Papillary thyroid carcinoma in a thyroglossal cyst

The incidence of Papillary Thyroid Carcinoma in a Thyroglossal Cyst is rare. Only about 160 cases have been reported in the last 85 years. We report a case of Thyroglossal Cyst who underwent Sistrunk ’s Operation. The Cyst was reported to contain a focus of papillary thyroid carcinoma. In the absence of metastases in thyroid gland and neck nodes, only thyroid suppression with Thyroxine was given. After I year of follow-up there are no metastases. The importance of Sistrunk’s operation lies not only in complete removal of Thyroglossal Cyst but also in management of small foci of Papillary thyroid Carcinoma.     

Papillary carcinoma of thyroglossal cyst

Malignancy of thyroglossal cyst is a rare entity. Medical literature has reported only a very few cases till date. Histopathologically papillary carcinoma of thyroglossal cyst is the most common variety encountered in clinical practice. Surgical excision by Sistrunk operation is the standard treatment of choice followed by subtotal or total thyroidectomy whenever indicated. We report here two cases of thyroglossal cyst carcinomas and their respective management.     

Papillary carcinoma in thyroglossal duct remnants

Summary About 100 cases of carcinoma arising in thyroglossal remnants have been reported in the world literature. Five additional cases were discovered incidentally on histopathological examinations of specimens following Sistrunk's operation for removal of thyroglossal cysts and are now reported. The possibility of preoperative clinical diagnosis and the modalities of treatment are discussed. Offprint requests to: L. Pacheco-Ojeda     

Thyroglossal duct papillary carcinoma in a 15-year old female and review of pediatric cases of thyroglossal duct carcinoma

Thyroglossal duct carcinoma is rare, occurring in approximately 1% of thyroglossal duct cysts. Excluding this case report there have been 25 cases of adolescent thyroglossal duct carcinoma reported in the English literature thus far. Most of the pathology reported has been papillary or follicular carcinoma, leading to the question of whether or not to perform concurrent thyroidectomy. Based on our review of the pediatric cases of thyroglossal duct carcinoma we elected not to perform a concurrent thyroidectomy and recommend close follow-up to monitor for signs of future thyroid involvement.     

甲状舌管癌的临床诊治并文献复习（附2例报告）

目的通过对甲状舌管癌患者的诊断和治疗,并复习相关文献,总结该病的临床特征和准确制定合理的治疗方案。方法报道2例甲状舌管癌患者的诊治过程,影像学特点及治疗方法。结果2例患者术前均被误诊为甲状舌管囊肿,常规行Sistrunk手术,术后病检1例为甲状舌管乳头状癌,另1例为甲状腺乳头状癌,结合术中所见最后诊断为甲状腺舌管乳头状癌,2例术后复查甲状腺功能均正常,复查甲状腺超声未见明显恶性肿瘤特征,均未行甲状腺手术治疗,1例未做任何其他补充治疗,随访8年无局部复发和转移,另1例行甲状腺素抑制治疗随访1年无复发。结论甲状腺舌管癌临床罕见,术前易误诊为甲状舌管囊肿,术前超声及增强CT有助于诊断,需病理确诊,手术方案的制定需综合考虑,病理分型决定其预后。     

Endolaryngeal extension of thyroglossal duct cyst

Thyroglossal duct cysts are the most common congenital neck masses that develop during childhood, The masses develop from remnants of thyroglossal ducts, and typically appear as midline neck masses. Endolaryngeal extension of thyroglossal duct cysts has been reported mostly as midline neck swelling. We observed a case of extension of the thyroglossal duct cyst to the supraglottic area without neck swelling. A 50-year-old man presented with a 1-month history of foreign-body sensation in the throat. Fiberscopic and radiologic findings were similar to those associated with a saccular cyst, but its proximity to the hyoid bone raised the possibility of thyroglossal duct cyst. Operation was performed via an external incision to completely remove the cyst. Postoperative fiberscopy revealed that the aryepiglottic fold swelling had disappeared. Diagnosis of thyroglossal duct cyst was confirmed on the basis of pathological findings. In cases in which it is difficult to remove the cyst from the hyoid membrane, the hyoid bone midline portion should be dissected. Thyroglossal duct cysts should be considered in cases with a submucosal tumor in the supraglottic region, and radiological examinations should be performed.     

Lingual thyroglossal duct cyst in newborns: previously misdiagnosed as laryngomalacia

OBJECTIVE: To distinguish lingual thyroglossal duct cyst (LTDC) from laryngomalacia in newborn. METHODS: The clinical data of five newborns who were diagnosed as LTDC were retrospectively analyzed. RESULTS: Inspiratory stridor with chest wall retraction was cardinal symptom of newborn with LTDC. A slightly gray and round cyst with smooth surface at the base of the tongue was found with laryngoscopy. In computed tomography examination of larynx, a well-circumscribed lesion with low intensity was detected at the base of the tongue protruding into the air passage. Pathological examination demonstrated the cyst wall was composed of tabular and columnar epithelium. CONCLUSIONS: LTDC is a common disease in newborns, which is similar with laryngomalacia. For neonate suspected of LTDC, laryngoscopy examination should be taken first, while laryngeal CT scan is an important diagnosis basis to be reg. Cyst puncture can ameliorate the symptoms of LTDC, while surgical removal serves as a radical cure for LTDC.     

