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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.
40 cases of cysts and fistulas of the thyroglossal tract duct offer to the authors occasion to review the rare problems of diagnosis raised by this pediatric pathology. They compare the results of surgery obtained by the classic technic of Sistrunck (1920) versus the Schlange's operation (1893) which remove the cyst with the hyoid bone's body only. The average of age is 17 years. A location of a thyroglossal cyst in the submandibular area was noted during operation. Sistrunck's operation was performed in 21 cases (52.5%) and the Schlange's one in 14 cases (35%) without recurrence. 4 cases (10%) recurrences were noted, all after simple cystectomy. Removal of the hyoid bone's body appear to us as the key of success in the surgery of thyroglossal anomalies.
I-123 thyroid scintigrams performed in 349 patients were evaluated with a focus on specific thyroid gland vestiges, namely a pyramidal lobe or a thyroglossal duct. The detection of these vestiges in patients with hyperthyroidiam is indicative of autoimmune hyperthyroidism. In Graves' disease, stimulating thyrotropin (TSH) receptor antibodies cause a significantly more frequent appearance of vestiges of the thyroglossal tract. In contrast, disseminated autonomously functioning thyroid nodules rarely show a pyramidal lobe. The frequency of pyramidal lobe visualization in patients with Graves' disease differed significantly from the frequency in patients with multifocal or disseminated autonomously functioning nodules. In euthyroidism patients, the vestiges may be indicative of the diagnosis of iodine deficiency with or without latent primary hypothyroidism. In thyroid scintigraphy, the pyramidal lobe and the thyroglossal duct can be visualized more easily using I-123 instead of Tc-99m sodium pertechnetate.
A clinical series of cysts and fistulas of the thyroglossal tract has been examined. Clinical aspects of this pathology and the results obtained with surgical treatment are compared with reported data.
A good knowledge of embryology and surgical anatomy allows for the anticipation of intraoperative findings, and, hence, for safer and more efficient care of patients with congenital anomalies of the neck. Presumptive thyroglossal anomalies that are at or above the level of the hyoid mandate extra vigilance: the patient may not have sufficient thyroid tissue in the usual thyroid location. The discontinuous character of thyroglossal tracts, related to ontogenesis, ordains dissection to the lingual mucosa. First branchial cleft cysts and fistulas require knowledge of facial nerve anatomy; in some of these cases, the facial nerve is best identified in the temporal bone. Branchial cysts, sinuses, and fistulas only can be assigned to a specific pouch-cleft by their anatomic relations to cervical structures.
BACKGROUND: Ectopic thyroid tissue as a result of thyroid developmental abnormalities is the most frequent cause of congenital hypothyroidism (CH). It is diagnosed by using radionuclide thyroid scanning. OBJECTIVE. To evaluate the sensitivity of US in the detection of such ectopias and to describe their US pattern before and during treatment. MATERIALS AND METHODS: Forty-two neonates (group A; aged 11.3+/-4.0 days) and 33 older children (group B; aged 11.1+/-3.9 years) with a biochemical diagnosis of CH and thyroid ectopia detected by radionuclide scanning were evaluated before (group A) and after (group B) treatment. Thyroid US included a survey of the pathway of the thyroglossal tract and an evaluation of the location, size, echogenicity and vascularity of any tissue along this pathway suggestive of thyroid ectopia. RESULTS: Thyroid ectopia was detected using US in 18 patients (24%) with a similar rate during the neonatal period and thereafter on therapy. Three patients demonstrated double ectopia. These 21 sites of ectopic thyroid tissue were located at the suprahyoid level (n=12), at the level of the hyoid (n=1), and at the infrahyoid level (n=8). The maximum diameter of the ectopic tissue ranged from 4 to 14 mm. In group A (9 patients), the 11 ectopias were all hypervascular. These were hyperechoic in all but one neonate. In group B (9 patients), the ten ectopias were not vascular, and were hyper (n=3) or hypoechoic (n=7). CONCLUSIONS: US allows for detection of ectopic thyroid tissue, but with a lower detection rate than radionuclide scanning. However, it does provide a more detailed description of such ectopias.
Anterior midline cervical anomalies, excepting thyroglossal tract abnormalities, are rare. Two unusual and almost identical cases of an anomalous congenital tube connecting the chin to the upper sternum are described; only one previous similar report exists in the literature. In all three cases, the tubes occurred as isolated anomalies in otherwise healthy children.
The standard nuclear medicine textbooks describe the pyramidal lobe of the thyroid as arising from the upper part of the thyroid lobes. Anatomy and surgical texts however describe it as a thyroglossal tract remnant and state that it arises from the isthmus. Review of 150 thyroid scintigrams confirms that on scintigraphy the pyramidal lobe does appear to originate from the upper pole. We have used single photon emission tomography to demonstrate the true origin of the pyramidal lobe by removing overlying thyroid tissue. We suggest that the pyramidal lobe arises from the isthmus and the appearances on scintigraphy are due to the lower part of the lobe being obscured behind the main thyroid lobe.
