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PubMedDate not supplied

Papillary thyroid carcinoma in thyroglossal duct cyst: case reports and literature review.

Although thyroglossal duct cysts represent a common developmental abnormality of the thyroid gland, malignant transformation is rare and occurs in only 1% of cases. This article describes four clinical cases observed at the Surgical Science Department of "La Sapienza" University of Rome between 1996 and 2000. Histologic examination indicated two pure papillary carcinomas, a sclerosing papillary carcinoma, and a follicular variant of papillary carcinoma. In all cases, treatment involved removal of the body of the hyoid bone and total thyroidectomy, which we associated with removal of the thyroglossal duct cyst. In one case, laterocervical lymphectomy was performed. Carcinoma multifocality was found in one patient. We recommend associating total thyroidectomy with removal of the tumor of the thyroglossal duct and of the body of the hyoid bone, because the carcinoma may be multifocal and there may be lymphatic invasion of the thyroid and to ensure a correct follow-up.

Adolescent↗

PubMed2004

Core excision of the foramen cecum for recurrent thyroglossal duct cyst after Sistrunk operation.

The recurrence rate for thyroglossal duct cysts after a Sistrunk operation is 5% compared with 20% if the hyoid cartilage is not removed. However, few guidelines exist when a lesion recurs after an adequate Sistrunk operation. A 2-year-old boy was referred for recurrent thyroglossal duct cyst after complete and adequate resection. Reexploration of the wound and wider excision of the midline cervical tissues failed to treat the problem. Using a combined transoral/cervical approach, a core of tongue around the foramen cecum was removed. A cystic structure was found at pathologic examination. The child remains asymptomatic 24 months later. If thyroglossal duct cysts recur despite an adequate Sistrunk operation, an intralingual remnant should be suspected. Transoral excision of tongue tissue around the foramen cecum may offer a cure.

Abscess↗

PubMedDate not supplied

Thyroglossal duct cyst in hyoid bone: CT confirmation.

In our report we describe an atypically sited thyroglossal cyst in a 67-year-old woman. The intrahyoid location is explained by one of the theories of the migration of the rudimentary thyroid during embryogenesis. The diagnosis was confirmed by CT.

Aged↗

PubMed2005

Simultaneous existence of papillary carcinoma in the thyroid gland and thyroglossal duct cyst in two patients.

Papillary carcinoma of the thyroglossal duct cyst is a rare occurrence. Two patients presenting with medial neck masses were diagnosed as having thyroglossal duct cysts by ultrasonography. The Sistrunk operation was performed. Histopathologic evaluation demonstrated papillary carcinoma in the surgical specimens of both patients. The thyroid glands were examined by ultrasonography, scintigraphy, and fine-needle aspiration biopsy. Biopsy showed papillary carcinoma, and total thyroidectomies were performed. Micropapillary carcinoma was detected in the resected thyroid glands. The patients were asymptomatic without complications after 24 and 32 months of follow-up, respectively.

Adult↗

PubMed1995

Sonographic demonstration of a normal thyroid gland excludes ectopic thyroid in patients with thyroglossal duct cyst.

OBJECTIVE: Preoperative thyroid scintigraphy has been performed in patients with presumed thyroglossal duct cyst to document a normal thyroid and to exclude the possibility of an ectopic thyroid mimicking a thyroglossal duct cyst. Often, an ectopic thyroid is the patient's only functioning thyroid tissue, and its removal will result in hypothyroidism. The purpose of this study was to determine whether demonstration of a normal thyroid gland by sonography in children with thyroglossal duct cyst can exclude ectopic thyroid and thereby obviate routine preoperative thyroid scintigraphy. MATERIALS AND METHODS: We studied 30 patients with pathologically proved thyroglossal duct cysts who had neck sonograms. The sonograms were evaluated for the presence or absence of a normal thyroid gland. The medical records of these children were also reviewed. Three children had normal preoperative radionuclide thyroid scans. All the children were clinically euthyroid preoperatively. Follow-up was available in 15 of the 30 patients, and all of these patients were clinically euthyroid postoperatively. RESULTS: A sonographically normal thyroid gland was detected in all patients. CONCLUSION: Preoperative sonographic identification of a normal thyroid gland in patients with thyroglossal duct cyst confirms a source of thyroid hormone separate from the thyroglossal duct cyst and thus excludes ectopic thyroid. Routine thyroid scintigraphy is not necessary.

