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Three cases of papillary carcinoma and three of adenoma in thyroglossal duct cysts: clinical-diagnostic comparison with benign thyroglossal duct cysts.

The clinical and diagnostic findings of 3 cases of papillary thyroid carcinoma in thyroglossal duct cyst (TDC) were compared to those of 3 cases of adenoma in TDC and 2 cases of benign TDC. The neck masses of the subjects with benign TDC grew slowly, whereas those of 2 patients with papillary carcinoma and 1 of the patients with adenoma grew rapidly (especially those with carcinoma). On the other hand, one case of carcinoma, and two cases of adenoma in TDC were diagnosed incidentally. Benign TDC had an anechoic pattern at US, whereas the cysts containing carcinoma and adenoma showed the presence of a mural nodule at US. Microcalcifications in the mural mass were present in one patient with carcinoma. The 3 patients with carcinoma in TDC underwent total thyroidectomy. The histology was negative in all 3 patients for thyroid cancer and thyroid nodules. However, in 2 of them it revealed the carcinoma invading the cyst wall and adjacent tissues, 1 of which also exhibited 2 metastatic lymph nodes in the central neck area. The cases reported illustrate the utility of enhancing one's clinical suspicion of carcinoma in patients bearing TDC, even when incidentally discovered. In particular, rapid growth of the cystic mass, and the presence of a mural nodule on US, especially with calcifications, must raise the physician's suspicion for a cancer arising in TDC.

Adenoma↗

Intrathyroid cysts of thyroglossal duct origin.

Thyroglossal duct cysts develop from a persistent portion of the thyroglossal tract and have been described as occurring anywhere from the base of the tongue to the manubrium. We present two patients who presented with a cystic thyroid nodule due to an intrathyroid thyroglossal duct cyst. A fine-needle aspiration biopsy was performed, which revealed benign squamous cells. Upon exploration, the first patient was found to have a 2-cm cyst within the thyroid isthmus, and in the second patient, a 1-cm cyst was found in the right thyroid lobe. Pathologic analysis revealed the cyst to be lined by a squamous epithelium consistent with a thyroglossal duct cyst. The lesions were completely surrounded by normal thyroid tissue. There was no evidence of a remnant of the thyroglossal duct extending from the thyroid in the region of the cyst. Both patients were treated by thyroid lobectomy and isthmusectomy and have remained without evidence of recurrence. Intrathyroid thyroglossal duct cysts should be included in the differential of patients with cystic thyroid lesions. Fine-needle aspiration revealing benign squamous cells is usually diagnostic and may detect an occult carcinoma arising within the cyst. Surgical resection is curative and should include a Sistrunk procedure if a thyroglossal duct tract is present.

Aged↗

Fatal asphyxia by a thyroglossal duct cyst in an adult.

Thyroglossal duct cysts arise from remnants of embryonic thyroglossal duct that connects the foramen cecum at the base of the tongue to the thyroid gland. The remnants enlarge secondary to secretions from the epithelial lining. Usually, thyroglossal cysts present as non-tender masses. However, they may also become infected, produce fistulas or give hoarseness and dysphagia. Rarely, especially if the mass is located at the base of the tongue, airway obstruction and dyspnea can ensue. This unusual presentation has been mainly seen in very young children and has caused death in about half of these cases. Nevertheless, in the adult population, very few cases of airway obstruction by thyroglossal duct cysts have been reported, only one being fatal. We present the case of a 55-year-old man who died from fatal asphyxia caused by a thyroglossal cyst.

Asphyxia↗

Papillary adenocarcinoma of a thyroglossal duct cyst.

Carcinoma in thyroglossal duct tissue is a rare occurrence. A case of papillary adenocarcinoma in a thyroglossal duct cyst is presented. Local excision by the Sistrunk technic appears adequate for the noninfiltrating, nonmetastatic lesion. Thyroid hormone should be given as a suppressive agent. Continuous follow-up is necessary for the rest of the patient's life.

Adenocarcinoma, Papillary↗

Squamous cell carcinoma in thyroglossal duct cyst.

Although a thyroglossal duct cyst (TDC) is a common cyst occurring in the neck, carcinomas arising in the TDC are a rare event. To date, approximately 100 cases have been reported, the majority of them being papillary carcinomas. Squamous cell carcinomas (SCC) are very rare, and only nine cases have been reported so far in the literature. We present a 55-year-old female patient with a SCC in a TDC to highlight the clinical and pathological features of this condition.

Carcinoma, Squamous Cell↗

Management of incidental thyroglossal duct cysts during laryngotracheal reconstruction.

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.

Child, Preschool↗

Thyroglossal duct cyst of the tongue.

Thyroglossal duct cysts commonly present as midline neck masses with or without infection. The presentation of thyroglossal duct cyst on the tongue is quite uncommon. The present report reviews the embryology of thyroglossal duct cyst development and describes two cases of lingual thyroglossal duct cyst. They presented in an infant of two months of age with feeding problems and also in an older child four years of age with a mass in the base of the tongue. Both patients were managed by marsupialization of the cyst of the tongue. The complications of tongue and mandible splitting or cervical approaches were avoided and satisfactory control was obtained. It is important to distinguish thyroglossal duct cyst of the tongue from other conditions that can affect this region.

Child, Preschool↗

Primary papillary carcinoma of the thyroglossal duct cyst--a case report.

