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PubMed2002

Thyroglossal duct: a review of 55 cases.

BACKGROUND: Thyroglossal duct remnants are the most common midline neck masses in childhood but can be found in adults and the elderly. Sistrunk's procedure, with dissection of the tract and removal of the hyoid bone, is accepted as the main operation of choice. STUDY DESIGN: Fifty-five patients were treated from January 1994 to November 2000, and these were studied. There were 29 men and 26 women, with a median age of 17 years. Diagnosis was clinical, with 13 cases of fistula and 42 of cyst. Size varied from 1.0 to 4.0 cm, with an average of 2.5 cm. Six patients presented with local abscess. RESULTS: All the patients underwent Sistrunk's procedure. Serum collection occurred in three patients as complication. In one patient papillary carcinoma was identified in the cyst. Total thyroidectomy was not performed. There was only one recurrence, managed with a second operation. CONCLUSIONS: We concluded that the diagnosis of thyroglossal duct is clinical. Sistrunk's procedure carries low rates of complications (9.08%) and recurrence (1.82%). Antibiotic therapy is avoidable as a rule and hospital stay is short.

Adolescent↗
PubMed1975

Thyroglossal duct carcinoma.

Primary carcinoma of the thyroglossal duct is rare. This discussion reports two cases and reviews the 50 previously reported in the literature. The criteria for diagnosis include evidence of a thyroglossal duct remnant and a normal thyroid gland. The differentiation from cystic metastases to lymph nodes is pointed out. The histologic types parallel those of carcinoma of the thyroid gland, papillary carcinoma being the most common and having a generally favorable prognosis. The clinical presentation of these tumors is similar to that with benign cysts and thus is of limited value in the diagnosis.

Adenocarcinoma, Papillary↗
PubMed1997

Squamous cell carcinoma arising from thyroglossal duct remnants: report of a case and results of immunohistochemical studies.

We report on the case of a 57-year-old male found to have squamous cell carcinoma (SCC) arising from thyroglossal duct remnants. The patient presented with an asymptomatic tumor in his anterior neck which was immovable on palpation. Aspiration biopsy cytology revealed class V malignancy with many atypical clusters and marked keratinization. After preoperative radiation, a radical operation employing Sistrunk's procedure with bilateral neck dissection was performed. Histopathological examination confirmed a diagnosis of moderately differentiated SCC, but revealed ciliated columnar epithelium in the walls of the cyst without a normal layer of squamous cells. Furthermore, immunohistochemical studies demonstrated the tumor to be negative for thyroglobulin staining, but positive for cytokeratin and carcinoembryonic antigen. These histopathological findings proved attributable to squamous metaplasia occurring in the ciliated columnar epithelium of the thyroglossal duct. Thus, SCC might originate in the metaplastic portion of the thyroglossal duct remnants. Although the prognosis associated with SCC in the thyroglossal duct is not as optimistic as that associated with papillary carcinoma, no evidence of recurrence has been observed in this patient in the 7 years since his operation. This suggests the effectiveness of our therapeutic approach for this unusual disease.

Carcinoma, Squamous Cell↗
PubMed1991

Subepiglottic cyst causing upper airway obstruction in a neonatal calf.

A 14-day-old female Brahman calf was referred because of respiratory stridor since birth. Radiography and endoscopy were used to diagnose a pharyngeal cyst, which was subsequently surgically removed. The subepiglottic location and histopathologic features of the cyst were consistent with origin from an embryologic thyroglossal duct remnant.

Airway Obstruction↗
PubMed1997

Thyroglossal duct carcinoma: report of 12 cases.

