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We report a case of a partly ossified thyroglossal cyst in close proximity to the hyoid bone and discuss the possible embryological significance of this. Thyroglossal cysts occurring within the hyoid bone or deep to the hyoid periosteum support previous suggestions that the thyroglossal tract can sometimes be trapped within the developing hyoid bone.
Cysts of the thyroglossal duct form the congenital, not odontogenetic, more frequent malformations of neck and head pathology. In percentage terms one percent developed a carcinoma, usually of good prognosis. This paper reports the case of a woman, 41, who was operated upon of a thyroglossal duct cyst and in the eradicated piece showed a papillary carcinoma invading neighbouring tissues. Treatment was completed, in a second time, with a complete thyroidectomy and a the papillary carcinoma was discovered. Some interesting aspects regarding diagnosis and treatment of this scarce entity are reviewed.
Cyst of the thyroglossal duct results from a developmental anomaly of the thyroid gland. There are many congenital neck masses only outnumbered by benign lymphadenopathies. The majority appear in children between 2 und 10 year-old, but nearly a third of cases does not manifest clinically until much later (20 year or so). In association to a carcinoma is an uncommon event, but there are published malignant cases. The AA. report the case of a 74-year-old patient with a neck cystic mass evolving during a 40-year-term associated to a laryngeal squamous carcinoma. The imagery shows the radiological and anatomopathological correlation of changes in the tissues interpreted as a cyst of thyroglossal duct and a squamous carcinoma of the larynx, independent of each other.
The authors report a case of an unusual inflammatory reaction in a thyroglossal cyst. It consisted of broad papillary intraluminal projections covered by histiocytes and occasional multinucleate giant cells. This benign process should not be confused with a true papillary neoplasm, a rare complication of a thyroglossal cyst.
The appropriate degree of investigation of thyroglossal cysts is uncertain. This retrospective study analyses the pre-operative investigations and correlates this with the post-operative results. The conclusion is that only radio-isotope studies are useful, but there is a limitation regarding the age of the patient and the authors only recommend this in patients over 10 years of age.
The case is described of a boy who presented at age six months with symptoms and signs of a thyroglossal cyst, which seemed to be confirmed by ultrasound findings. The cyst slowly increased in size, and eventually the patient underwent Sistrunk's procedure at age four years. Histology showed that the cyst was in fact a mixed thyroglossal and dermoid cyst. This casts doubt on the doctrine that thyroglossal cysts and dermoid cysts are anatomically and histologically separate entities, and strengthens the view that these cysts should be more appropriately named 'thyroglossal abnormalities'.
Rarely does a thyroglossal cyst reach such proportions as to compromise the upper respiratory airway. Such a case is presented and the manner in which it was satisfactorily treated is described.
8 patients over 30 years of age with a thyroglossal cyst, who had not been operated on before and who underwent excision of the cyst by a Sistrunk procedure, are described. In 8 additional patients, a wait-and-see policy was adopted. Follow-up data of these 16 patients are reported 1.5-14 years after their last visit to the hospital. There were no recurrences in the group of treated patients. In the group of untreated patients, the cyst remained unchanged in 1, decreased in size in 3 and disappeared completely in the remaining 4 patients. The present study indicates that removal of a thyroglossal cyst in patients over 30 years of age is not obligatory.
During the 16-year period, July 1, 1959 to June 30, 1975, inclusively, there were only 20 patients with thyroglossal cyst found at the Howard University Hospital (0.03 percent of routine surgicals). There were 12 males and eight females, all of whom were black. Anatomic and histopathologic variations of thyroglossal cysts will be emphasized, and the pitfalls in diagnosis discussed. A brief review of the literature will be presented.
Carcinoma of the thyroglossal tract is a rarity--over the past 85 years only 160 cases have been reported. We report the first case of carcinoma arising in a thyroglossal tract remnant 10 years after simple excision of a thyroglossal cyst. This case highlights the importance of the Sistrunk procedure, (the removal of the entire thyroglossal tract) for preventing not only cyst recurrence, sinus and fistula formation, but also the occurrence of carcinoma.
