[Papillary cancer of the thyroglossal duct].
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AA. present two cases of carcinoma arising on thyroglossal duct's cystic. Those carcinomas are a rare event and will be suspected in the patients that present an irregular tumefaction of medial neck's district. Etiology is unknown; is possible that a preceding irradiation on the neck will represent a factor risk. AA. retained that in case of medial neck's district tumefactions is necessary executed a total examination of neck's and head's district, an echography, a thyroid scintigraphy, a thoracic radiography, a panendoscopy and a FNAB. When we found a squamous carcinoma on residual thyroglossal duct the therapy is chirurgical in function of dimension of T and N with following radiotherapy in function of stage (possible lymph node metastasis). When we found a different adenoma is necessary chirurgical removal of tumefactions with hyoid bone's a body resection (Sistrunk's operation) with total thyroidectomy and following Pochin's test for seeking eventual residual with radiometabolic and suppressive therapy.
The presenting symptoms and the clinical findings in 4 children with histologically proven thyroid carcinomas are described. The child with a single nodule in the thyroid gland, the child with a dyshormonogenetic goitre, the child with a thyroglossal duct remnant and the child with thyroid carcinoma and metastatic cervical lymph node involvement are discussed separately.
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Cervical adenopathies are common in children. The four categories, based on clinical findings are acute unilateral adenitis, acute bilateral adenitis, subacute (chronic) adenitis, and cervical node cancers. Most cases of acute pyogenic adenitis-both unilateral and bilateral-respond well to early antibiotic treatment. Penicillin is the drug of choice unless Staphylococcus aureus is thought to be the infecting organism. S aureus is trated with dicloxacillin or erythromycin. Subacute adenitis due to cat scratch fever usually resolves spontaneously. Nodes due to infection with atypical mycobacteria require excision. Because cervical node cancer is usually asymptomatic, excision and pathologic study should be done for any cervical node persistently enlarged without apparent reason.
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We report on the appearance of parathyroid, thyroid, and cervical thymic cysts on computed tomography (CT) scans. The differential diagnostic considerations include thyroglossal and branchial cleft cysts, cystic hygromas, primary and metastatic tumors, dermoids, teratomas, choristomas, tracheoesophageal and cervical bronchogenic cysts, as well as cystic neuromas, abscesses, and lipomas. Most cannot be differentiated using CT alone and require clinical observations, laboratory testing, and surgical and histologic findings for definitive diagnosis. Our experience with these rare lesions is reported, and the differential diagnoses are discussed.
An unusual thyroglossal duct anomaly characterized by a branched tract terminating in two separate cysts is described. The patient presented with a long-standing fistula following previous incomplete excision. Thyroglossal cysts are common congenital anomalies (Moussatos and Baffes, 1963; Allard, 1982), which do not usually present any diagnostic difficulty. However, they may sometimes present with unusual clinico-pathological features. In this report we describe a branching and polycystic thyroglossal duct abnormality occurring in a young woman with a history of previous surgery for a midline cervical mass.
Soft tissue cystic masses arising in the neck in children are commonly of embryologic origin and often surgically excised. Depending on location and histology, they can be classified as thyroglossal duct, branchial cleft, or rarely bronchogenic in origin. We present an unusual case of an infant with a lateral neck mass that communicates with the midtrachea. The histologic appearance is that of a combination of the features seen in cysts of branchial cleft and thyroglossal duct origin. The possible embryologic development of such a lesion is discussed.
A study of all patients operated on with a clinical diagnosis of midline neck cyst at the Children's Hospital of Eastern Ontario confirms our impression that certain important facts regarding the microanatomy of thyroglossal duct cyst and its associated tract are the subject of a number of misconceptions entrenched both in surgeon's minds and in some standard reference texts. Our own observations and a review of the literature dating back to Sistrunk's own original contribution in 1920 lead us to emphasize the following: (1) thyroglossal duct cysts seldom have an intact lining; (2) the thyroglossal duct is frequently multiple and arborizes; (3) its course is always anterior to the hyoid bone; (4) it is seldom discernible to the naked eye and it is futile to attempt to dissect it out at operation. By the same token, a full Sistrunk procedure must be done even if the tract is not seen; and (5) deep cervical dermoid cysts may mimic thyroglossal duct cyst when firmly fixed to the hyoid bone, but the presence of sebaceous material in the cyst will identify it as a dermoid because thyroglossal duct cysts do not undergo keratinizing squamous metaplasia.