OBJECTIVE: To report the relative frequency, natural history, and optimal treatment of thyroglossal duct (TGD) carcinoma. DESIGN: We retrospectively reviewed all cases of TGD carcinoma surgically treated during a 44-year period at a tertiary referral center. MATERIAL AND METHODS: The computerized medical records database at Mayo Clinic Rochester was searched for patients who had the diagnosis of TGD carcinoma or TGD cyst carcinoma from 1950 through 1994. Medical records and pathologic specimens of these patients were reviewed. RESULTS: Twelve patients (six male and six female patients), who were 17 to 60 years old (mean, 40), were identified. The frequency of TGD carcinoma among surgically removed TGD cysts was 0.7%. A midline upper neck mass was the initial symptom in all patients. The diagnosis of cancer was made after the Sistrunk procedure in 11 of 12 cases and preoperatively (by fine-needle aspiration biopsy) in only 1 case. All patients had papillary carcinoma. Thyroid involvement was noted in three cases. Nine patients had subtotal or near-total thyroidectomy, and three received postoperative radioactive iodine. After a mean follow-up of 13 years (range, 1 to 38), no patient had a documented local recurrence or distant metastatic involvement, and no tumor-associated mortality was observed. CONCLUSION: TGD carcinoma is a rare malignant tumor that is usually diagnosed postoperatively. Papillary carcinoma is the most common pathologic finding. The recommended treatment is the Sistrunk procedure followed by near-total or total thyroidectomy by a skilled thyroid surgeon because of the possibility of intrathyroidal foci of cancer. The prognosis is excellent in patients with papillary tumor.

Adolescent↗
PubMed2006

[A diagnostic pitfall: papillary adenocarcinoma arising in ectopic thyroid tissue within a branchial cyst].

A case of thyroid papillary carcinoma arising in ectopic thyroid tissue within a branchial cleft cyst is described. Complete dissection of the thyroid gland was necessary to rule out the differential diagnosis of primary thyroid carcinoma. The thyroglossal duct tract is an unusual localization for thyroid carcinomas in ectopic thyroid tissue. Thyroid carcinoma arising in ectopic thyroid tissue within a branchial cyst is extremely rare. Complete thyroidectomy may be necessary to eliminate an occult thyroid carcinoma.

Adenocarcinoma↗
PubMed2006

Thyroid disease in the pediatric patient: emphasizing imaging with sonography.

Thyroid disease does occur in the pediatric patient, and imaging plays an important role in its evaluation. A review is presented of normal development of the thyroid gland, the technique and indications for thyroid sonography, and key imaging features of congenital thyroid disorders (ectopic or absent thyroid, infantile goiter, thyroglossal duct remnants), benign thyroid masses (follicular adenoma, degenerative nodules, colloid and thyroid cysts), malignant masses (follicular, papillary and medullary carcinoma) and diffuse thyroid disease (acute bacterial thyroiditis, Hashimoto's thyroiditis, Grave's disease).

Humans↗
PubMed1977

[The embryology of cysts and fistulae of the neck (author's transl)].

The term "branchial" should not lead to errors of interpretation and of classification. The essential points of normal embryology and comparative anatomy are reviewed: the special nature of the first entobranchial or spiracular pouch, the important role played in correlation by the second pouch, the general course of the two parts, external and internal, of the branchial apparatus and, finally, with regard to the latter, the problems posed by the development of lymphoid tissue in this region. The thyroglossal duct, although distinct from the branchial apparatus, remains in close relationship with it, in particular in the region of the hyoid where median cysts do not have an exclusively, thyroid origin. Amongst the lateral fistulae and cysts, the different types of which are described in relation to the tissue of their origin, the distinction must be drawn between two main types: those derived from the second pair of branchial pouches and those derived from the third entobranchial pouch only. It should be possible to recognise them on the basis of the characteristics described before operation, the latter being different in the two cases.

Branchioma↗
PubMed2006

Thyroid papillary carcinoma arising in ectopic thyroid tissue within a neck branchial cyst.

BACKGROUND: Thyroid gland derives from one median anlage at the base of the tongue, and from the two fourth branchial pouches. A number of anomalies may occur during their migration. These can be in form of ectopic tissues, which are frequently found along the course of thyroglossal duct and rarely in other sites, many of these may develop same diseases as the thyroid gland. CASE PRESENTATION: A 36-years-old female presented with a 3 month history of left side neck mass. The mass disappeared following aspiration of brown colored fluid, which on cytological examination showed cells with nuclear irregularities that warranted the resection of the lesion. The histology demonstrated a thyroid papillary carcinoma arising within the branchial cyst. Thereafter, the patient underwent a total thyroidectomy with central lymph nodes dissection. Histology showed a multifocal papillary carcinoma with central lymph nodes metastases. Only four cases of primary thyroid carcinomas in neck branchial cyst have been described so far. CONCLUSION: In a lateral cystic neck mass, although rare, occurrence of ectopic thyroid tissue and presence of a papillary thyroid carcinoma should be kept in mind.