Child↗

PubMed1996

[Papillary carcinoma developed in the wall of a thyroglossal duct cyst].

A case of papillary carcinoma arising in the wall of a thyroglossal duct cyst is described. This is a rare occurrence (1% of cases). Controversies exist concerning its nature (cancer of the thyroid or primary cancer of the thyroglossal cyst) and its treatment (Sistrunk's operation alone or combined with thyroidectomy).

Carcinoma, Papillary↗

PubMed1995

[Papillary carcinoma arising in thyroglossal duct cyst: a case report and review of the literature].

While thyroglossal duct cysts are a frequent cause of cervical masses, carcinomas arising in thyroglossal duct remnants are rare. In this paper the Authors report a new case, which occurred in a young woman. The diagnosis of carcinomas in thyroglossal duct cysts almost always comes as a surprise upon pathologic examination. The type of neoplasia most frequently described in Literature is that of the papillary carcinoma (82%). Other types of carcinomas are also reported in Literature: mixed follicular-papillary carcinomas (9 cases), squamous cell carcinomas (10 cases) and follicular carcinomas (3 cases). There are different theories regarding the origin of and therapy for these malignancies. In the sixties some Authors thought that these carcinomas were metastases of thyroid carcinomas. Now, following demonstration of normal thyroid tissue occurrence in the wall of thyroglossal duct cysts, it is almost universally accepted that a carcinoma may arise from thyroglossal remnants. The foci of cancer found in the thyroid reported only infrequently in Literature are a result of the plurifocality of papillary carcinoma. The Authors suggest that the Sistrunk procedure is an adequate, sufficient treatment if the carcinoma is limited to the cyst's walls. They also recommend postoperative administration of substitution therapy of thyroid hormones. Indications for thyroidectomy are then discussed.

Adenocarcinoma, Follicular↗

PubMed1983

Management of recurrent thyroglossal duct cysts.

In a review of 141 patients with thyroglossal duct cysts between 1961 and 1981, 28 patients were found to have surgical treatment for recurrent cysts and sinuses. Recurrent disease following surgical failure results in a high incidence of fistula formation. In the operative treatment of recurrent disease, all patients had a segment of hyoid bone excised. The dissection was extended to include a core of the base of the tongue in 20 of the 28 patients. There have been no surgical failures in this population of patients treated for recurrent thyroglossal duct cysts. We are currently treating patients with recurrent cysts and sinuses with en bloc anterior neck dissections, a modification of the classic Sistrunk procedure.

Adolescent↗

PubMedDate not supplied

Percutaneous ethanol injection of thyroglossal duct cysts.

OBJECTIVE: To report the results of treating 3 patients with a thyroglossal duct cyst by percutaneous ethanol injection and compare the outcome with the results of treatment in 17 patients with thyroid cysts. METHODS: The details of the ultrasound-guided injection procedure and the clinical course of the patients are presented, along with review of the literature pertaining to alcohol ablation for thyroglossal duct cysts. RESULTS: Percutaneous ethanol injection was successful in only 1 of 3 patients with thyroglossal duct cysts, in whom the diagnosis was confirmed by ultrasonography, during a 2-year period. During the same 2-year interval, 17 patients with a thyroid cyst received similar treatment. Ablation of the thyroid cyst was successful in all 17 patients, only 1 of whom required a second ethanol injection procedure. CONCLUSION: Percutaneous ethanol injection does not seem to be as effective in treating thyroglossal duct cysts as in treating thyroid cysts. If the presence of a malignant lesion can be excluded, percutaneous ethanol injection may be considered a secondary treatment in patients with thyroglossal duct cysts who cannot undergo a surgical procedure.