AIMS AND BACKGROUND: The coincidence of benign or malignant thyroid tumors with thyroglossal duct remnant (TDR) cysts is rare. Although the precise etiology is still unclear, thyroid origin and spread from a primary site have been suggested and this obviously has important implications for the therapeutic approach. Three cases of thyroglossal duct carcinoma are presented and its management is discussed on the basis of the current rationale for treatment of thyroid cancer. The indication for surgery depends on positive findings in the thyroid gland (nodules, FNAB). The aim of this study was to review our experience in the management of papillary thyroid diseases associated with TDR. MATERIALS AND METHODS: The records of three patients with thyroid tumors associated with TDR treated at the Department of ENT and Head and Neck Surgery of the First Medical Faculty UK of Prague between January 1991 and January 2001 were analyzed. We searched for risk factors of thyroid carcinoma: history of ionizing radiation, history of thyroid diseases, age, tumor size, tumor spread and histopathological factors. RESULTS: We used a triple approach consisting of clinical and ultrasound examination and fine-needle aspiration biopsy for preoperative assessment. Our diagnostic and therapeutic procedures included TDR excision (Sistrunk or Schlange procedure) and total thyroidectomy. Although the therapeutic approach could be a matter of discussion, most patients agreed with our suggestion of relatively radical but non-mutilating treatment. Postoperative radiation or radioiodine ablation is considered in cases of TDR carcinoma or thyroid carcinoma associated with TDR. Oncological follow-up included clinical and ultrasound examination three times during the first year, twice in the second year, and once yearly thereafter. Tumor marker evaluation and/or scintigraphy were performed 6, 12 and/or 24 months following surgery.
Two cases of sudden infant death are described in which relatively large posterior lingual midline cysts were demonstrated at autopsy. Death in both patients was attributed to upper airway obstruction due to the cysts, both of which represented thyroglossal duct remnants.
Thyroglossal duct anomalies and dermoid cysts comprise the vast majority of congenital midline cervical masses seen in children. Unusual lesions of the midline neck include ranulae and midline cervical clefts. Workup and management is lesion-dependent, and an accurate preoperative diagnosis is essential for planning and performing an appropriate surgical procedure. This discussion presents an overview of the relevant embryology, pathophysiology, and diagnostic modalities for these congenital midline cervical anomalies. Additionally, the current principles of surgical management are described.
A carefully taken history and thorough physical examination are the first steps in establishing the cause of a neck mass. Location, size, consistency, and mobility of the mass provide clues and are useful for comparison during follow-up. Further studies are ordered on the basis of the impressions gathered from this evaluation. Congenital neck masses can be found in patients of any age. Thyroglossal duct and branchial cleft cysts and fistulas are formed by incomplete obliteration of the thyroglossal duct and branchial clefts during embryonic development. Other congenital causes include lymphangiomas, cystic hygromas, dermoid cysts, and hemangiomas. Laryngoceles are acquired cysts that arise from an anatomic remnant, the laryngeal ventricle. Treatment for these neck masses is nearly always surgical removal.
Report the case of a young feminine patient, 17, presenting since the first year of her life, a swelling of few milimeters diameter, close to the frenulum of the tongue, with progressive enlargement. At examination is verified a swelling about 10 cms. diameter filling the whole ground of the mouth and pulling backwards the tongue and producing a clear protrusion in the suprahyoid region. After lateral X-ray of the neck, echography and cervical TAC, surgery is advised with the suspicion of ranula sublingualis. Removal of the tumor through medial cervictomy, finding, besides the main mass, a second one about 3 cms. diameter. The histopathological diagnosis of a cyst of the thyroglossal duct, its sitting place and the clinical course, compelled the AA. to review the slides and being obvious the presence of sebaceus glands, they change the prior diagnosis for that of dermoid cyst.