[Cancer of the root of the tongue developing from thyroglossal duct residues].
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An understanding of thyroid anatomy and physiology is a necessary prerequisite for interpreting diagnostic test results and managing thyroid disorders. A review of the basic sciences is presented with examples of their relationships to the diagnosis and embryogenesis of thyroid disorders.
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Various congenital cervical anomalies are found in the neck region including defects of the branchial apparatus (branchial, thymic and parathyroid anomalies) and vascular anomalies. They manifest as cystic masses, sinuses, fistulas and as ectopic glands. This multicentric retrospective imaging study done in 5 different radiological centers (4 adult radiological departments and 1 pediatric radiological department) shows the result in understanding the congenital cervical anomalies and include 63 patients. The age of the patients varied between 24 days-81 years with a mean age of 23 years. This study included 27 patients having congenital branchial pouch anomalies (4 cases of anomalies of obliteration of the 4 th arch), 14 cases of cervical cystic hygromas, 11 thyroglossal tract cyst cases, 1 congenital laryngocele case, 1 case of jugular ectasia, 3 cases of capillary haemangioma. The embryologic basis of these different malformations were reviewed. Their characteristic findings and sites were illustrated together with their typical et atypical appearances. The frequency of occurrence of each branchial anomaly were plotted, the second branchial cleft cyst being by far the most common congenital cystic neck mass (70%). The study revealed the role of different imaging modalities in the diagnosis of various congenital cervical anomalies, especially in some particular complicated cases of congenital neck masses presenting in adult. Imaging study helps the clinician to anticipate any difficulties in unforeseen circumstances that may arise including infection haemorrhage, or parapharyngeal extension. Understanding the various radiologic appearances of these anomalies is greatly aided by familiarity with their embryologic origin. Moreover, considering the anatomic location and radiologic appearance, the precise embryologic origin can be accurately predicted.
Ectopic thyroid tissue is a rare entity. The occurrence of a thyroid carcinoma in such aberrant thyroid tissue has been reported, but is very rare. Surgical excision is considered the treatment of choice in managing the lesions associated with ectopic thyroid. If the ectopic thyroid is excised, all the thyroid may have been ablated, resulting in permanent hypothyroidism. We report two cases of ectopic thyroid in emphasizing the importance of thyroid ultrasonography and fine-needle aspiration (FNA) cytology in evaluating ectopic thyroid before surgery.
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Current ultrasound instrumentation yields high-resolution scans that allow accurate assessment of the fetal neck. Most neck structures are normally small and barely visible, so anomalous development can be easily identified, for example, when the nuchal fold is measured in the second trimester. The author examined the anterior and anterolateral nuchal region in a total of 15,200 second- and third-trimester scans obtained over a 10-year period. The abnormalities identified were differentiated with respect to their position (at the central midline or anterolateral or lateral to the midline) and ultrasonographic characteristics (solid, cystic or mixed; calcified or vascular). This pictorial essay depicts the ultrasonographic appearance of masses that can be detected antenatally, including thyroid masses, teratoma, thyroglossal duct cyst, cystic hygroma, hemangioma, branchial cleft cyst and other developmental cystic lesions. In addition, the methods of elucidating these lesions is described.
The approach to the evaluation of a neck mass requires careful history and physical examination to determine if the mass is thyroidal or non-thyroidal. Thyromegaly can be classified as diffuse or nodular, painless or painful, or associated with a solitary or multiple nodules. While the most common cause of diffuse enlargement is chronic lymphocytic thyroiditis, the presence of nodularity should prompt consideration of cancer. Results of a radionuclide scan, ultrasonogram, and/or a fine-needle aspiration of a cystic nodule should help guide the physician to those patients in need of an open thyroid biopsy.