Administration, Cutaneous↗

PubMed1998

[Thyroid carcinoma in a thyroglossal duct cyst: tumor resection alone or a total thyroidectomy?].

Tumours arising in a thyroglossal duct cyst are very rare. Most of them develop from ectopic thyroid remnants. Controversies persist concerning th treatment of these neoplasms, some authors preferring local excision (Sistrunk procedure), while others prefer a more radical approach (associated total thyroidectomy). From 1977 to 1996 we observed and treated 10 patients with by a thyroglossal duct tumour: 8 females and 2 males. A mass in the midline of the neck was the presenting complaint in all cases. Each patient was treated by a Sistrunk procedure associated with total thyroidectomy. Histopathology reports showed 7 papillary carcinomas, 1 Hürthle cell carcinoma, 1 follicular carcinoma and 1 insular carcinoma. Systematic examination of the thyroid gland revealed foci of papillary cancer in 4 cases (40%), with only 1 tumour being larger than 1 centimetre. Cervical metastases were found at operation in 1 case. This series suggests that total thyroidectomy for tumours of thyroglossal cysts could be justified by the high incidence of associated papillary carcinomas of the thyroid and by the relatively aggressive nature that some tumors. In these cases, a radical therapeutic attitude allows, better patients management (total scintigraphy, serum thyroglobulin measurement) and allows the possibility of a complementary radioiodine treatment.

Adult↗

PubMed1995

[Thyroglossal duct cysts. Apropos of 17 cases in the National Hospital Center in Ouagadougou, Burkina Faso].

The thyroglossal duct cysts originate from thyroglossal duct involution default. The case record of 17 patients admitted for that disease in the ORL department of the national hospital of Ouagadougou during those past 7 years, is reviewed. They represent 1.5% of patients operated in this department during the same period, all diseases concerned. In the present report, the thyroglossal duct cysts are essentially observed in children under 10 years old (13/17 patients). In most of the cases (12/17), our patients have needed medical advice for an anterior cervical tumefaction 7 years after the first symptoms. Between clinical and paraclinical findings we give preference to the first ones that can avoid, in most of the cases, a lot of complementary tests which are of limited interest and too expensive in our countries. In the therapeutic field, the Sistrunk technic has been recognized since 1920 as the best method. Our patients who have been operated according to that technic have no tendency to relapse.

Adolescent↗

PubMed1992

What is the optimal depth for core-out toward the foramen cecum in a thyroglossal duct cyst operation?

The high recurrence rate of thyroglossal duct cyst operations is well documented. Sistrunk's operation is widely accepted as the best procedure to prevent recurrence. Nonetheless, the optimum depth of core-out is still not well documented. We previously reported a standard running pattern of the thyroglossal duct in an anatomical reconstruction study. In more detailed pathological studies, we have tried to determine the optimal depth for core-out toward foramen cecum and the optimal width of the hyoid bone to be resected. The following items were clarified. (1) Double the horizontal distance from midline to the most distant thyroglossal duct in front of the hyoid bone was 2.4 to 9.6 mm. (2) The length of the single duct above the hyoid bone which spreads into many ductuli as it approaches the foramen cecum was about 3 to 5 mm in 2- to 6-year old children. (3) The diameter of the thyroglossal duct at the level of the cranial top of the hyoid bone was 175 to 1,400 microns. Half of the examined cases were less than 500 microns, which may have rendered direct dissection impossible. Based on these studies, we propose: (1) that a minimum of 10 mm of the hyoid bone should be resected, and for the sake of safety, more than 15 mm is preferable; and (2) that the depth of the core-out should be less than 5 mm in young children to avoid the breakdown of the branched ductuli near the foramen cecum.

Cecum↗

PubMed2005

Thyroglossal duct cyst: a cytopathologic study of 26 cases.

