[CONGENITAL CERVICAL CYSTS AND FISTULAE ACCORDING TO DATA OF THE GDA'NSK CLINIC].
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Thyroglobulin (Tg) concentrations in the aspirates of various types of cystic neck masses were measured by RIA to assess the usefulness of this determination in differential diagnosis. The subjects consisted of 16 patients, whose final diagnoses were all established on the basis of operative results; three patients had follicular thyroid adenomas (F-Ad), 11 had papillary thyroid carcinomas (P-Ca), one had a thyroglossal duct cyst (TDC) and one had a lateral cervical cyst (LCC). Tg concentrations in the cyst fluids of F-Ad and P-Ca were very high (0.042-2.83 mg/ml) compared with serum Tg concentrations. There was no difference in Tg concentrations in the fluids of P-Ca between primary lesions (n = 5) and metastatic lesions (n = 6). On the other hand, Tg concentrations of TDC and LCC were very low (less than 100 ng/ml). Difficulty was experienced in diagnosing three patients, even though they had been examined by all nonsurgical diagnostic techniques. However, an occult thyroid carcinoma with lymph node metastasis was diagnosed by demonstrating a high Tg concentration in the aspirate of the cystic lymph node. T3 concentrations in cyst fluids of F-Ad were higher than those of P-Ca. T3 concentrations in the fluids of P-Ca, TDC and LCC did not differ, and were similar to serum T3 levels. Cytology of cyst fluids was positive in four of 10 patients examined with P-Ca. In conclusion, we can clearly confirm the thyroid origin of a cystic neck mass by demonstrating a high Tg concentration in the aspirate. This is especially useful for diagnosis in patients with thyroid carcinoma, including occult thyroid carcinomas with cystic lymph node metastasis.
Neoplasia in thyroglossal duct cysts or ectopic thyroid tissue deposits is rare but well recognized. The first known case of Hurthle cell adenoma in thyroglossal duct anomaly is described. The pathologic course and treatment of Hurthle cell tumors in general is reviewed. Treatment was based on the view that neoplasms in thyroglossal duct remnants represent changes in the ectopic thyroid tissue.
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Thyroglossal duct cyst is an unusual cause of intermittent upper airway obstruction and rarely produces obstructive symptoms in adults. Previous reports discuss airway obstruction in small children and infants and point out the complications of such cysts, including thyroid carcinoma, adenoma, thyroiditis, and thyrotoxicosis, as well as inflammation and infection. Diagnosis should be considered in all cases of midline neck masses and is usually aided by diagnostic imaging. Treatment may involve airway maintenance and surgical excision of the cyst and its entire tract.
Ultrasonography of the thyroid gland permits differentiation between cystic, solid, and mixed lesions, allowing conservative management of cystic lesions, which constitute 20% of hypofunctioning nodules. The combination of ultrasonography and fine needle aspiration cytology appears to be a great advance in the preoperative diagnosis of nontoxic goiter and permits individualized treatment in as precise a manner as is possible at present.
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A case is reported in which a thyroglossal duct cyst was removed from the anterior portion of the neck of a patient. This lesion may occur after an upper respiratory tract infection. Treatment consists of complete removal of the entire cyst and tract. Without extensive surgery, recurrence can be expected.
A five year old girl presented with a mid-line neck swelling. At operation, a multiloculated cyst was excised with a portion of hyoid bone and a suprahyoid gelatinous tract extending into the base of the tongue. Histology revealed a benign colloid cyst with associated thyroid tissue. Post-operative investigations indicated severe hypothyroidism. The cystic nature of the lesion was misleading at operation and pre-operative thyroid ultrasonography (US) is recommended for all patients with suspected thyroglossal tract cysts (TGC).