甲状舌管囊肿术后嗓音分析

目的探讨甲状舌管囊肿(TDC)患者手术前后的嗓音变化特点。方法选取2018年1月—2019年12月行TDC切除术的患者49例为研究对象,其中男24例,女25例,年龄为22~65岁,平均年龄为(41.55±11.78) 岁。对患者术前,术后1周及术后6个月分别行嗓音障碍指数（VHI）和GRBAS的主观评估、嗓音声学分析的客观检测以及频闪喉镜检查,比较手术前后的评估结果。结果①VHI的评估：女性患者的情感（E）评分在术后1周较术前显著性差异（P<0.05）,术后6个月与术前差异不明显,而其功能（F）和生理（P）评分较术前无明显差异;男性患者手术前后的VHI各评分均无显著性差异;②GRBAS的评估：女性患者的气息度（B）和无力度（A）评分在术后1周较术前差异显著（P<0.05）,术后6个月同术前差异不大,而其总分（G）,粗糙度（R）和紧张度（S）评分无显著性差异;男性患者手术前后的GRBAS各评分均无显著性差异;③嗓音声学分析：男性及女性患者的基频（F0）和最长发声时间（MPT）在术后1周均较术前差异显著（P<0.05）,术后6个月同术前差异不明显;而其基频微扰（jitter）和振幅微扰（shimmer）无显著性差异。结论TDC患者手术后会出现嗓音评估指标的一过性改变,及早行嗓音评估、发音训练或心理干预,有利于患者的嗓音康复。     

颈外径路Sistrunk手术治疗成人复发性舌甲状舌管囊肿的临床分析

目的 探讨成人复发性舌甲状舌管囊肿（LTGDC）的临床特点、误诊原因及手术治疗。方法 回顾性分析2018年1月—2021年3月收治的6例反复复发的成年LTGDC患者,术前行甲状腺B超提示甲状腺位置并排除异位甲状腺,颈部CT检查明确肿物大小、部位及与舌骨的关系,喉咽部MRI明确肿物性质。手术均采用颈外径路Sistrunk手术。结果 6例患者曾误诊为会厌囊肿4例,舌根囊肿2例,均已行囊肿切除术,复发时间3周至1年。所有患者行颈外径路Sistrunk手术完整切除甲状舌管囊肿及瘘管,术后病理确诊为甲状舌管囊肿。术后随访1年以上无复发。结论 复发性舌根部或会厌间隙的囊性肿物应考虑LTGDC的可能性。所有患者术前均应行喉镜检查和颈部影像学检查以了解囊肿的形态、位置及其和舌骨的关系来选择手术方式。对于成人复发性LTGDC,Sistrunk手术可彻底切除囊肿减少复发。     

Total persistence of thyroglossal duct with direct communication between cyst and foramen caecum

During embryonic development the thyroid gland migrates through the thyroglossal duct from the pharyngeal endoderm to the anterior cervical region. The final step in this process is the total obliteration of the thyroglossal duct. A case is presented of a patient with a thyroglossal cyst together with a complete failure of the obliteration of the duct, which caused regurgitations of mucopurulent material after the expression of the cyst. This indicates a complete failure of the obliterative process. To the best of our knowledge, this phenomenon has not been described previously in the literature.     

Cricoid injury complicating excision of thyroglossal duct cyst

The Sistrunk procedure is the treatment of choice for thyroglossal duct cyst excision (TGDC) due to its low recurrence rate and incidence of minor complications. Given the proximity of TGDC to the airway, injury to the laryngotracheal cartilages during this procedure is possible. We report a case of a 2-year-old girl transferred to our institution who had a cricoid cartilage injury during a Sistrunk procedure. The pattern of injury, its treatment and outcome in our patient, as well as preventative measures are described. To our knowledge, this is the first report describing injury to the cricoid cartilage following this procedure.     