Thyroglossal duct cyst is the most common developmental anomaly of the thyroid gland, presenting as a mid line neck swelling. Malignancy arising in them is a rare event, with papillary thyroid carcinoma being the commonest. Thyroglossal duct cyst carcinomas are usually asymptomatic and are not suspected preoperatively in most instances, hence the need for surgical excision and careful pathological examination of these cysts. We present a case of a 57 year old lady who underwent a Sistrunk procedure for the removal of thyroglossal duct cyst, which was responsible for a progressive mid line neck swelling of 2 months duration. The thyroid gland was normal. Histological examination of the excised cyst showed a papillary thyroid carcinoma arising in the thyroglossal duct cyst. Long term survival of patients with thyroglossal duct cyst carcinoma is excellent.

Carcinoma, Papillary↗

Papillary carcinoma arising on cervico-mediastinal thyroglossal ductal cyst resected via transcervical and partial upper sternotomy incision.

Thyroglossal cyst is the most common congenital cervical pathology of childhood. Malign transformation in thyroglossal cyst is very rare and seen generally in adults. Here, we report on a 40-year-old female patient who presented with progressive dyspnea and enlarging cervical masses. Radiological examination revealed multiple cystic lesions in cervical and mediastinal region. The cysts were resected surgically via transcervical and partial upper sternotomy incision. Pathological examination revealed malignant change in the cervico-mediastinal thyroglossal cysts.

Adult↗

[Thyroglossal duct cyst with anomalous localization].

The cyst of thyroglossal duct (CTD) are the more frequent congenital mass of the neck, so you must consider them in the differential diagnosis of the neck's tumours. We present one case of CTD with certain clinical peculiarities.

Adult↗

Lingual thyroglossal duct cyst presenting in infancy.

Lingual thyroglossal duct cysts are a rare form of thyroglossal cysts. We present two infants, 10 and 12 weeks of age, with midline intraoral cystic swellings stretching from the base of the tongue to the thyroid cartilage. Complete excision of the cysts by Sistrunk's procedure were carried out. Both infants are well on follow-up, at 6 months postoperatively. Their unique presentation with regard to age, location, and symptomatology is discussed. Lingual thyroglossal duct cysts large enough to cause dysphagia, stridor, respiratory distress, and failure to thrive in infants have not been previously reported in the literature.

Follow-Up Studies↗

Presentations of thyroglossal duct cysts in adults.

The thyroglossal duct cyst is the most common congenital neck mass, resulting from persistence and dilatation of remnants of an epithelial tract formed during migration of the thyroid during embryogenesis. Approximately 7% of the population has thyroglossal duct remnants. Although thyroglossal duct cysts generally present clinically in children, it is important to understand that the lesion can present in adults as well, sometimes much later in life. Incidental carcinoma of the thyroglossal duct cyst is rare, but is more likely to occur in adults than children. Between 1991 and 1998, 11 cases of thyroglossal duct cysts were seen in adult patients at Georgetown University Medical Center, including 2 cases containing papillary carcinoma. This report discusses their clinical presentations and management.

Adult↗

Thyroglossal duct cyst masquerading as a haematoma.

Thyroglossal duct cysts most frequently present in childhood as painless midline swellings around the level of the hyoid. Classically the cyst moves upwards on protruding the tongue. Here we report a novel case of a thyroglossal cyst in an adult in whom the history, examination and fine needle aspiration cytology were typical of a traumatic haematoma. This case is also unique because the thyroglossal duct cyst extended beyond the thyroid gland to the suprasternal notch and actually required two parallel transverse cervical incisions for its complete en bloc removal.

Adult↗

Papillary adenocarcinoma of the thyroid in a thyroglossal duct cyst.

A case report is presented of an 8-year-old boy who underwent resection of a thyroglossal duct cyst to illustrate a rare, but significant, complication of a common clinical problem. Pathological examination revealed that it contained a papillary adenocarcinoma of the thyroid, presumably arising from ectopic glandular tissue in the cyst. Thyroglossal duct cysts are a common cause of midline neck masses in children. Occult thyroid carcinoma is a rare co-morbid finding. It infrequently leads to death, but thyroglossal duct cysts may also contain the only functioning, albeit ectopic, thyroid tissue. Patients with clinical thyroglossal duct cysts should be carefully evaluated preoperatively for the presence of tumor and other functioning thyroid tissue prior to excision of the cyst.

Adenocarcinoma, Papillary↗

Presentation and management of a thyroglossal duct cyst with a papillary carcinoma.

Thyroglossal duct carcinoma is rare, and its presentation is similar to that of a thyroglossal duct cyst: a nontender, palpable mass in the midline location. Rapid increase in growth may be a sign of malignancy, but the diagnosis is based on the pathology of the cyst. Initial treatment of thyroglossal duct carcinoma is the same surgical procedure used for removal of a thyroglossal duct cyst. Further surgery depends on the finding of thyroid nodules or positive lymph nodes but is rarely necessary. The recurrence rate after simple excision is low. Postoperative radioiodine ablation or radiation is considered in cases of recurrence or metastasis. In this report, we describe a patient with a new-onset, nontender, neck mass who had a Sistrunk procedure for a presumed thyroglossal duct cyst and was found to have papillary carcinoma.

Aged↗

Papillary carcinoma of thyroglossal duct cyst: a case report.

We report a papillary carcinoma of thyroglossal duct cyst. Thyroglossal duct carcinoma is rare: only about 160 cases have been reported. Preoperative diagnosis of malignancy is even rare, except for a few cases by fine needle aspiration cytology or biopsy. A primary lesion or metastasis from the thyroid gland is widely discussed. However, the prognosis is good.

Carcinoma, Papillary↗