Thyroglossal duct cyst in hyoid bone: Unusual location

A 10-year-old female presenting with a discharging sinus in the midline of the neck of one month duration was diagnosed to have a thyroglossal sinus. She underwent sistrunk’s operation, intra-operatively a thyroglossal duct cyst was atypically sited in the intrahyoid region. The cyst may be located in the intralingual, suprahyoid, thyrohyoid or suprasternal region. A literature search revealed that this intrahyoid location of a thyroglossal duct cyst is extremely rare and so far only three cases have been reported. A case and review of literature regarding this unusual entity are presented.     

Papillary carcinoma in a supra hyoid thyroglossal duct cyst — an unusual presentation

Carcinomatous transformation of ectopic thyroid elements within the thyroglossal tract is a rare entity. We report a case of primary papillary carcinoma of thyroid presenting within the thyroglossal duct cyst in a 23 year old gentleman. The patient presented to us, as a case of suprahyoid thyroglossal cyst with sub-lingual involvement and he underwent surgical excision of the entire thyroglossal tract by Sistrunk’s approach. The post-operative histopathological diagnosis was of a papillary carcinoma within the thyroglossal duct cyst. Hence, the patient was evaluated for a malignant focus in the thyroid which proved negative. He was counseled regarding the possibility of developing Carcinoma in the thyroid gland and offered two options of further management viz., total thyroidectomy followed by life long thyroid suppression or watchful observation and follow up. As the patient belonged to the low risk group, he opted for the second option. He is presently kept under meticulous follow up and remains asymptomatic till date. We present the pre- and post-operative imaging, intra-operative findings, histo-pathological features and review the present world literature on this rare entity.     

Nasopalatine Duct Cyst: Report of a Case with Review of Literature

The nasopalatine duct cyst is the most common non-odontogenic developmental cysts. Nasopalatine duct cyst also termed as incisive canal cyst, arises from embryologic remnants of nasopalatine duct. Most of these cysts develop in the midline of anterior maxilla near the incisive foramen. This article reports a case and review of literature with respect to epidemiology, etiology, clinical presentation, radiographic and pathological findings, treatment and recurrence rates.     

Intrathyroid thyroglossal duct cyst simulating a thyroid nodule

A case of intrathyroid thyroglossal duct cyst is reported. A 50-year-old woman presented with a right lateral neck mass that was clinically indistinguishable from a thyroid nodule. Ultrasound-guided fine-needle aspiration biopsy (US-FNAB) revealed normal-looking squamous cells. Right thyroid lobectomy was performed and microscopic examination revealed a cyst lined by squamous epithelium that was consistent with a thyroglossal duct cyst. The lesion was completely surrounded by normal thyroid tissue. Our experience suggests that intrathyroid thyroglossal duct cyst should be remembered in the differential diagnosis of a thyroid nodule. Detection of benign squamous cells by US-FNAB may be useful for ruling out the possibility of a cystic thyroid tumor.     

18例阴道壁肿瘤临床分析

 资料系我院1965~1992年,手术治疗、病理诊断,18例阴道壁良性肿瘤.其中阴道平滑肌瘤6例,中肾智囊肿7例,付中肾管囊肿2例、纤维瘤2例、卵巢冠纵管囊肿1例.本组重点叙述了阴道壁平滑肌瘤的来源、误诊原因,诊断要点和治疗.     

甲状舌管囊肿术后复发的多因素分析及手术处理

目的：探讨甲状舌瞥囊肿术后复发的原因及再次手术的效果。方法：运用统计学软件，采用单因素和logisitic模型分析，分析了12例甲状舌管囊肿术后复发的原因。结果：误诊、感染和不当的手术方法是复发的主要原因，12例复发病人再次手术后，疗效满意。结论：正确的术前诊断，术前抗感染治疗及正确的手术方法可避免术后复发，再次手术是治疗甲状舌管囊肿复发病例的理想方法。     

Foreign Body Wharton’s Duct

A case of fingernail sliver lodged in the Wharton’s duct is reported as the incidence of foreign body in duct is scarcely reported due to small puncta. Foreign body was removed under local anesthesia by opening the Wharton’s duct as a day care procedure.     

Thyroglossal duct cyst papillary carcinoma

Thyroglossal duct cysts are usually located in the midline of the neck. The coexistence of carcinomas in thyroglossal duct cysts is extremely rare, with most being papillary carcinomas. Usually, the diagnosis is only made postoperatively after excision of the cyst. Although the Sistrunk procedure is often regarded as adequate, controversies exist concerning the need for thyroidectomy depending on histopathological findings. We report the case of a 31-year-old man diagnosed with papillary carcinoma within a thyroglossal duct cyst, who underwent total thyroidectomy as has been recommended for differentiated papillary cancer.     

Foreign body in the Wharton’s duct

A case of unususl foreign body in the Wharton’s duct is reported. The patient presented with severe throat pain and odynophagia following ingestion of a paper pin which got lodged in the wharton’s duct. Surgical excision of submandibular gland and duct along with the removal of foreign body was done under general anaesthesia.     