Incidental radiographic findings of thyroglossal duct cysts: Prevalence and management

Objectives/HypothesisTo determine the epidemiology of incidental thyroglossal duct cysts (TGDC) discovered on imaging studies obtained in the head and neck area in children and to discuss subsequent management.MethodsA retrospective chart review was performed at Texas Children's Hospital of all computed tomography (CT) and magnetic resonance (MR) imaging studies obtained in the head and neck region between July 2011 and July 2014. Images obtained for the purpose of evaluating a neck or lingual mass were excluded from the study, as were patients with previously known TGDCs. Data including age, sex, location of TGDC, size, presence of symptoms, referral to Otolaryngology, and intervention were recorded.ResultsA total of 60,663 CT and MR studies of the head, brain, sinus, neck, and C-spine during this time period were reviewed; of these 69 (0.1%) cases contained incidental discovery of probable TGDCs with more males (40) than females (29). Ages ranged from 3 days to 17 years old, with the mean age at 5 years. Locations varied, with majority at base of tongue (83%) followed by hyoid (13%) then infrahyoid straps (4%). Sizes ranged from 2 to 28 mm with average size at 8 mm. 11 of these patients were referred to an Otolaryngologist; 9 were asymptomatic and decision was made to observe, the other two subsequently underwent surgical excision secondary to mass effect and dysphagia with histologic confirmation of diagnosis.ConclusionTGDCs commonly present as an anterior neck mass, however the majority of incidentally discovered TGDCs on imaging are located at the base of tongue. Management of these findings should include referral to an Otolaryngologist for further evaluation with the decision to intervene surgically based on development of clinical symptoms.     

Outcome of thyroglossal duct cyst excision is independent of presenting age or symptomatology

BACKGROUND: Thyroglossal duct cysts (TGDCs) are the most common form of congenital neck cyst, accounting for up to 70% of such lesions. There has been no consensus on which factors predict outcome of thyroglossal duct cyst excision. The objective of the current study is to evaluate the relevance of symptomatology and age at presentation with outcome of TGDCs. METHODS: Retrospective review of patients with TGDC at a tertiary care children's hospital. Data collected included patient's age, gender, clinical presentation, presence or absence of preoperative infection, imaging modality, type of procedure performed, size and location of the lesion, postoperative infection, complications, and recurrence of disease. RESULTS: Twenty-nine patients were identified (59% female, 41% male). Age of presentation was bimodal and ranged from 18 months to 14 years. The most common presenting symptom was the presence of an asymptomatic midline neck mass (76%). A history of preoperative TGDC infection was present in 22% of patients /=5 years of age. Recurrence rate after the Sistrunk procedure was 3.4%. CONCLUSIONS: The finding of a midline neck mass is the most common presentation of TGDCs in toddlers, whereas infection is the most common presenting symptoms in school-aged children. The incidence of preoperative infection was 41% in our series, much higher than previously reported. Independent of presenting age and symptomatology, recurrence of TGDC remains low when the Sistrunk procedure is employed.     

甲状舌管癌1例并文献复习

目的〓〖HTK〗探讨甲状舌管癌的诊断及治疗方法。〖HTW〗方法〓〖HTK〗回顾性分析1例甲状舌管癌患者病历资料,结合复习相关文献,对甲状舌管癌的起源、诊断及治疗方法进行讨论。〖HTW〗结果〓〖HTK〗甲状舌管癌多为乳头状癌,颈部CT有多囊结构、囊壁实性结节或钙化表现。〖HTW〗结论〓〖HTK〗甲状舌管癌临床罕见,囊肿迅速长大、颈部CT表现和细针穿刺是术前诊断的重要依据,Sistrunk术式是有效的原发灶切除方法。     

Endoscopic carbon dioxide laser procedure for an endogenous thyroglossal duct cyst

From 1940 to September 2008, 21 cases with TDCs extending into respiratory tract have been reported, often with misdiagnosis. There were only 10 cases by the end of 2006, but the number increased rapidly recently. To evaluate endoscopic carbon dioxide (CO₂) laser procedure for thyroglossal duct cyst (TDC) extending into respiratory tract, we reported an unusual case and performed a retrospective correlate review. A 3-year-old female patient with a TDC extending into respiratory tract, without any neck lumps, was previously misdiagnosed as an epiglottic cyst. An asymptomatic follow-up visit had been for 10 months after she had received endoscopic CO₂ laser procedure. To our best knowledge, endoscopic CO₂ laser procedure was administered for the first time for TDCs, though it had been a valid management of other benign lesions in respiratory tract. The endoscopic CO₂ laser procedure might be for TDC extending into respiratory tract. In order to increase awareness of this situation, we recommend that the novel concept of endogenous type should be considered to unify these TDCs extending into respiratory tract without projecting neck masses.     

低温等离子射频技术在婴幼儿甲状舌管囊肿手术中的应用

目的 探讨低温等离子射频技术在婴幼儿喉内型甲状舌管囊肿手术切除中的应用.方法 实施低温等离子手术治疗由于喉内型甲状舌管囊肿引起上呼吸道梗阻的婴幼儿患者9例,回顾性分析临床资料,结合相关文献进行总结讨论.结果 9例患者均手术成功,无术后出血、感染等并发症,患者术后随访1年呼吸道梗阻消失,未复发.结论 低温等离子技术应用于婴幼儿喉内型甲舌囊肿切除术时短,创伤小,并发症发生率低.