). Staging of squamous-cell carcinomas must focus on deep invasion, spread to the brain, nerves, mandible, prevertebral muscle, and pre-epiglottic fat.
The extremely rare occurrence of invasive squamous cell carcinoma arising from normal epithelial lining of a thyroglossal duct remnant cyst is documented by demonstrating the histopathologic transition from normal squamous epithelium to squamous cell carcinoma. The requirements that must be fulfilled to accept a lesion as arising de novo from the epithelial lining are outlined, and all requirements are achieved. The lesion is differentiated from the less rare papillary or papillary-follicular adenocarcinoma of residual thyroid tissue of the thyroglossal duct tract remnants. This is the sixth report in the world literature of invasive squamous cell carcinoma arising from benign thyroglossal remnant squamous epithelium, and the second demonstrating the transition from normal squamous epithelium to invasive squamous cell carcinoma.
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PURPOSE: Major neck surgeries are conventionally performed under general anesthesia. To receive general anesthesia, patients must meet certain criteria that have attendant limitations. This report discusses the investigator's experiences with performing major neck surgeries under regional anesthesia. MATERIALS AND METHODS: Fifty major neck surgeries were performed (30 thyroidectomies, 10 laryngectomies with or without neck dissection, 3 thyroglossal cyst, 2 branchial cyst, and 5 submandibular gland excisions) under regional anesthesia over a period of 2 years between March 1994 and March 1996. The selection criteria of patients for regional anesthesia, the regional neural blocks used, the technique of performing these blocks, the efficacy, advantages, and limitations of these blocks are all discussed. RESULTS: The combination of regional neural blocks and intraoperative medications produced superb analgesia and good patient compliance. Intraoperative blood loss was minimal. With postoperative complications being negligible, recovery was faster. CONCLUSION: Regional anesthesia is an effective alternative to general anesthesia for neck surgeries of less than 4 hours' duration.
A 71-year-old female presented with a midline neck mass. The clinical impression was that of a thyroglossal cyst but preoperative assessment suggested a solid lesion, possibly malignant. The mass was removed surgically using the Sistrunk technique and shown pathologically to be a mixed papillary-follicular carcinoma of the thyroid with no cystic elements. Clinically and radiologically the thyroid was normal and thyroidectomy was not performed. This management is discussed along with a brief review of the relevant literature on the pathology and treatment of similar lesions.