Carcinoma arising in the wall of congenital bile duct cysts.

The incidence of carcinoma arising in the wall of the congenital bile duct cysts is much higher than previously assumed. The authors report 4 such cases of primary and secondary carcinomas and review their clinical features through the similar 59 cases in the literature. Of the 63 cases, the average age was much younger, at least several decades, compared with cases of extra-hepatic carcinoma without bile duct cysts. The female-male ratio was 2.5:1. Racial preponderance was also observed, namely, the majority were Japanese. Additionally, many patients previously received various internal drainage procedures, especially choledochocystoduodenostomy. As the treatment, primary excision of the extrahepatic bile duct cyst seems to give the best results because it can avoid ascending cholangitis and prevent development of carcinoma. However, carcinoma still can arise in the intrahepatic bile duct cyst, which cannot be removed at the present time.     

Papillary thyroid carcinoma identified after Sistrunk procedure: report of two cases and review of the literature

Thyroglossal duct cysts represent the most common congenital cervical malformations. Carcinomas arising in the thyroglossal duct cysts are rare neoplasms characterized by a relatively non aggressive behavior with rare lymph node spread. Approximately 1% of thyroglossal cysts contain a carcinoma. The most frequent histological type is papillary carcinoma, accounting for about 80% of cases. Currently, most authors agree about their primary origin ex novo from ectopic thyroid tissue in the cyst. In most cases the diagnosis of thyroglossal duct carcinoma (TDC) is not made until histopathological examination has been performed on a resected cyst without any suspected clinical sign of malignancy. The definition of the correct surgical treatment for these carcinomas is still controversial; most authors maintain that resection of a TDC with the Sistrunk procedure can be considered oncologically adequate when dealing with a differentiated carcinoma without extracapsular invasion and/or lymph node metastases and with a normal thyroid. We present two cases of papillary thyroid carcinoma identified after resection of a thyroglossal cyst according to the Sistrunk procedure and managed with different surgical approaches according to the different sites of the tumors. In addition, we discuss appropriate therapeutic strategies in light of the most recent data in the literature.     

Two‐tone pancreas on T1‐weighted images: Correlation with abnormalities on magnetic resonance pancreatography

Two patients are presented in whom geographical alteration in signal between areas of normal and abnormal pancreatic tissue on T1‐weighted magnetic resonance images of the pancreas was observed. This alteration in signal intensity produced a ‘two‐tone’ pattern; magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) in both patients revealed altered pancreatic duct drainage. It is believed that the ‘two‐tone’ pancreas effect on T1‐weighted images of the abdomen, may indicate aberrant duct drainage and that MRCP is an ideal means of further evaluation.     

Cutaneous dermoid cyst: cytokeratin and filaggrin expression suggesting differentiation towards follicular infundibulum and mature sebaceous gland

We experienced two cases of cutaneous dermoid cysts (DC). To elucidate the histogenesis of DC, we have studied cytokeratin (CK) expression in DC using ten different anti-keratin antibodies against CK1, 7, 8, 10, 14, 15, 16, 17, 18 and 19, and anti-filaggrin (filament aggregating protein) antibody. In the cyst wall of DC, CK1 and 10 were expressed in suprabasal layer, and CK14 was limited to the basal layer. In sebaceous gland-like structures, CK14 was detected in sebaceous acinus, and CK17 was detected in sebaceous duct. The other CKs were not detected. Filaggrin was intensely detected in the granular layer in the cyst wall of DC. CK expression profile of DC was similar to follicular infundibulum and sebaceous gland. These results suggested that DC differentiates towards follicular infundibulum and mature sebaceous gland.     

Dentigerous cyst in a young boy

A huge maxillary dentigerous cyst in a young boy is a rare entiry as this cyst commonly accurs in the mundible of middle-aged persons. Massive sive as well as gross disfigurment reflect long-drawn neglect by the patient & his attendents, which seems to be a rare happening in today’s society. Though, in zhildren the present trend of management is marsupiadisation of dentigerous cyst to make unerupted tooth erupf, but as in this case, huge entargsment had made the viability of displaced tooth qmertinmable, its removal was rought for Moreover, as the cyst had lined the amtral cavity, here, marsupialization would have led to an oroaniral firtula with antral simusitis, which was arerted by enucleation of the cyst through Caldwall-Lac approach.     

原发性脾肿瘤25 例临床分析

 目的 探讨原发性脾肿瘤临床特点及其治疗. 方法 回顾性分析1991年1月至2003年12月中国医学科学院肿瘤医院收治的25例原发性脾肿瘤患者的临床表现、影像学特点、诊断依据和治疗预后资料. 结果 25例原发性脾肿瘤均行脾切除术,其中11例良性病变包含脾表皮样囊肿、脾血管瘤各3例,脾炎性假瘤2例,脾错构瘤、脾假性囊肿、脾肉芽肿性病变各1例;14例恶性肿瘤包含脾原发性非何杰金氏淋巴瘤10例,血管肉瘤4例.随访,良性肿瘤患者均无复发;10例非何杰金氏淋巴瘤,除1例术后14个月死于复发外,4例分别随访18月、19月、41月和45月未发现复发和转移,5例随访超过4年仍健在,其中1例存活已达11年2个月.4例脾血管肉瘤中分别于手术后7月、9月、28月因肿瘤转移而死亡,1例随访16个月未见复发和转移. 结论 原发性脾肿瘤以手术治疗为主,良性肿瘤效果好;原发性非何杰金淋巴瘤结合辅助治疗预后好,恶性肉瘤预后差,早期诊断、早期治疗是唯一希望.     