Thyroglossal duct cysts can be found in several different locations, although intra-thyroid presentations are rare. We present the case of an 11-year-old patient with a visible neck mass on the right thyroid lobe. On sonogram, it was consistent with a unilocular cyst measuring 2 centimeters in diameter. The cyst did not take up the radioisotope during a gammagram. Fine needle aspiration cytology suggested a diagnosis of thyroglossal duct cyst. At surgery, we found that there were no lesion-dependent thyroglossal tracts; we therefore performed a simple enucleation of the cyst, sparing the rest of the gland. The pathologic examination confirmed that it was an intra-thyroid thyroglossal duct cyst. After 8 months of follow-up, the patient has remained without complications of any kind or recurrence. Only four prior cases of intra-thyroid thyroglossal cysts have been described in the pediatric population. Half of them presented with a typical thyroglossal tract crossing the hyoid and the other half presented an isolated cyst. It is highly unlikely that a cold, cystic, thyroid mass in a child is a thyroglossal duct cyst. Diagnosis is made on the basis of fine needle aspiration cytology and the lesion is treated surgically. A thyroglossal tract must be methodically sought out during intervention, although they frequently do not exist.
Surgical techniques for thyroglossal cysts still vary considerably. In this review, one-third of patients treated by simple cyst excision had recurrence and this operation cannot be recommended. There should be consensus that excision of the mid-portion of the hyoid bone be performed routinely. However, variations have been described in the syprahyoid dissection. The present review indicated that the classic Sistrunk operation provided the lowest rate of recurrence and should remain the standard procedure.
Thyroglossal duct cysts most frequently present in childhood as a painless midline swelling of the neck. Uncommonly, these embryonal remnant cysts present clinically in adult life. The majority of adults with thyroglossal duct cysts present with a swelling at the level of the thyrohyoid membrane. On rare occasions, a thyroglossal duct cyst can present with more sinister symptoms, such as hoarseness, dysphagia and dyspnoea. On these occasions, the pre-operative clinical and investigative diagnosis remains in doubt until histology is available.
Thyroglossal duct cysts are one of the most commonly encountered benign neck lumps found in the paediatric population. Despite their relative frequency, reports of familial inheritance are rare. A total of 21 patients with hereditary thyroglossal duct cysts from seven families worldwide have been reported. The most common inheritance pattern is dominant, with a minority possibly representing a recessive aetiology. We describe a further instance of dominantly inherited thyroglossal duct cysts in two generations.
The cytologic and histologic features of two cases of carcinoma arising in thyroglossal cyst are reported. The carcinoma in both cases was papillary thyroid carcinoma. The aspirated cyst fluid in one case revealed only macrophages and benign squamous epithelial cells, while in the other case the cyst fluid showed cytologic features of papillary carcinoma including psammoma bodies and epithelial cells with papillary clustering, intranuclear cytoplasmic inclusions, and positive immunohistochemical reaction to thyroglobulin.
Thyroglossal duct cysts are common primary neck tumors, resulting from remnants of the ductus thyroglossus. They can occur at any point along the migratory path of the thyroid gland anlage until the 2nd or 3rd decade of life. The usual symptoms leading to the diagnosis are painless midline neck masses orfistulas. Despite their close proximity, the cysts normally do not affect the larynx. We report on the eighth case mentioned in the world literature of a thyroglossal duct cyst invading the larynx in a 62-year-old patient. Preoperatively, the voice of the patient sounded metallic, and the frequency of the voice field was reduced. Postoperatively, the voice onset was physiological, and the voice increased by an octave in the higher frequencies. The intonation of the voice was steady. The analysis of formants of the vowels "a" and "i" showed that the fourth formant of the vowel "i" was lower in frequency postoperatively.
Thyroglossal duct cysts are common congenital abnormalities or developmental field defects, usually detected in early childhood. Despite their frequent occurrence, familial patterns are rare. We report on two new families with thyroglossal duct cysts. In the first family three siblings were involved, while in the second one, father and son were affected. This trait may be autosomal recessive or possibly multifactorial, as the first family would indicate, and also autosomal dominant, as the second family would suggest.