Thyroglossal duct cyst (TDC), or embryologic remnants of thyroid gland, is a common congenital anomaly. TDC may cause a midline neck mass, which occasionally may become infected, and rarely gives rise to carcinoma. As a number of other nonneoplastic and neoplastic lesions can cause cystic masses in the neck, we explored the role of fine-needle aspiration (FNA) in making a preoperative diagnosis of TDC for a more accurate and timely clinical intervention. Twenty-six cases of TDC were identified from the cytopathology files of The Johns Hopkins Hospital in a 15-yr period (1990-2004). Material was obtained by FNA with or without radiologic (ultrasound) guidance. Smears were air-dried and stained with Diff-Quik, or wet-fixed and stained with Papanicolaou stain. Cytomorphologic characteristics were serially analyzed. Follow-up (tissue resection [n = 9] and clinical charts [n = 17]) was reviewed in all cases. Patients ranged in age from 8 to 83 yr (mean age, 55) with M:F ratio of 1.4:1. The size of the cyst ranged from 1.2 to 5 cm (mean 2.5 cm), as evaluated on radiological scans. The most common clinical presentation was a non-tender, mobile neck mass, which was painful on swallowing. Follow-up confirmed TDC in 18/26 cases (69%), whereas 8/26 cases resulted in various other benign lesions. During the same time period, 11/18 (61%) cases of surgically resected TDC were missed on prior FNA. Therefore, FNA showed a diagnostic sensitivity of 62% and a positive predictive value (PPV) of 69% for the diagnosis of TDC. The cytomorphologic features of TDC included the following: colloid (thick and fragmented, thin and watery, or mucinous), macrophages, lymphocytes, or predominantly neutrophils. The epithelium was ciliated columnar, metaplastic squamous or of mature squamous type. Thyroid epithelium was only rarely present (11%). FNA is only moderately sensitive for a preoperative evaluation of TDC. Cytomorphologic features are not unique; however, in the right clinicoradiologic setting should lead to an accurate diagnosis. Abundant colloid, most often with ciliated columnar epithelium, is the predominant cytopathologic finding. Thyroid epithelium is rarely identified. Differential diagnosis involves branchial cleft cyst, lymphoepithelial cyst, thyroid gland lesions, and lymphadenopathy (of various etiologies).

Adolescent↗

PubMed1986

Is the treatment for thyroglossal duct cysts too extensive?

From 1970 to 1985, 64 patients underwent surgical management for thyroglossal duct cysts at the University of Oklahoma Health Sciences Center. Their ages ranged from 1 to 63 years with a mean of 12.4 years. Ninety-one percent of the patients were available for follow-up. All patients underwent one of three forms of treatment: the classic Sistrunk operation, a modified Sistrunk operation, or excision of the cyst only. Eleven percent had undergone a previous procedure. The majority of patients were found to have a cyst in the midline at the level of the hyoid bone. Eighty-eight percent of the patients underwent excision of the midportion of the hyoid bone. There were no postoperative deaths and the perioperative complication rate was 20 percent, the majority being wound-related. All recurrences took place within 4 months of operation. Factors that appeared to be associated with an increased risk of complications and recurrence included young patient age (less than 10 years), rupture of the cyst at the time of operation, infection, and failure to excise the midportion of the hyoid bone and the suprahyoid tract. One patient was found to have a mixed papillary and follicular carcinoma in the thyroglossal duct. We support the original premise of Sistrunk that "the cure of thyroglossal cyst are unsuccessful unless the epithelium-lined tract, running from the cyst to the foramen cecum is completely removed," including the hyoid bone.

Adolescent↗

PubMed2005

Thyroglossal duct cyst's inflammation. When do we operate?