Carcinoma of the cystic duct remnant with direct colonic invasion

Carcinoma of the cystic duct remnant is extremely rare, and only five cases have been reported previously in the English literature. We present another case of carcinoma of the cystic duct remnant and review the literature. A 62-yr-old woman was diagnosed as having hilar cholangiocarcinoma and transverse colon cancer. However, at laparotomy, the center of the tumor mass was in the cystic duct remnant with contiguous colonic invasion. The pathology of the surgical specimen confirmed carcinoma of the cystic duct remnant. The diagnosis of carcinoma of the cystic duct remnant was made using Ozden’s new criteria.     

Papillary carcinoma in a thyroglossal cyst: report of a case and review of literature

A 29-years old male presenting with a midline neck swelling four centimetres in diameter of one years duration was diagnosed to have a thyroglossal cyst. He underwent a Sistrunk’s operation. Histological examination of the specimen revealed a papillary thyroid carcinoma limited to the cyst wall. The thyroid scan was normal indicating no further need for surgery. The patient has been on suppressive therapy with thyroxin for one year and is currently disease-free. A review of literature is also presented.     

Management of well-differentiated thyroid carcinoma presenting within a thyroglossal duct cyst

BACKGROUND AND OBJECTIVE: Well-differentiated thyroid carcinoma (WDTC) is diagnosed in approximately 1.5% of thyroglossal duct cysts (TGDC). No clear consensus exists regarding further management after adequate excision of the cyst, especially the role of total thyroidectomy and postoperative radioactive iodine therapy. The current review was undertaken in an attempt to clarify these issues. METHODS: Demographic, clinical, tumor, treatment, pathology, and outcome data on 57 eligible patients reported in recent literature were pooled together with 5 patients treated at our institution for this analysis. RESULTS: A Sistrunk operation was performed for resection of the thyroglossal duct cyst in the majority (90%) of patients. Histologic examination of the tumor in the cyst revealed that papillary carcinoma was the most frequent (92%) histologic type. A total thyroidectomy was performed consequent to the diagnosis of thyroglossal duct cyst carcinoma in approximately half of the 62 patients. A malignant tumor was reported in 27% of the thyroidectomy specimens. Postoperative radioactive iodine therapy was administered in 16 (26%) patients. With a median follow-up of 71 months (range 1-456 months), the 5- and 10-year Kaplan-Meier overall survival was 100 and 95.6%, respectively. There were no disease-related deaths reported in any of the patients. Univariate analysis revealed that the only significant predictor of overall survival was the extent of primary surgery for the thyroglossal cyst. The addition of total thyroidectomy to Sistrunk operation did not have a significant impact on outcome (P = 0.1). Patients treated with postoperative radioactive iodine (RAI) fared significantly worse than those that did not need RAI, which may be explained by the fact that this modality would generally be used in patients with higher risk tumors. CONCLUSIONS: The Sistrunk operation is adequate for most patients with incidentally diagnosed TGDC carcinoma in the presence of a clinically and radiologically normal thyroid gland. Results of adequate excision using the Sistrunk operation are excellent and the concept of risk-groups should be used to identify patients, who would benefit from more aggressive treatment.     

Type 1 Choledochal Cysts: Preoperative Evaluation by Ultrasound

Type I choledochal cysts were diagnosed on ultrasonography in 14 patients. The cysts were seen as oval or fusiform anechoic structures located in the subhepatic space and separate from the gallbladder. The continuity of the cyst with the bile duct in the porta hepatis was a specific feature for correct diagnosis of the condition.     

Surgical management of non-parasitic hepatic cyst with biliary communication: a case report

Non-parasitic hepatic cysts with biliary communication are rare. The clinical symptoms involved are not specific to this condition, thereby making diagnosis difficult and treatment controversial. Here, we report a case of 70-year-old woman complaining of abdominal satiety, combined with non-specific pain in the right upper quadrant. The abdominal contrast-enhanced MRI-scan revealed a large and thick-walled septus cystic lesion in the liver. During operation, the biliary fistula was confirmed in the cyst cavity. A silica gel tube was inserted via the cystic duct for cholangiography, which demonstrated communication between the cyst and biliary tract. We performed wide-scale cyst wall resection; the biliary fistula was completely repaired by the closure of communicated bile ducts. The postoperative course was uneventful, and the patient was discharged with no sign of cholangitis or any other symptoms. The novel surgical management via wide resection of the cyst wall and closure of biliary communication proved to be an adequate and effective procedure for treating nonparasitic hepatic cysts with biliary communication.KEY WORDS : Hepatic cyst, biliary communication, surgical management