Journal Article↗
PubMed1991

Congenital head and neck masses in infants and children. Part II.

Congenital head and neck masses in children are a diverse group of lesions. Thyroglossal duct abnormalities are the most common, followed by branchial apparatus abnormalities, lymphangiomas (cystic hygroma), and subcutaneous vascular abnormalities (hemangioma, AVM). It is important to note that cutaneous hemangiomas are not included in this discussion of congenital masses. If they are considered within the general topic of congenital head and neck masses, vascular lesions by far are the most common. Teratomas and dermoid cysts represent true congenital neoplasms and are relatively uncommon. Several rare lesions have been noted in the discussion and should be included in the differential diagnosis. The diagnosis of these particular masses depends largely on history and physical examination. The location of the mass itself greatly limits the differential diagnosis. Ancillary studies such as plain x-rays, ultrasound, CT scanning, and angiography are useful in further limiting the possible diagnoses. Subcutaneous hemangiomas, ectopic thyroid, congenital goiter, and fibromatosis colli can be treated medically or with simple observation. Surgery is reversed for enlarging lesions or lesions affecting vital structures. The remainder of the congenital head and neck masses generally require early excisions to avoid complications of infection, airway obstruction, nutritional compromise, or the risk of malignant transformation.

Child↗
PubMed1997

Current management of thyroglossal-duct remnant.

OBJECTIVE: Thyroglossal-duct remnant (TGDR) should be differentiated from ectopic thyroid prior to surgical excision. The purpose of this study is to discuss our experience with TGDR and review the role of technetium 99m-labelled sodium pertechnetate (99mTc), thyroid function test (TFT), ultrasound (US), and computerized tomography (CT) scan in the management of TGDR. METHODS AND RESULTS: This retrospective study comprised 24 (18 M:6 F) patients with TGDR, whose ages ranged between 3 and 52 years, 83.3% of whom were less than 30 years of age. The most common complaints were anterior neck swelling in 79% (19/24) and draining sinus in 37.5% (9/24). Other rare complaints include throat discomfort, hoarseness, and pain. Axial CT scan through the area of interest in four patients revealed intralaryngeal and extralaryngeal extension, with some cartilage destruction and pre-epiglottic extension in two patients. 99mTc and US and TFT demonstrated normal thyroid in 11 and 10 patient, respectively. Thyroid tissue element reported histologically in 58.3% (14/24) of cases. These 24 patients underwent 10 simple cyst excisions and 21 Sistrunk procedures. The rate of recurrence was 40% and 7%, respectively. CONCLUSION: When the thyroid gland can be identified in the normal position, coexistent ectopic thyroid is seldom found. However, when ectopic thyroid is suspected, 99mTc and TFT are valuable tests. Furthermore, CT scan may be profitable when there is evidence of laryngeal involvement. Sistrunk's procedure replaces simple cyst excision and continues to be the mainstay treatment of TGDR.

Adolescent↗
PubMed1989

[Fistula of the pyriform sinus. Report of 2 cases].

The authors present two patients of 8 and 11 years of age that presented a left sided piriform sinus fistula diagnosed by esophagram and surgically treated in our centre. One had been operated previously with a diagnosis of relapsing thyroglossal quist on five occasions. The piriform sinus fistula is a recently recognised entity as cause of thyroiditis and suppurative cervical infections in the pediatric age. Communicated for the first time in the literature in 1957 by Japanese authors, it was not until 1973 that Tucker published for the first time in English a case of recurrent cervical abscess caused by a fistula initiated in the piriform sinus. Until now very few cases have been published. The majority of authors consider it to be an embryological residue of the third or fourth pharyngeal pouch. The key to diagnosis is to bear it in mind whenever a patient presents suppurative thyroiditis or repetitive cervical infections, principally of the left side. An esophagram is necessary to demonstrate the course of the fistula. In cases of thyroiditis a thyroidal gammagraphy will allow vision of a cold zone in the upper third of the affected lobe. Treatment consists of total extirpation of the fistula and affected portion of the thyroidal lobe, once the infection has been solutioned. Before intervention it is important to collocate a tube in the fistula's course by means of a direct microlaryngoscopy which will serve as guide and allow the injection of methylene blue.

Abscess↗