Thyroglossal duct cyst (TGDC) disease, one of the most common developmental neck lesion in the pediatric population, often presents as infected neck mass. The authors reviewed their experience in the management of inflamed TGDC cases, in order to suggest the most efficient approach of these patients regarding the ideal type and time of surgical intervention. The medical records of all the patients with the diagnosis of TGDC treated at our department from 1988 to 2003 were reviewed. Data collected included age, gender, preoperative inflammation, treatment and time of definitive surgery. The outcome of the operation was graded as successful, recurrence, or postoperative infection. Eighty-nine (89) patients with histologically confirmed TGDC were treated at our department. Mean age at operation was 6.0 years (range, 9 months-14 years). Male to female ratio was 1.2:1. All patients underwent Sistrunk operation and the mean follow-up was 3 years. Fifty-four (54) patients (60.6%) presented with an inflamed TGDC. Among them, 24 patients were operated immediately after diagnosis at the phase of acute inflammation, and 30 patients after antibiotic administration and resolution of inflammation. The overall recurrence incidence was 6.7%. Recurrence was noted in 6 of 24 (25%) patients operated during the acute phase of inflammation and none in patients operated after resolution of inflammation (P = 0.0052) or with no preoperative inflammation (P = 0.0002). Postoperative wound infection was noted in seven cases but none of them developed recurrence of the disease. The presence of inflammation at the time of surgery is an important risk factor for relapse. We suggest that in the inflamed cases of TGDC disease, the initial treatment should be antibiotic administration and after resolution of the inflammation, surgical management should follow.

Humans↗

PubMedDate not supplied

[Thyroglossal duct cysts in paediatric patients: early operative intervention reduces rate of complications].

BACKGROUND: Thyroglossal duct cysts arise from mucus production in an incomplete regressed thyroglossal duct. Often they are only noticed in case of infection or secondary fistulation. The operative management is a Sistrunk procedure. METHOD AND PATIENTS: In a retrospective study we analyse 26 patients aged 0,3 - 10 years with histological confirmed thyroglossal duct cysts, 13 of these (50 %) had signs of infection. In 15 patients the cyst was primarily cored out, in 11 patients the core out followed a primarily incision and drainage. RESULTS: 5 patients (19 %) developed recurrent cysts. Patients with signs of infection or incomplete resection of hyoid bone had a high risk of developing recurrence. CONCLUSIONS: We propose an early operative treatment for thyroglossal duct cysts with a complete Sistrunk procedure.

Age Factors↗

PubMed1991

[Ultrasonography and CT of thyroglossal duct cysts].

A retrospective analysis of pathologically proved 7 cases of thyroglossal duct cysts was performed in an attempt to determine the characteristics of these lesions using both ultrasonography (US) and computed tomography (CT). US showed cystic mass with variable internal echoes or debris in 6 of 7 cases and internal septation in two. CT showed hypodense mass in all 4 cases of which attenuation value were higher than that of water, and rim-enhancement of the wall in one case. CT and US also showed calcification of the wall in one patient. To our knowledge, calcification of the wall of thyroglossal duct cyst was not reported previously. These findings described above may be due to complicated inflammation, and may enable to differentiate the thyroglossal duct cyst from the other neck masses.

Adult↗

PubMedDate not supplied

[Papillary carcinoma of the thyroid arising on thyroglossal duct cysts: report of a case and review of the literature].

Thyroglossal duct cysts are the most common congenital disorder of the neck. One percent of cases may degenerate and give rise to a cancer, mainly arising in the pericystic thyroid tissue. Some 250 cases have been reported in the literature to date. We report here on a 39-year-old man with a midline mass in the neck measuring 4 cm max. The patient was examined preoperatively by ultrasonography of the neck and assay of thyroid hormones, which yielded a diagnosis of a thyroglossal duct cyst. On the basis of these findings, the patient underwent surgery to remove the mass and, after an extempore histopathological examination, was submitted to total thyroidectomy owing to the presence of papillary carcinoma of the thyroid arising on the thyroglossal duct cyst with multiple foci in the context of the thyroid gland. Most thyroid cancers at the time of surgery are confined to the thyroid gland, infiltrating the adjacent structures in approximately 20% of cases and the local-regional lymph nodes in 8 to 11.5%. Thyroid papillary adenocarcinoma is multifocal in 21% of cases. The multifocal nature of the cancer makes total thyroidectomy mandatory at the same time as surgery is performed to remove the cyst.

Adult↗