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.
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OBJECTIVE: To analyze, in detail, the clinical and pathological findings in a patient population that had undergone previous Sistrunk procedures for the removal of thyroglossal duct cysts, in order to identify any possible factors that could be related to recurrence after 'definitive' surgery. SETTING: A large pediatric tertiary care center. METHODS: A retrospective chart review was performed to include all patients treated at a single center for thyroglossal duct cysts with a Sistrunk procedure, between 1978 and 1992 inclusive. RESULTS: A total of 108 consecutive patients were analyzed. We noted that the presence of recent preoperative infection of the cyst was the only statistically significant (P < 0.05) clinical difference noted between the successful and the unsuccessful surgical groups. However, pathological analysis revealed that there was a substantially greater number of multiple thyroglossal duct tracts (P < 0.05) noted in the group that failed a Sistrunk procedure. CONCLUSIONS: We feel that multiple thyroglossal tracts may play an etiologic role in some recurrent cysts. Thus, a wide conservative excision, including the middle two thirds of the hyoid bone, is necessary in order to include any multiple tracts in the resection.
Thyroglossal duct cysts originate from trapped elements of the thyroglossal duct tract during embryological descent of the thyroid gland. The incidental finding of a thyroglossal duct cyst during cervical surgery has not been described previously. We present four cases of small asymptomatic thyroglossal duct cysts discovered as an incidental finding during laryngotracheal reconstruction. In each case, the cyst was removed using a Sistrunk procedure. In all four cases the patient was successfully decannulated, and there were no cases of cyst recurrence. We also consider the implications that these four cases may have on the perceived incidence of the thyroglossal duct cysts and their management.
The extremely rare occurrence of invasive squamous cell carcinoma arising from normal epithelial lining of a thyroglossal duct remnant cyst is documented by demonstrating the histopathologic transition from normal squamous epithelium to squamous cell carcinoma. The requirements that must be fulfilled to accept a lesion as arising de novo from the epithelial lining are outlined, and all requirements are achieved. The lesion is differentiated from the less rare papillary or papillary-follicular adenocarcinoma of residual thyroid tissue of the thyroglossal duct tract remnants. This is the sixth report in the world literature of invasive squamous cell carcinoma arising from benign thyroglossal remnant squamous epithelium, and the second demonstrating the transition from normal squamous epithelium to invasive squamous cell carcinoma.
A case of carcinoma in a thyroglossal duct remnant is presented. The tumor was a rare follicular variant of the papillary type of thyroid carcinoma. The patient had received external beam radiation to the head and neck both as a child and as an adolescent. The recently reported increased incidence of thyroid carcinoma is believed to be related to the former practice of irradiating cervical thymic and lymphoid tissue in children. Since it is normal thyroid tissue that remains in the thyroglossal duct tract, this ectopic tissue presumably has the same malignant potential as that in the thyroid gland. Therefore, more cases of carcinoma in a thyroglossal duct remnant may be seen as those patients who underwent head and neck irradiation in childhood mature.
Embryologic remnants of thyroid tissue often line the thyroglossal duct tract and may commonly become cystic. Calcification in such a cyst is thought to be a specific marker for malignancy, which may develop in 1% of thyroglossal duct cysts. We describe a 3-year-old boy with a midline neck mass that showed radiologic calcification. Pathologic evaluation revealed psammomatous calcification in association with a benign thyroglossal duct cyst. These findings, not previously reported (to our knowledge), expand the radiologic differential diagnosis of calcified neck masses and broaden the spectrum of pathologic findings seen in association with benign thyroglossal duct cysts.
OBJECTIVE: The recurrence rate of thyroglossal duct cysts removed by the classic Sistrunk procedure exceeds 4%, even in skilled hands. Simple reexcision fails in 33% of these patients. Recent pathology literature suggests that the tracts of thyroglossal duct cysts may arborize, arguing for a wide-field approach to recurrent lesions. We describe the anatomic rationale and technique of an en bloc central neck dissection in children, on the basis of cadaver dissections and histopathologic review of recurrent thyroglossal duct cyst specimens. METHODS: We reviewed the medical records of all the children undergoing surgery for thyroglossal duct cysts and fistulas during the years 1990 to 1998 by the senior author. En bloc central neck dissections were performed on several cadaver specimens to further delineate the anatomic rationale for this procedure. RESULTS: We have performed an en bloc central neck dissection in 7 children, 5 with recurrent or multiply recurrent thyroglossal duct cysts. None has had a recurrence after follow-up of 9 months to 6 years. All have acceptable functional and cosmetic results. CONCLUSION: An en bloc central neck dissection is a logical and effective surgical technique for the removal of recurrent or multiply recurrent thyroglossal duct cysts.
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.